EMF Effects Neurologic and Cardiometabolic Sharon Goldberg MD

EMF Effects: Neurologic and Cardiometabolic Sharon Goldberg, MD Voluntary Associate Professor Department of Medicine University of New Mexico School of Medicine SGoldberg@salud. unm. edu

Goals • Introduce the concept of Clinical Electromagnetics – Applied EMF science with the goal of improving patient outcomes – i. e. connect EMF biological effects with clinical medicine • Understand that EMF exposure is an ubiquitous, but modifiable risk factor that changes patient management • Learn how to scientifically respond when you hear a colleague say “there is no evidence of harm from EMFs”

Overview • Identify the 4 EMFs important to clinicians • Discuss selected EMF bioeffects • Review neurologic and cardiometabolic conditions associated with EMF exposure • Discuss current epidemics in context of EMF bioeffects

Why this material is important now • U. S. population is getting progressively sicker, at a younger age • Patients are working harder than ever to maintain health • Interventions that lower EMF exposure target many of the same mechanisms as standard lifestyle changes: i. e. diet, exercise, and supplementation • Rationale of EMF lowering interventions is fully substantiated by the basic science

Key Concept #1 – All EMFs Are Biologically Active 5. 8 GHz Spectrum shows how EM energies fit together based on frequency / Wavelength © BBI - 5

2ø Current e- e- e-eeeeee- e- e- Lattice of copper atoms with one free electron per copper atom Push on the first one and the last one falls out IBE 221. 5, page 6 © BBI - 6

4ø Definitions • Direct Current (DC) – Static charge – Constant Force Current (Amps) • Alternating Current (AC) – Vibrates or oscillates – Cycles back and forth – 60 Hz (cycles per sec) BBI 221. 5, p. 6 Time (sec) © BBI - 7

Key Concept #2 EMF Sources Of Clinical Interest Microwave Radiation (RFR) Dirty Electricity (VLF) Modifiable EMF Exposures AC Magnetic Fields (ELF) AC Electric Fields (ELF)

Low Frequency Remediation Targets ELF – Extremely Low Frequency AC Electric Fields Controllable Sources: Laptops/tablets (esp. if ungrounded), electronic devices – lamps, appliances, extension cords Uncontrollable Sources: Power lines AC Magnetic Fields Controllable Sources: wiring errors, appliances i. e. refrigerator, products with motors or transformers Uncontrollable Sources: Electrical panel/service drop, power lines, VLF – Very Low Frequency Microsurge Electrical Pollution (MEP) Dirty Electricity and Electromagnetic Interference The Electromagnetic Spectrum defines how the various radiations fit together. Sources: Fluorescent lights, dimmer switches, personal electronic on the basis of frequency IBE Manual page 43 device transformers (chargers - laptops, phones)

Remediation Targets – Higher Frequency Radio frequency/Microwave Radiation Range: RFR 30 k. Hz-300 GHz – Microwaves are the highest energy and frequency RFR (300 MHz-300 GHZ) Behavior: Like a beam, not a wave Measurement: Electric and magnetic fields can not be measured separately (measured as power density) m. W/m², µW/m², or V/m Sources: Inside home – All wireless devices: Wi-Fi, cell phones, cordless phones, Bluetooth, video games, baby monitors The Electromagnetic Spectrum defines how the various radiations fit together on the basis of. Outside home – Cell Towers, Utility Meters, frequency Neighbors devices IBE Manual page 43

EMF Effects - General Principles Duration of exposure matters Acute effects generally differ significantly from chronic effects Pulsed more biologically active than continuous wave Measuring RF is not like taking a temperature Population exposure has been gradually increasing since homes electrified in the mid 1900’s • Because entire population is exposed to multiple frequencies, measurable effects are harder and harder to detect – i. e. no unexposed control group. • • •

3ø Digital RF Sources • Information Carrying Radio Waves (ICRW) • Carrier frequency (clothesline) – 700 - 2600 MHz for cell phones • Information – pulses (clothes) Wi. Fi Router Beacon Signal BBI 221. 5, p. 22 © BBI - 12

Blue Cross Blue Shield The Health of America Reports https: //www. bcbs. com/the-health-of-america/reports Wide variety of health statistics on commercially insured Americans – Highly recommended

BCBS Millennial Health Study Exhibit 2: Top 10 Conditions Affecting millennials and prevalence increase (ages 21 -36 in 2017) https: //www. bcbs. com/the-health-of-america/reports/the-health-of-millennials

Blue Cross Blue Shield Millennial Health Study • Study of 55 Million Millennial Americans (born between 1981 and 1996) with commercial insurance • Aged 21 -36 in 2017 • Severe impacts expected on U. S. Economy

https: //www. bcbs. com/the-health-of-america/reports/major-depression-the-impact-overall-health

EMF Bioeffects and Current Epidemics Share Common Mechanisms Oxidative Stress DNA Damage Biological Effects of EMFs Heat Shock Proteins Calcium Channel Effects Mitochondrial damage Membrane leakage

Oxidative Stress Yakymenko, I. , Tsybulin, O. , Sidorik, E. , Henshel, D. , Kyrylenko, O. , & Kyrylenko, S. (2016). Oxidative mechanisms of biological activity of low-intensity radiofrequency radiation. Electromagnetic Biology and Medicine, 35(2), 186 -202. • Reviewed 100 currently available peer reviewed studies of oxidative effects of low intensity RFR • 93/100 confirmed that RFR induces oxidative effects in biological systems • Conclusion: Low intensity RFR is an oxidative agent for living cells with a high pathogenic potential

Oxygen/ROS = essential to life Immune Function – Pathogen Defense Energy Production – ATP - ETC • Body produces high levels of reactive oxygen species to kill pathogenic bacteria, viruses and fungi • Oxidative Immune response Constitutional Symptoms(? ), we can withstand it, bugs can not and die. • Reactive nature of O 2 makes energy production (ATP) possible • ATP = Energy Currency needed to power brain, heart, essential to life

Oxygen/ROS • Essential for survival but can also destroy/damage (DNA, fats, proteins etc. ) • Any molecule with an (unpaired electron) is unstable, but O 2 has 2 (missing ? )2 electrons • Needs to neutralize charge by taking e- from other sources

Oxidative Stress: an imbalance between oxidation and antioxidant capacity Why it is Confusing Causes/Contributing factors • Occurs all over the body, at the molecular level • Many different types of O 2 related (reactions) • Can be good or bad • Most oxidizing exposures trigger antioxidant responses that are protective • • • Modern living Combustion products Chemicals Stress ELECTROMGANETIC FIELDS

National Toxicology Study – Heart, Liver and Pancreas • Right ventricular cardiomyopathy in the heart • Malignant schwannomas of heart • Increases in lesions of various organs including the liver & pancreas. • DNA damage increased in various organs. Heart CCCardiac Schwannoma - NTP Study Images from Birnbaum NIEHS Presentation 2017

EMFs – An Emerging Risk Factor for Cardiovascular Disease • Increasing proportion of ST elevation MI patients lack traditional cardiac risk factors (Vernon ST, Eur J Prev Cardiol 2017) • RF is an environmental pollutant with cytotoxic effects • RF generates oxidative stress, which is implicated in CVD • RF may contribute to CVD via oxidative cellular damage Bandara, P. , & Weller, S. (2017). Cardiovascular disease: Time to identify emerging environmental risk factors. In: SAGE Publications Sage UK: London, England.

RF Exposure and CVD – Observational Data 1) Army Medical Intelligence and Information Agency 1976 • Increased coronary artery disease, HTN and hyperlipidemia in RF/MW exposed personnel relative to unexposed controls • CVD risk factors and family history were similar 2) North Karelia, Finland • Site of former Soviet early warning radar station • Heavy RF/MW exposure to local population • Local population found to have unusually high number of MI’s and cancer Bandara, P. , & Weller, S. (2017). Cardiovascular disease: Time to identify emerging environmental risk factors. In: SAGE Publications Sage UK: London, England.

Oxidative Stress and Cardiovascular Disease In conditions of associated of increased oxidative stress and inflammation (ischemic heart disease, cardiomyopathy, hypertension) NO and superoxide (O 2 • −) react to form peroxynitrite (ONOO−) which induces cell damage via oxidation and nitration: • lipid peroxidation • inactivation of enzymes/proteins • activation of stress signaling • matrix metalloproteinases (MMPs) Pacher, P. , Beckman, J. S. , & Liaudet, L. (2007). Nitric oxide and peroxynitrite in health and disease. Physiological Reviews, 87(1), 315 -424.

Oxidative Stress and Heart Failure Pacher, P. , Beckman, J. S. , & Liaudet, L. (2007). Nitric oxide and peroxynitrite in health and disease. Physiological Reviews, 87(1), 315 -424.

The brain is especially susceptible to ROS – it is a major metabolizer of O 2, yet has relatively feeble protective antioxidant mechanisms Popa-Wagner, A. , Mitran, S. , Sivanesan, S. , Chang, E. , & Buga, A. -M. (2013). ROS and brain diseases: the good, the bad, and the ugly. Oxidative Medicine and Cellular Longevity, 2013.

Stroke in the Young – An Epidemic • Review of two data sets showed significant increase in AIS hospitalization rates for men and women – 2003 -2004 (362, 339 hospitalizations) – 2011 -2012 (421, 815 hospitalizations) • Acute Ischemic Stroke hospitalization rates have nearly doubled for men aged 18 -34 and 35 -44 since 1995 -1996 • Trends consistent with other studies (next slide) • Rates for men and women 55 -64 have not changed from 20032004 George, M. G. , Tong, X. , & Bowman, B. A. (2017). Prevalence of cardiovascular risk factors and strokes in younger adults. JAMA neurology, 74(6), 695 -703.

Diabetes The pancreas has poor defenses against oxidative stress RF causes oxidative stress RF interferes with mitochondrial function Insulin release from the pancreatic beta cells requires calcium channel activation • Many diabetic complications (retinopathy, CVD, NAFLD etc. ) linked with oxidative stress. • RF triggers a cellular stress response (heat shock proteins), with evidence of systemic stress response (increased excretion rates of stress hormones: cortisol, adrenaline and noradrenaline (Vangelova KK Rev Environ Health 2005) • •

Diabetes and EMFs Circa 1971 • Increase in Blood Glucose Concentration • Glycosuria (sugar in urine) • Change in Concentration of Glycogen in Liver (Hyperglycemia) • Altered Carbohydrate Metabolism • Liver Enlargement Glaser, Z. (1971). Bibliography of reported biological phenomena (‘effects’) and clinical manifestations attributed to microwave and radiofrequency radiation. Naval Medical Research Institute Research Report Project MF 12. 524. 0150004 B. Res. Inst. , Nat. Naval Med. Center, Bcthesda, Md.

Mechanism of Generation of Oxidative Stress and Pathophysiology of Type 2 Diabetes Mellitus: How Are They Interlinked? Journal of Cellular Biochemistry, Volume: 118, Issue: 11, Pages: 3577 -3585, First published: 29 April 2017, DOI: (10. 1002/jcb. 26097)

Masoumi, A. , Karbalaei, N. , Mortazavi, S. , & Shabani, M. (2018). Radiofrequency radiation emitted from Wi-Fi (2. 4 GHz) causes impaired insulin secretion and increased oxidative stress in rat pancreatic islets. International Journal of Radiation Biology, 94(9), 850 -857. “Wi-Fi leads to hyperglycemia, increased oxidative stress and impaired insulin secretion” “RF Exposure induced a diabetes like status” Salah, M. B. , Abdelmelek, H. , & Abderraba, M. (2013). Effects of olive leave extract on metabolic disorders and oxidative stress induced by 2. 45 GHz WIFI signals. Environmental Toxicology and Pharmacology, 36(3), 826 -834.

Diabetes - Economics Association, A. D. (2018). Economic costs of diabetes in the US in 2017. Diabetes Care, 41(5), 917 -928.

The Future of Glucose Monitoring is Here? • FDA Approved for age 2 and up • Checks up to 288 glucose readings per day, sent wirelessly to your smart device • Medicare Covers for Type 1 AND Type 2 DM • ? Does anyone care about effect of increasing oxidative stress/potential for more diabetic complications: Retinopathy, CVD?

Progressive liver disease in NAFLD • NASH Transplant Statistics • Role of Oxidative Stress • Device placement in schools (laptops, tablets) exposes liver and pancreas to RFR oxidative stress Byrne CD, Targher G. J Hepatol 2015; 62: S 47– 64 Copyright © 2014 European Association for the Study of the Liver

1965 German Ford Motor Company Report On CNS Effects of Microwaves Findings: Diffuse effects on the autonomic nervous system affecting circulation, respiration, fluid balance, EEG, sleep and CSF glucose. Bergman, W. (1965). The Effect of Micro Waves on the Central Nervous System: Ford Motor Company.

Microwave Effects – Small Versus Large Doses • Small doses increase parasympathetic tone • Higher dose increases sympathetic tone • “Dosage cannot be simply determined even under completely identical physical conditions (wavelength. type of transmitter, etc. ) - the same dosage under otherwise equal conditions can cause parasympathetic reactions in one patient and sympathetic reactions in another” • “The effect even differs in one and the same patients at different times” • Consequently, the dosage cannot be based on the principle of measuring the energy absorbed by the body, but must also be based on the principle of measuring the reaction of the body to the absorbed energy. Bergman, W. (1965). The Effect of Micro Waves on the Central Nervous System: Ford Motor Company.

Galvanic Skin Response Autonomic Nervous System Effects in ALL SUBJECTS from Microwave Exposure

Sleep Animals were aroused from states of deep sleep by irradiation (Pulsed RF/MW) Bolen, S. M. (1994). Radiofrequency/Microwave Radiation Biological Effects and safety standards: a review (No. RL-TR-94 -53). ROME LAB ROME NY.

CNS Effects - Enzymes • EMFs modify hydrogen bonds Effecting • Hippocampus • Cholinergic System • GABA • Structural changes to many enzymes • Cytochrome p 450 reductase • Ach. E – enzyme that catalyzes hydrolysis of acetylcholine. Affects learning and wakefulness Health Effects of Electromagnetism - Mc. Gill Course OCCH-605, January 2019, Dr. Paul Heroux http: //www. invitroplus. mcgill. ca

Conclusion: Significant impairment in motor screening task and spatial working memory was identified among the group of students exposed to the high RF-EMF from mobile phone base station. Meo, S. A. , Almahmoud, M. , Alsultan, Q. , Alotaibi, N. , Alnajashi, I. , & Hajjar, W. M. (2019). Mobile Phone Base Station Tower Settings Adjacent to School Buildings: Impact on Students’ Cognitive Health. American Journal of Men’s Health.

Neurodegeneration and EMFs • Alzheimer’s Dementia – Available epidemiological evidence suggests an association between occupational exposure to ELF-EMF and AD. (García, Sisternas, & Hoyos, 2008) – Add other effects (hippocampus) other studies • Multiple Sclerosis – Kostic 2013, Ohl 2016, Abbasi • ALS • Autism

ALS • Less common than AD • <5. 4 Million people worldwide affected • Loss of voluntary muscle movement – deterioration of nerves of brain and spine • Electrical occupations 5 X as likely to develop ALS (Savitz 1998) • Other observational studies with similar associations

Cortical Excitability in ALS • Oxidative Stress • Mitochondrial Toxicity • Glutamate induced excitotoxicity • Calcium dependent enzymatic pathways Geevasinga, N. , Higashihara, M. , Menon, P. , & Vucic, S. (2019). Pathophysiology and Diagnosis of ALS: Insights from Advances in Neurophysiological Techniques. International Journal of Molecular Sciences, 20(11).

Twenty-five states had suicide rate increases of more than 30 percent. Increases in suicide rates ranged from 6 percent (Delaware) to over 57 percent (North Dakota). SOURCE: CDC’s National Violent Death Reporting System https: //www. cdc. gov/vitalsigns/suicide/infographic. html

Clear evidence of neuropsychiatric effects of EMFs at various frequencies • Voltage gated calcium channels have near universal role in release of neurotransmitters and hormones by neuroendocrine cells • EMFs act via downstream VGCC activation effects: increase intracellular Ca, excessive Ca and NO signaling, excessive peroxynitrite, free radicals and oxidative stress. Pall, M. L. (2016). Microwave frequency electromagnetic fields (EMFs) produce widespread neuropsychiatric effects including depression. Journal of Chemical Neuroanatomy, 75, 43 -51.

Conclusions • All EMFs are biologically active • EMFs interfere with normal physiologic function at multiple levels • Everyone is affected by EMF exposure – effects manifest differently • Current epidemics including neuropsychiatric compromise, CVD, and diabetes have been linked with EMF exposure at the basic science level and via observational studies • (Finish Conclusions)

Further Reading