Sarah A. LoBisco, ND
There is no doubt that our environment is increasing in toxicity.1-10 In fact, it seems that almost every day we are bombarded by journal articles and media advertisements that inform us about the need to cleanse and detoxify from our surroundings. As NDs, we are well aware of the burden these chemicals have on our patients’ long-term health. Even before the emergence of society’s philosophy of “better living through chemistry,” our ancient roots were imprinted by our predecessors’ use of detoxification for removing obstacles to cure. Today, much more scientific research is validating this link of toxic burdens to chronic health conditions and environmental concerns.10-13
For example, as these unnatural chemicals enter our water supply, they affect even the best established biochemistry. The following testimony was given by Dr Gina Solomon to the US Congress Committee on Energy and Commerce:
Multiple contaminants are turning up in our nation’s waterways, including in water millions of people rely on for drinking. Studies by the U.S. Geological Survey (USGS) have revealed an unsavory mix of pharmaceuticals, steroid hormones, unregulated pesticides, flame retardants, rocket fuel chemicals, plasticizers, detergents, and stain repellants in both the surface water and the groundwater we rely on for drinking, and in our drinking water itself…. The USGS surface water study found a median of seven and as many as 38 chemical contaminants in any given water sample…. Among the chemicals most commonly detected in this national survey are known and suspected endocrine disruptors, including triclosan, alkylphenols and alkylphenol polyethoxylates, bisphenol A, and estriol. As a scientist, I wish I could tell you these chemicals are unlikely to be a problem at the concentrations measured. Unfortunately I can’t tell you that, because my assessment of the data suggests a problem.11
The Fourth National Report on Human Exposure to Environmental Chemicals by the Centers for Disease Control and Prevention12 states that an estimated mean of 212 chemicals was found in the average person’s urine or serum sample. The chemicals were categorized into metals, herbicides, fungicides, polycyclic aromatic hydrocarbons, and parabens. In this biannual report, 75 new chemicals were found in the urine and serum samples of 2400 participants. The new chemicals that were included in this compilation were acrylamide, arsenic, environmental phenols (including bisphenol A and triclosan), and perchlorateorate. Among the wide variety of all analyzed chemicals are potential human carcinogens, endocrine disruptors, and immune disruptors.
The European Union has already taken action for the public’s health safety.13 They have begun phasing out some of these harmful chemicals under their Registration, Evaluation, Authorization & Restriction of Chemical Substances legislation. Included are the following: (1) the phthalates di(2-ethylhexyl)phthalate, benzyl butyl phthalate, and dibutyl phthalate (shown to be connected to reproductive toxicity); (2) the toxic flame retardant hexabromocyclododecane; (3) 5-tert-butyl-2,4,6-trinitro-m-xyelenem, a synthetic musk (shown to be bioaccumulative and toxic); and (4) 4,4-diaminodiphenylmethane, a compound used in epoxy resins and adhesives and classified as carcinogenic.
Another area of increasing environmental concern is everyday exposure to electromagnetic frequencies.14-20 Recently, the International Agency for Research on Cancer (http://www.iarc.fr/en/media-centre/pr/2011/pdfs/pr208_E.pdf) issued the following warning linking the use of cell phones to a possible increased risk of brain cancer: “After reviewing all the evidence available, the IARC working group classified radiofrequency electromagnetic fields as possibly carcinogenic to humans,” panel chairman Jonathan Samet, MD, chair of preventive medicine at the University of Southern California (Los Angeles) Keck School of Medicine, said at a news teleconference. He continued: “We reached this conclusion based on a review of human evidence showing increased risk of glioma, a malignant type of brain cancer, in association with wireless phone use.”
The scientific evidence on the damages of electromagnetic frequencies to health caused the Council of Europe Parliamentary Assembly to issue its own warning,21 even before the warning by the International Agency for Research on Cancer. Furthermore, the Council of Europe made specific recommendations to protect children, who are considered at greatest risk, from electromagnetic frequency irradiation in schools. A summary to Parliamentary Assembly states the following:
The potential health effects of the very low frequency of electromagnetic fields surrounding power lines and electrical devices are the subject of ongoing research and a significant amount of public debate. While electrical and electromagnetic fields in certain frequency bands have fully beneficial effects which are applied in medicine, other non-ionizing frequencies, be they sourced from extremely low frequencies, power lines or certain high frequency waves used in the fields of radar, telecommunications and mobile telephony, appear to have more or less potentially harmful, non-thermal, biological effects on plants, insects and animals, as well as the human body when exposed to levels that are below the official threshold values. One must respect the precautionary principle and revise the current threshold values; waiting for high levels of scientific and clinical proof can lead to very high health and economic costs, as was the case in the past with asbestos, leaded petrol and tobacco.21
Naturopathic physicians are in the position of dealing with an already sensitive population with chronic conditions; therefore, our patients may experience a greater cumulative and negative effect of these toxins on their health.2,6,8 Furthermore, with many patients in a state of adrenal burnout and its resultant hypothalamic-pituitary-adrenal axis disorders, we must learn to assess the extent to which the symptoms of estrogen dominance, heightened sensitivity to electromagnetic frequencies, insulin resistance, inflammation, mood imbalances, and metabolic syndrome that our patients have is a result of swimming in this murky biochemical soup of chemical endocrine disruptors. If we simply aim to correct these symptoms with fancy nutraceuticals, pills, and potions, without removing the obstacles that are causing downstream effects, we have not upheld our naturopathic philosophy to its highest potential.
The Patient With Multiple Chemical Sensitivity in the Rural Naturopathic Office
Multiple chemical sensitivity (MCS) is the term used to describe the adverse responses of hypersensitive individuals to the levels of chemicals present in our everyday environment. These reactions are not typical in most of the population who are exposed to the same toxicants without negative symptoms.
The process of MCS begins with an initiation reaction, induced by a chemical, creating intolerance and sensitivity to that chemical. This response then triggers further reactionary patterns to many more chemicals until the individual is unable to tolerate any exposure to chemicals without a negative response.
Symptoms are varied and can range from allergic reactions (such as irritation to mucous membranes, breathing difficulties, or skin irritations) to mood imbalances, muscle and joint pain, and fatigue. Women in their late 30s to 50s and those in the military, particularly Gulf War veterans, seem to be most affected by MCS. Allopathic treatments are palliative and include psychological support, such as antidepressants.
Allergist Theron G. Randolph, MD (1906-1995) was the first to introduce MCS to the medical establishment, in the 1950s. He believed the syndrome was related to the increasingly high amounts of chemicals introduced into the environment at that time. Multiple chemical sensitivity is a syndrome that is not well understood by allopathic medicine, and controversy exists about the validity of the diagnosis. In fact, some physicians refuse to accept MCS as a medical term and view it as a psychosomatic or an emotional disturbance.22
An issue of debate in the diagnosis of MCS may relate to the fact that there is no uniform picture of those with the syndrome. Because environmental exposures create such a variety of symptoms unique to each individual, creating a diagnostic algorithm for health providers to agree on is a daunting task.22
WebMD reports the following allopathic understanding of the symptoms of MCS:
Multiple chemical sensitivity (MCS) is also called “environmental illness” or “sick building syndrome.” It refers to a variety of non-specific symptoms reported by some people after possible exposure to chemical, biologic, or physical agents. Some say that levels of exposure generally considered safe for most people can have an effect on a few.
The symptoms people report are wide-ranging and not specific. They include headache, fatigue, dizziness, nausea, congestion, itching, sneezing, sore throat, chest pain, changes in heart rhythm, breathing problems, muscle pain or stiffness, skin rash, diarrhea, bloating, gas, confusion, difficulty concentrating, memory problems, and mood changes.23
The US Consumer Product Safety Commission and other organizations are advocating for physicians to view this syndrome as a physiological disease and to treat it as such.22,24 Alpers25 reported on the connection between MCS and irritable bowel syndrome symptoms, indicating that, although the disease of MCS may be overlooked, the problem of toxicity and its effects on our patients is no longer being ignored.
The Role of NDs in Managing Patients With MCS Who Are Hard to Manage
As medicine and the public become more aware of the negative consequences of our chemical world, NDs will have a vital role in advocating safe and medically sound practices to prevent or deal with its effects. The goal of treatment should be to find the cleansing or protective method that will best serve the patient. Considering the individual and his or her cumulative environmental effects, diet, single-nucleotide polymorphisms, and overall emotional and spiritual balance should serve as a guide to which therapy to implement.
If our patients are willing to pay the added expense for more specific and individualized biochemical support, a helpful method that is being used in functional medicine is testing for impaired detoxification pathways via single-nucleotide polymorphisms and other markers. These tests can assist with treatment plans, which include various nutrients to use that can modulate these compromised pathways. They can also provide reassurance to our patients with MCS that they do indeed have a biochemical condition.
These tests include the following: impaired methylation, methylenetetrahydrofolate reductase, methionine synthase, catechol-O-methyltransferase, other methyltransferases, impaired sulfation single-nucleotide polymorphisms, GSTM1 and GSTP1 glutathione transferases, apolipoprotein E4 allele, and impaired metallothionein function.
Useful nutrients for patients with MSC are the following: (1) Phase 1 detoxification support includes magnesium, copper, zinc, vitamin C, folic acid, and vitamins B2, B3, B6, and B12. Antioxidants, such as vitamin C, N-acetylcysteine, α-linolenic acid, carotenoids, and flavonoids, prevent oxidative damage. (2) Phase 2 detoxification support includes cofactor supplementation, such as whey, N-acetylcysteine, glutamine, glycine, sulfur donors (taurine and sodium sulfate), pantothenic acid, magnesium, and methyl donors (folic acid, choline, methionine, trimegestone, and S-adenosylmethionine).6
Patients With MCS in Team Health
Patients with MCS tend to have an acute awareness of how their bodies handle nutrients, foods, and supplements. Working with these patients is a perfect opportunity for combing the physician’s knowledge of biochemical individuality with the patient’s knowledge of his or her own body.
(63-Year-Old Female Building Worker With Toxic Effects)
I was intrigued with DA right when I met her. DA was a 63-year-old woman who originally consulted with me to get off her hypertension medication. She just did not think she needed it and was experiencing all the adverse effects.
DA’s history includes a kidney cyst (related to medication use), headaches, chronic sinus infections, fibroids, hysterectomy (in 1978), periventricular contractions, low thyrotropin level, and toxic exposure. DA’s exposure list includes asbestos, primary and secondhand smoke, toxic fumes, and mold. Her medications include nifedipine and albuterol-ipratropium inhalation (as needed for paraben exposure). DA’s laboratory results revealed a homocysteine level below 6 µmol/L (<0.81 mg/L). She also has a history of “sensitivity to B vitamins,” feeling better at first with them and then worse.
DA’s medication sensitivity and hormonal imbalance and her exposure to toxins pointed to compromised liver detoxification as an underlying contributor to many of her symptoms. Because of her low homocysteine level and B vitamin sensitivity, I also thought that DA was an overmethylator and could have a defect in her cystathionine-synthase allele.
I implemented the following protocol for her. I took DA off her B vitamins so as not to aggravate symptoms.
(Gastrointestinal Permeability Healing)
The first goal was to heal the gastrointestinal permeability resulting from chronic environmental and biological stressors, inflammation, and compromised liver detoxification. This was supplemented with antioxidants and anti-inflammatory support to assure that toxicants were removed and to protect DA’s organs from damage as she underwent detoxification. Avoidance of any food sensitivities of gluten, dairy, corn, and inflammatory foods was vital during this time, as there was already a lot of gasoline on the fire.
The protocol consisted of 3 support elements: First, a gastrointestinal combination product of the nutrients listed in Table 1 was administered at half dose. (I find that patients with MCS need smaller dosages because of their hypersensitive nervous systems.)
Second, coenzyme Q10 (100 mg) was prescribed to treat inflammation and to protect the kidneys. Third, a probiotic blend (300 mg) was prescribed that contained the following: Saccharomyces boulardii (≥5.0 billion colony-forming units [CFUs]), Lactobacillus rhamnosus (≥2.5 billion CFUs), Bifidobacterium bifidum (≥1.25 billion CFUs), and Bifidobacterium breve (≥1.25+ billion CFUs).
After 1 month on this protocol, DA has more consistent bowel movements, decreased bloating, more energy, less airway reactivity, decreased nausea, alleviation of leg cramps and joint pain, and better emotional balance. She feels the “best she has in years.”
My plan for this lovely woman is to continue to mend her gut and to follow the sequential protocols, with individual variation of nutrients and dosages for her specific needs. For example, we will supplement with an altered form of vitamin B12, hydroxocobalamin, if needed so as not to overmethylate.26,27
Sarah LoBisco, ND is a graduate of the UBCNM in Bridgeport, CT. She is licensed in Vermont State and holds a BA in psychology from SUNY Geneseo. She is a contributing item writer for the CNME and has had several articles published. Dr. LoBisco is also a speaker on integrative medical topics for medical professionals. Recently, she completed the Applied Functional Medicine in Clinical Practice coursework, which is accredited by the Accreditation Council for Continuing Medical Education (ACCME). Dr. LoBisco currently has a private integrative medical consulting practice in Ballston Spa, NY, where she incorporates naturopathic, functional, and conventional medicine, along with her training in essential oils, herbs, whole food supplements, mind-body medicine, and psychology to form an integrated approach to each individual client. Her recent blogs, along with various resources and references and information on her clinic, can be found at www.dr-lobisco.com and www.saratoga.com/living-well. She is also a featured expert at www.360menopause.com.
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