The Health Impact of Arsenic
A deep dive into Episode 107 with Dr. Joseph Pizzorno
Earlier this Summer I reached out to one of my role models and inspirations in Naturopathic Medicine; Dr. Joseph Pizzorno; to see if he would be willing to join me in a discussion about Arsenic. I was a student of Dr. Pizzorno back in the early 2000’s and also joined him weekly on the basketball court for some competitive pick-up games.
Not only do I share his love of basketball but I also share his passion for pathophysiology and the pursuit of the underlying factors in health.
Gladly, he agreed to the conversation and we explored the nuances of Arsenic and how it is disruptive in the human body. Lately we have been working on a case together of chronic arsenic toxicity which has highlighted the difficulty in testing for arsenic toxicity.
As the founder of Bastyr University; a premier institution of Naturopathic Medicine; one of the founders of Functional Medicine, and world-renown author; Dr. Pizzorno is one of the most recognized people in the field of Natural Medicine. He has a special passion for Environmental Medicine and he co-authored ; Clinical Environmental Medicine: Identification and Natural Treatment of Diseases Caused by Common Pollutants alongside the great Walter Crinnion, ND. He also authored The Toxin Solution: How Hidden Poisons in the Air, Water, Food, and Products We Use Are Destroying Our Health--AND WHAT WE CAN DO TO FIX IT . As publisher of the Integrative Medicine Clinician Journal; his editorials are often focused on solving the problems related to the environmental impact on health. So no doubt that hs is an excellent source on this topic.
What is so inspiring about Dr. Pizzorno is he never stops learning. When you speak with him he seems like the eternal researcher and student; always building on his base of knowledge and never acting like he has “figured it out”.
As we understand more and more about the environmental impact of Arsenic we still have much work to understand testing practices , avoidance practices, and detoxification/biotransformation practices. So, this conversation while a launching point is certainly still a work in progress. The full episode of our discussion is at the bottom of this post. However, first lets get into an overview of Arsenic.
What is Arsenic?
Arsenic, is a ubiquitous, naturally occurring element, that has significant impact on human health. While arsenic is often associated with acute poisoning, the emphasis of this post is on chronic, low-level exposure, a hidden threat affecting a substantial portion of the population.
What are the different Forms of Arsenic?
Arsenic exists in both organic and inorganic forms, with the latter being significantly more toxic.
Organic arsenic, also known as arsenobetaine and arsenocholine, is primarily found in seafood and is generally considered non-toxic and generally excreted in the Urine within 48 hours according the CDC. In seafood Organic Acid is especially prevalent in bivalves [clams, oysters, scallops, mussels], crustaceans [crabs, lobsters], and certain cold water and bottom feeding finfish, and seaweed/kelp. (ATSDR 2007). Organic arsenic compounds contain arsenic-carbon bonds.
Inorganic arsenic; including arsenic trioxide (arsenite), arsenic pentoxide (arsenate), are found in contaminated water, soil, and certain foods like rice and chicken. Of note, inorganic forms of arsenic have been found in some types of seaweed such as hijiki seaweed has very high levels of inorganic arsenic. [Rose et al. 2007.) Inorganic arsenic means arsenic is bound to elements other than carbon, typically oxygen, chlorine, or sulfur (e.g., arsenate (AsO₄³⁻) or arsenite (AsO₃³⁻)). When inorganic arsenic is cleared from the human body it is converted/methylated to somewhat toxic form called monomethylarsonous acid (MMA) and then further methylated and excreted to low harm form called dimethyl arsenic acid (DMA). In a small percentage of people they are poor methylators and MMA is retained in higher amounts.
Primary sources of Arsenic:
Natural events like forest fire smoke, volcano ash and gases, and rock sediment release as well as emissions from factories are the primary sources of arsenic being released into the environment. Pesticides are another concern. However, since 1993 and much more aggressively in 2000’s the United states has phased out arsenic in in domesticated pesticides . The use arsenicated pesticides is still common other areas of the world and the EPA regulates the import of these pesticides very carefully.
Vectors of Arsenic into the human body.
Drinking water: A significant source of inorganic arsenic exposure is contaminated drinking water/tap water. However, there are strict guidelines on allowable amounts. You can look up the levels of arsenic in your own water at EWG tap water score and you can see the contaminants in finished water in your zip code (ironically at the time of this publishing my neighborhood in Bellevue, WA has 625X the guideline allowable levels of Arsenic that the EWG deems acceptable).
If you don’t trust the website you can do test your water yourself through my tap score.
Rice: Rice readily absorbs arsenic from the soil and water, making it a significant dietary source of exposure, particularly for populations that heavily rely on rice as a staple food. Its important to know both organic and non-organically grown rice can contain arsenic . And, brown rice typically contains higher levels of arsenic than white rice due to its bran layer. Please note, rinsing rice thoroughly before cooking is a good way to get the arsenic levels down but over rinsing has also been shown to reduce nutrient levels of the rice.
Chicken: Until recently, arsenic compounds were routinely added to chicken feed in the United States to promote growth and control parasites. While this practice has been largely phased out, there is still a risk of arsenic contamination in chicken products. This practice may still occur in some countries.
Health Impacts of Arsenic Exposure:
Arsenic is a potent toxin that can affect multiple organ systems, leading to a wide range of health problems.
Chronic exposures of arsenic have been linked to :
Neurological Effects such as peripheral neuropathy (numbness, tingling, and pain in the extremities) and impairing cognitive function.
Cardiovascular Effects: Arsenic exposure is linked to an increased risk of cardiovascular disease, including heart attacks, strokes, and peripheral arterial disease.
Skin Effects: Chronic arsenic exposure can cause skin lesions, hyperpigmentation (darkening of the skin), and hyperkeratosis (thickening and roughening of the skin). Hyperkeratosis can be an early clinical sign of arsenic toxicity.
Cancer: Arsenic is a known human carcinogen, increasing the risk of cancers of the skin, bladder, lung, liver, prostate, and pancreas.
Endocrine Disruption: Arsenic can disrupt hormone function, potentially contributing to various health problems, including reproductive issues and diabetes.
Impact on the Microbiome: Arsenic can disrupt the gut microbiome, the community of microorganisms that live in the intestines. This disruption can lead to various health problems, including digestive issues, impaired immunity, and increased inflammation. Some bacteria, such as Bilophila and Desulfovibrio, can metabolize arsenic, producing toxic nitrogen metabolites.
Arsenic Toxicity Testing:
Urine Testing: The most common method for assessing arsenic exposure is a urine test, which measures the total amount of arsenic excreted from the body. This is usually done first morning urine collection without provocation. A good lab that I have used for years is Doctor’s Data:
Challenges with Urine Testing: Current medical guidelines recommend avoiding fish consumption for several days prior to urine testing, assuming that elevated arsenic levels are due to the non-toxic organic arsenic found in seafood. Dr. Pizzorno, an expert in environmental medicine, challenges this guideline, as some fish contain significant amounts of toxic inorganic arsenic, and gut bacteria may convert organic arsenic into inorganic forms. So perhaps it might be best to do one test after eating fish leading up to the test and another test avoiding fish several days prior.
Speciation Testing: This specialized test differentiates between the various forms of arsenic in the urine, helping to identify the source of exposure. It is much harder to find this test and we have had to order it through the Mayo Clinic when needed. Dr. Pizzorno recommends speciation testing for anyone with a total urinary arsenic level above 10 micrograms per liter. However, accessing speciation testing may be challenging due to limited availability and cost. In Washington State, I was able to find the Mayo Clinic speciation test by working with University of Washington laboratory.
Genetics and Detoxification
Genetic Testing: Genetic variations can influence an individual's susceptibility to arsenic toxicity. As mentioned above, some people are genetically predisposed to struggle converting a more toxic form of arsenic (monomethyl arsenic acid or MMA) into a less toxic dimethyl arsenic acid (DMA).
Arsenic is eliminated through Phase II detoxification processes, specifically through conjugation reactions like methylation, sulfation, and glutathione conjugation. These processes transform arsenic into water-soluble compounds that can be excreted from the body. Polymorphisms in enzymes and receptors that drive these biochemical processes may be partially responsible for bioaccumulation of arsenic.
Some of the Polymorphisms of Interest that may disrupt Arsenic metabolism.
Cystathionine-beta-synthase (CBS) rs4920037 and rs234709. There is and Association of genetic variation in cystathionine-beta-synthase and arsenic metabolism with increase in toxic metabolites. (higher MMA). [PMID 20670920], [PMCID: PMC2913479}
Arsenate Methyl Transferase (AS3MT) catalyzes the transfer of a methyl group from S-adenosyl-L-methionine (AdoMet) to trivalent arsenical and may play a role in arsenic metabolism. If it is slow functioning, levels of toxic MMA may accumulate.
In addition ,Arsenic accumulation may inhibit the function of certain enzymes. Of note Arsenic has an affinity to bind to sulfhydryl groups , may inhibit folic acid absorption, and may inhibit hemoglobin synthesis.
Minimizing Arsenic Exposure Through Clean Water:
Perhaps the most important way to reduce Arsenic water is via water filtration. There are under the counter and counter top options that can accomplish this goal.
Reverse osmosis (RO) systems are considered the most effective method for removing arsenic from drinking water. These systems are mostly under-counter and must be installed…not a great option for renters. Filters must be changed at specific intervals adding the costs; however the initial install is not outrageously expensive. RO systems typically come in 3, 4, or 5 stages, with at least 4 stages recommended for optimal filtration. To assure you are getting a good brand make sure it is WQA Certified.
Some RO brands to consider
•Kinetico K4 Drinking Water Station with VOC Guard
There are also some really good table top options that have carbon filters. Each brand will have different levels of performance on xenobiotic filtration. Making sure the brand has NSF certification certification, and is 3rd party tested. Here are some brands that were tested by the Environmental Working Group (EWG) or Consumer Labs (CL).
•Epic Pure Pitcher (EWG). My current filter!
•Clearly Filtered Water Pitcher (EWG_
•Aquagear Water Filter Pitcher 2023 (CL)
•Aquasana® The Clean WaterMachine (CL)
•Brita® Soho With Longlast® Filter (CL)
•Brita Water FilterPitcher For Tap And Drinking Water With Elite Filter. (CL)
•PUR Ultimate 7Cup Pitcher With Lead Removal (CL)
•Shower Filter brand Many affordable brands at Home Depot
Biotransformation and Elimination Practices
In cases of chronic arsenic toxicity, a structured biotransformation /detoxification protocol might be needed.
This may involve taking nutrients that help conjugate and eliminate these chemicals (such as glutathione) or possibly even taking compounds that bind and help excrete arsenic by a process called chelation. Commonly used chelation agents for arsenic include dimercaprol, DMPS (dimercaptopropane sulfonate), DMSA (dimercaptosuccinic acid), and penicillamine Chelation therapy should be administered under the supervision of a qualified healthcare professional, as it can have side effects.
Since toxin accumulation doesn’t happen in a silo , its important to look at testing for multiple xenobiotics including metals, PFAS, PCB’s, VOC’s, and Pthalates.
Arsenic is a serious environmental health threat, but by understanding the sources of exposure, the health impacts, and the strategies for mitigation, individuals can take proactive steps to protect themselves and their families.
Watch podcast episode below
<iframe width="560" height="315" src="
title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe>
About Dr. Pizzorno:
Dr. Joseph Pizzorno, ND is a transformational leader in medicine. Through half a century of work, he has helped establish and advance the academic, scientific, and clinical foundation of natural, functional, integrative, and environmental medicine. As founding president of Bastyr University in 1978, he coined the term “science-based natural medicine” and led Bastyr to become the first ever accredited institution in the field. He has set worldwide standards of practice by authoring or co-authoring 6 textbooks for doctors, including the Textbook of Natural Medicine (over 100,000 copies in 4 languages across 5 editions) and Clinical Environmental Medicine. He is Editor-in-Chief of PubMed-indexed IMCJ—the most widely read, peer-reviewed journal in the field (25,000 copies each issue). He is a founding member of the Board of Directors of the Institute for Functional Medicine, where he served 3 terms as Chair. A licensed naturopathic physician, educator, researcher, and expert spokesman, he is also author or co-author of 8 consumer books (most recent, Healthy Bones, Healthy You! with wife Lara).