by Robert W. Boxer, MD, Fellow of the American Academy of Environmental Medicine, the American Academy of Allergy and Immunology, and the American College of Allergy and Immunology.

On October 28-31, 1990, the American Academy of Environmental Medicine held its 25^th annual meeting at Coer D’Alene, Idaho; the subject was "Chemical Sensitivity: Then and Now." Founded twenty-five years ago as the Society for Clinical Ecology by a group of five doctors, including NOHA Professional Advisory Board member Theron G. Randolph, MD, the AAEM holds annual meetings and instructional courses that broaden the consideration of allergy to include reactions to common foods and environmental chemicals. All these meetings and courses are recognized by the American Medical Association for Continuing Medical Education (CME) credit. The AAEM’s new president is Gary Olberg, MD, of Crystal Lake, Illinois. Before I briefly summarize some of this year’s talks, I want to say a few words about Dr. Randolph.

Since I first met Dr. Randolph about 23 years ago, he has remained one of the physicians in my career that I have held in the highest esteem. I admire him for having the courage of his convictions: when he first began talking about chemical susceptibility almost 40 years ago, it certainly was very controversial and he undoubtedly alienated many vested interest groups with his strong stands on food allergy and chemical susceptibility. He has been a teacher to some of us and an inspiration to all of us in the American Academy of Environmental Medicine.

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Dr. Oberg: In its "model for environmental medicines," the AAEM believes that "optimal health requires all bodily functions to be in homeostasis with all environmental stressors and that environmental illness results from a disruption of homeostasis by environmental stressors. This disruption may result from a wide range of possible exposures, from a severe acute exposure to a single stressor – to cumulative, relatively low-grade exposures to many stressors over time. The disruption can affect any part of the body. . . . The total load, the level of adaptation, the bipolarity of responses [stimulated and then depressed], and individual susceptibility (biochemical individuality)" are some of the governing principals that shape an illness over time. [Editors’ note: the term "environmental illness," "multiple chemical sensitivities," "chemical sensitivity," and "chemical susceptibility" mean essentially the same thing and are often used interchangeably.]

Gerald H. Ross, MD: About three fourths of patients with environmental illness are women, usually in their twenties, thirties, or forties, or even in their teens. Triggers can be overwhelming chemical exposure, cumulative exposures, a new job or home, a new baby, or even weak electromagnetic fields. Frequent symptoms of environmental illness are red outer ears, particularly in children reacting to food; tachycardia (rapid heart beat) on exposure to offending substances; increased bowel sounds with food ingestion; diaper rash; tender muscles; and cold hands and feet.

NOHA Honary Member Jeffrey S. Bland, PhD: Broadly speaking, environmental medicine refers to both exogenous (outside) and endogenous (inside) factors that influence living organisms, such as humans. Endogenous factors depend on our unique, genetic individuality, which translates into particular organ and system functions, including our gut ecology and our endocrine, immunologic, and nervous-system responses to the external environment. The exogenous environment includes air, water, food, radiation, and biological and chemical factors as well as physical and emotional trauma-inducing factors. Expressions of disease are the result of these environmental stressors exceeding the individual resiliency factors that attempt to maintain homeostasis.

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If a patient has low or no stomach hydrochloric acid (HCl), the gastrointestinal (GI) tract will malabsorb nutrients and will grow harmful organisms that disrupt beneficial ones. The first line of defense to kill bacteria is proper acid secretion. Thirty percent of patients over 60 have been found to have low stomach HCl.

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If a patient has low or no stomach hydrochloric acid (HCl), the gastrointestinal (GI) tract will malabsorb nutrients and will grow harmful organisms that disrupt beneficial ones. The first line of defense to kill bacteria is proper acid secretion. Thirty percent of patients over 60 have been found to have low stomach HCl, possibly because various toxins in the GI tract can kill the particular cell activity that produces HCl. Also, if along with these disruptions the GI tract becomes more permeable, more antigens will enter the blood stream and will eventually be carried to the liver, which acts as a final buffer against a hostile GI environment.

Two things can go wrong with the body’s own detoxification process: (1) the oxidants that the body uses to detoxify foreign substances have little discrimination and can damage body tissue, and (2) when the liver is confronted with too many demands, an "oxidative burst" can deplete the liver’s own reserve of antioxidants, which can in turn cause the release of oxidants that attack not only the liver but the fat-soluble regions such as the central nervous system. Helping the liver, however, are antioxidant pathways like glutathione (a peptide composed of three amino acids), taurine (another amino acid), vitamin E, and the enzymes catalase, peroxidase, and super-oxide dismutase.

Our task, then, is to lower the body’s burden of exposure and to enhance the body’s natural detoxification pathways. A specially designed dietary supplement used exclusively for one week and then together with a rotation diet for several weeks can help lower the load on the GI tract and liver and can provide protective antioxidant nutrients to help the liver do its important work.

Miscellany:

NOHA Professional Advisory Board member Jon B. Pangborn, PhD: The aluminum ion, being a relatively small ion, can migrate into the nucleus of some cells in the central nervous system. It is felt that there may be an additional factor predisposing some patients with either amyotrophic lateral sclerosis (ALS) or Alzheimer’s disease to accumulate aluminum in their brain tissue, so that these diseases may be a combination of exposure with an as yet poorly understood propensity. In any event, excess exposure to aluminum is unwise.

Nancy A. Didriksen, PhD: Particularly appropriate for the environmentally ill person to consider are the "four options of life": (1) to be angry and upset, (2) to be assertive, (3) to deal with an untenable situation by "divorce with love," meaning to sever a relationship with love rather than with vindictiveness, (4) to accept and forgive.

NOHA Honorary Member William G. Crook, MD: In addition to food colors and preservatives that the late NOHA Honorary Member Benjamin F. Feingold, MD, first warned against in 1973, sugar and specific food allergens can play a major role in hyperactivity and attention deficit disorder in children. A high percentage of children have recurrent ear infections and are hyperactive; they should be considered allergic, with Ritalin used only as a last resort. [RWB: Personally, I find that Ritalin is sometimes useful as a short-term crutch to increase a child’s self-esteem while environmental factors are being sorted out.]

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Our task, then, is to lower the body’s burden of exposure and to enhance the body’s natural detoxification pathways.

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Sherry A. Rogers, MD: Magnesium deficiency is common and can lead to increased cholesterol and triglycerides; arteriosclerosis; hypertension; cardiac arrythmia; and sudden death. [RWB: It is well recognized that patients who have an inadequate magnesium intake over a period of years, because of a high consumption of softened water, will have a greater likelihood of dying if they suffer a heart attack.] Also, magnesium is essential to glutathione, which [as previously mentioned] is a detoxification pathway. Factors that deplete magnesium are (1) sweating, (2) use of diuretics, (3) alcoholism, (4) a high-phosphate diet, such as one with an abundance of soft drinks, and (5) a high-phytate diet. [Phytates are found in many foods, especially those of plant origin.] Food processing lowers the magnesium content of food. Seaweed, brown rice, and wheat germ are high in magnesium. [Editors’ note: Actually, other foods, including quail, buckwheat flour, and many nuts, are much higher in magnesium than brown rice is.] Correcting magnesium deficiency often reduces chemical and food sensitivity; if it doesn’t, the problem may be manganese deficiency. Interactions between various nutrients are very important.

NOHA Honorary Member Russell M. Jaffe, MD, PhD: Environmental cues or stresses can affect immune responses. In a study of normal subjects shown several movies, secretory IgA (an immunoglobulin) increased after positive experiences and decreased after negative experiences. These changes lasted for 10 to 14 days, indicating that a single experience can affect our innate mucosal defense system for up to two weeks.

William J. Rea, MD: In the Dallas, Texas, environmental control unit (ECU) 210 patients went through detoxification in the past 18 months. Most were chemically sensitive and had not been helped by other treatments. They had a wide range of overlapping symptoms -–83 percent neurologic, 26 percent cardiovascular and respiratory, 20 percent musculoskeletal, 10 percent gastrointestinal, and a few dermatologic. The automatic nervous system, balance in particular, seemed to be greatly affected in these patients. In the exercise and deep heat [sauna] program, which lasted an average of three weeks, patients were given up to 3 grams of vitamin niacin daily, as well as other vitamins, minerals, the antioxidants alpha-keto glutaric acid and glutathione, and an ample supply of compatible food and water.

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The controlled experiment of the ECU helps to evaluate not only pollutants that the patients had in their environments, but also foods that they are eating as well as water they are drinking.

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By measuring blood and sometimes fat levels of chlorinated pesticides, hydrocarbon solvents, and other contaminants, it was found that in 127 patients these levels were lowered by the treatment. Interestingly, some chemicals would not come out of the body until another chemical had completely come out. Also, during the exercise and massage parts of the program, one could smell individual pollutants as they came out, a bit of a surprise to the physicians.

The controlled experiment of the ECU helps to evaluate not only pollutants that the patients had in their environments, but also foods that they are eating as well as water they are drinking.

Charles A. Moss, MD: Electromagnetic fields are a topic of great interest now, and there are dangers in and out of our homes. While the average electromagnetic background of a house in this country is 1 to 2 milligauss, the electromagnetic field near an electric stove can be up to 1 gauss – one thousand times as great. Epidemiologic studies show that there is a higher fetal loss in homes with electric-wire heating systems and that some types of childhood cancer were up threefold in homes with an electromagnetic background of 2.53 milligauss. Outside dangers can come from being within 100 yards of high-tension wires or near electric transformers. [RWB: In my own practice, I advise patients, especially women trying to become pregnant, to limit their use of electric blankets and electrically heated water beds. I also think that electric clock radios should be as far away from the head of the bed as possible.]

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At the AAEM meting, there were a number of other excellent presentations, which space does not permit me to mention. Lay people are always welcome to attend, and many do. The next annual meeting will be in October, 1991 in Jacksonville, Florida; I am sure that Professional Advisory Board members will be happy to provide more information to those interested in attending.