Causes of Environmental Illness/Chemical SensitivityWilliam J. Rea, M.D. is President of the Environmental Health Center-Dallas. The introduction to his four-volume textbook Chemical Sensitivity states:
Modern technology has given man many conveniences and the ability to explore the outer limits of knowledge. It has allowed us to travel to the moon and send probes into outer space. But this technology that has led us to uncover secrets of the universe has also brought into focus the severity of environmental pollution on earth. The Apollo astronauts emphasized the extent of this problem when viewing the earth from space. Although they initially called it the "blue planet," these astronauts saw at closer range pollution on all areas of the earth, which led them to state that "man has fouled his nest and this must be corrected."
The astronauts' observation reminds us of a simple truth: man's well-being is a function of his environment and living in polluted surroundings adversely affects health. Today, more than ever, substances that pollute the earth and pose health risks are many, including biological factors such as pollens, foods, water, bacteria, virus, fungus, and parasites, chemical factors such as inorganic and organic compounds, and physical forces such as heat, cold, weather, cyclic phenomenon, radon, light, sound, and electromagnetic fields.
As the number of dangerous environmental pollutants continues to multiple, so do reports of increasing numbers of people sensitive to these contaminants. And although identification of a causal link between an individual's pollutant exposure and any subsequent development of illness has been difficult to demonstrate through much of this century, recent technological advances have made possible scientific study of the effects of these many environmental contaminants upon individual health and have contributed directly to our understanding of environmentally triggered illness as a specific clinical entity. Further, our improved research methods and expanding knowledge of environmentally triggered illness have led to definition of the early parameters of pollutant injury and to specification of the evolving principles used for diagnosing and treating chemical sensitivity, which include total body load (total of all pollutants that are in the body at one time); adaptation (the increase of the body's immune and nonimmune response systems to a new set point in order to accommodate environmental pollutants for acute survival); bipolarity (stimulation, withdrawal and depressive reactions to environmental pollutants); biochemical individuality (the uniqueness of individual responses to environmental pollution; the nature of these responses depends on each individual's genetic make-up, total body load, and state of nutrition); switch phenomenon (a patient's symptoms may totally change, i.e., from sinusitis to phlebitis to hemorrhoids), and spreading phenomenon (the patient may become sensitive to additional incitants, and new organs may be come involved).
Better Living Through Chemistry?
In the 1950's chemical technology blossomed and the slogan of the day was "Better Living through Chemistry." However, exposure to thousands of chemicals has resulted in "Bitter Living through Chemistry" for many unsuspecting people.
In a Winter 1989 Amics Journal article, researcher and psychologist Linda Lee Davidoff reported that: Since 1965, more than 4 million chemical compounds have been described in the scientific literature. Of at least 60,000 chemicals in wide use in the United States, scientists have investigated comprehensively only about 2 percent; there is spotty knowledge of about 30 percent, but no research data at all on roughly 50,000 widely used substances. More disconcerting yet, nothing is known about the millions of synergistic mixes created on the spot as the 60,000-plus chemicals mingle in the air we breathe.
More specifically, according to a 1984 study by the National Research Council: No toxicity data or minimal data are available for 66 % of pesticides and their supposedly inert ingredients, 84% of cosmetic ingredients, 64% of drugs, 81% of food additives, and 88% to 90% of chemicals in commerce.
And, according to the Office of Technology Assessment, few of the now 80,000 chemicals inventoried by the EPA have been tested to determine if they adversely affect the nervous system of humans. Indeed, government research of widely used chemicals for neurologic and immunologic toxicity was just getting organized in 1993. Therefore, it is correct to say that most of the chemicals in use today have not been thoroughly researched regarding health effects, either individually or in combination with each other.
Bitter Living Through Chemistry
A January 17, 2008 report of a study by the University of California found that: Toxic chemicals sicken and kill thousands of people in California each year and cost the state an estimated $2.6 billion in medical expenses and lost wages. (Pasadena Star-News, January 17, 2008) The researchers estimate that in 2004 more than 200,000 California workers suffered from chronic diseases linked to workplace exposure to industrial chemicals. Another 4,400 people died of those diseases, which include cancer, emphysema and Parkinson's disease....[The report] calls for state policies to phase out dangerous substances and promote safer alternatives.
A March 11, 2008 Union-Tribune article reported on research done by Dr. Beatrice Golomb published in the March 10, 2008 Proceedings of the National Academy of Sciences: A class of chemicals that includes nerve agents, pesticides and a drug to counter nerve gas may be causing the chronic fatigue, severe muscle pain and other illnesses that about 250,000 Persian Gulf War veterans are experiencing...."Enough studies have been conducted and the results shared to be able to say with considerable confidence that there is a link between chemical exposure" and those ailments. In another report of the study by MedPage Today, Dr. Golomb is quoted as saying "We should be cautious about exposing people, whether military personnel or civilians, to these chemicals." See the separate Gulf War study in this section regarding chemical exposure and chemical sensitivity.
What we hear about in the recognition that chemicals cause disease, as above, is the toxicological effects of chemicals. There are also sensitizing effects of chemicals. Many of the people mentioned in the two articles above have acquired chemical and food sensitivity from exposures to sensitizing chemicals. Then, it is the exposure to their antigens which cause their symptoms. Some may know that they are sensitive and others do not know. How are people exposed to sensitizing chemicals today?
EPA Connects Indoor Air Pollution with Chemical Sensitivity
The Environmental Protection Agency (EPA) found in its 1987 indoor air study, The Total Exposure Assessment Methodology (TEAM) Study, that indoor air is more polluted than outdoor air and that it is causing chronic health effects such as cancer, chemical sensitivity and Sick Building Syndrome (SBS). Here is the excerpt from the conclusion of the study on health effects:
Although this study is concerned only with documenting exposures and identifying possible sources, some discussion of health effects may be appropriate, since these are the ultimate reasons for our interest in these compounds. Two broad types of health effects may be distinguished: chronic and acute.
Chronic Effects:
The chronic effect of greatest interest is cancer. One of the TEAM target compounds (benzene) is generally considered a known human carcinogen. Five others are considered animal carcinogens and therefore possible human carcinogens - carbon tetrachloride, chloroform, trichloroethylene, tetrachloroethylene, and p-dichlorobenzene. Risk assessments of human exposure to these six compounds have been made using the TEAM exposure measurements and potency estimates from EPA and other oganizations, with an estimated range of 1000-5000 excess cancer cases per year nationwide. These numbers far exceed the estimates of 5-27 cases per year that have been used to regulate hazardous air pollutants (NESHAPS).
Other TEAM target compounds are mutagens and therefore possible carcinogens. These include styrene, 1,1,1-trichloroethane, and a-pinene. Still others are promoters (co-carcinogens) - octane, decane, and undecane. Others are presently being tested for carcinogenicity (xylenes, ethylbenzene). Risk assessments of these chemicals are at present highly speculative; however, it is possible that their effects on cancer incidence are not negligible.
A second chronic effect is chemical sensitivity. This is an ill-defined condition marked by progressively more debilitating severe reactions to various consumer products such as perfumes, soaps, tobacco smoke, plastics, etc. The incidence of this syndrome is unknown; however, anecdotal accounts indicate that it may be increasing sharply. The effects on productivity of affected persons can be severe.
Acute Effects:
A second ill-defined group of symptoms, sometimes known as "Sick Building Syndrome," affects a number of office workers. The symptoms include sleepiness, nausea, eye irritation, irritability, forgetfulness, and a number of other respiratory and central nervous system disorders. One experiment has determined that the symptoms are unlikely to be related to mass psychology or otherwise psychosomatic. A second experiment has shown that mixtures of common organic pollutants (mostly xylenes) at levels similar to those in new buildings can cause both subjective and objective symptoms in a group of sensitive individuals. The lowest experimental concentration was 5 mg/m3; effects were still apparent, leading the experimenter to hypothesize that effects may appear at levels as low as 1 mg/m3. Thus, the indoor air levels measured in the TEAM Study, which exceeded 1 mg/3, (sum of 11 organics) in ~3% of New Jersey homes, may have some potential of being associated with frank acute health effects, although no attempt was made to observe such effects.
How did our indoor air get so polluted? Due to advancing technology, better living through chemistry, more chemicals began to be used in construction materials and furnishings. For example, formaldehyde is used in press board cabinetry and wall paneling, and in wall-to-wall carpet. Toxicologists have long recognized that formaldehyde is a sensitizer. The 1990 study "Immune Activation and Autoantibodies in Humans with Long-Term Inhalation Exposure to Formaldehyde," reported that the people in the study exposed to formaldehyde - residents of mobile homes, office workers, those occupationally exposed, etc. - had many symptoms:
All patients in this study had sought continuous medical attention because of multiple organ symptoms involving the central nervous system (CNS) (headache, memory loss, difficulty with completing tasks, dizziness), upper-and lower-respiratory symptoms, skeletal-muscle complaints, and gastroenteritis. Three common symptoms were expressed: (1) an initial flu-like illness from which they had not fully recovered, (2) chronic fatigue, and (3) an olfactory sensitivity to ambient conditions containing low concentrations of chemicals.
The Abstract of the study reported: Four groups of patients with long-term inhalation exposure to formaldehyde (HCHO) were compared with controls who had short-term periodic exposure to HCHO. The following were determined for all groups: total white cell, lymphocyte, and T cell counts; T helper/suppressor ratios; total Ta1+, IL2+, and B cell counts; antibodies to formaldehyde-human serum albumin (HCHO-HSA) conjugate and autoantibodies. When compared with the controls, the patients had significantly higher antibody titers to HCHO-HSA. In addition, significant increases in Ta1+, IL2+, and B cells and autoantibodies were observed. Immune activation, autoantibodies, and anti-HCHO-HSA antibodies are associated with long-term formaldehyde inhalation.
It would be good if we could learn from the past. Regarding formaldehyde, in recent news, FEMA tested 519 trailers and mobile homes of people who became ill after living in them. The trailers were provided for thousands of people who needed housing following hurricane Katrina. The tests revealed that formaldehyde was detected "at levels that averaged about five times what people are exposed to in most modern homes." (The Associated Press, Feb. 23, 2008) Testing will be done on all these dwellings and dwellings provided in other states for evacuees of other natural disasters. A prior article from the Pasadena Star-News, February 15, 2008, stated "The Federal Emergency Management Agency said Thursday it will rush to move Gulf Coast hurricane victims out of roughly 35,000 government issued trailers because tests found dangerous levels of formaldehyde fumes." The FEMA Administrator said: "The real issue is not what it will cost but how fast we can move people out. The CDC findings could also have disturbing implications for the safety of other trailers and mobile homes across the country."
And, to compound the higher level of chemical use in homes and furnishings, in the 1970's, Americans began to practice energy conservation because of an oil boycott of America by Middle Eastern Arab nations. Contractors began to build tighter buildings with windows that could not be opened to conserve heated or cooled air. Unfortunately, the ventilation systems were not upgraded at that time to compensate for the loss of air exchange. A detailed account of the difference in indoor air attributed to this change can be found in Chemical Exposures, Low Levels and High Stakes by Drs. Ashford and Miller.
EPA Connects Residential Pesticide Exposure with Chemical Sensitivity
Besides new construction materials and furnishings, another major indoor and outdoor toxic pollutant is pesticide. Pesticide is poison. It is made to kill living creatures and can never be advertised as safe even if used as directed. And pesticides can sensitize.
Pesticide is now a major toxic indoor air pollutant. It is routinely applied in and/or around most buildings and people are not aware of it. Markets, health food stores, offices, restaurants, banks, libraries, schools, churches, hospitals, theaters, hotels, airplanes, trains, and buses are treated routinely by exterminators. The cabins of some planes which fly to foreign countries are even sprayed with aerosol cans of pesticide while the passengers are in the plane! One of our members had become seriously ill and pesticide-sensitive following the application of pesticide in her Puerto Rico home. She said, before she died a few years ago, "There is no escaping pesticide."
According to the book Chemical Exposures by Drs. Ashford and Miller: In a survey of some 6,800 persons claiming to be chemically sensitive, 80 percent asserted they knew "when, where, and what, and how they were made ill" (National Foundation for the Chemically Hypersensitive 1989). Of the 80 percent, 60 percent (that is, almost half of those who replied) blamed pesticides.
Between the year 1997 and the year 2000, the EPA acknowledged that the two most widely used residential pesticides, Dursban and diazinon containing chlorpyrifos can cause chronic illness and they were banned from residential use. They were used in 1,000 common pest control products in foggers and sprays, and lawn care and animal care products under such brand names as Ortho, Black Flag, Raid and Spectracide. 11 million pounds of Dursban alone had been applied in and around homes annually, and 2 million pounds had been applied on crops. They can still be used on crops.
Here are the health effects cited by Jerome Blondell, Ph.D., M.P.H., the Health Statistician, Special Review and Registration Section of the Occupational and Residential Exposure [pesticide] Branch, Health Effects Division (7509C) of the EPA in a January 14, 1997, memo "Review of Chlorpyrifos Poisoning Data" sent to Linda Propst, Section Head, Reregistration Branch, Special Review and Reregistration Division (7509C):
In addition to acute poisoning, chlorpyrifos and other organophosphate insecticides have been reported to be associated with chronic effects in humans, including peripheral neuropathy [weakness of limbs], chronic neurobehavioral effects [cognitive problems, memory loss, mood swings], and the reported development of a sensitivity to chemicals previously tolerated which is associated with a wide variety of symptoms. [See Allergy/Sensitivity Symptoms in another area of this web site.]
Therefore, widely used organophosphate pesticides are sensitizing chemicals as well as poisons. In the year 2000, Dr. Blondell, now the Health Statistician of the Chemistry and Exposure Branch I of the Health Effects Division (7509C) of the EPA defined neurobehavioral effects in his April 20 "Chlorpyrifos incident review update...and 1995 critique of EPA's review of neuropathy allegations" memo to Deborah Smegal, Toxicologist of Reregistration Branch 3 of the EPA Health Effects Division (7509C) to:
include persistent headaches, blurred vision, unusual fatigue or muscle weakness, and problems with mental function including memory, concentration, depression, and irritability.
While many people with chemical sensitivity experience these symptoms, neurobehavioral effects are also experienced by people diagnosed with Chronic Fatigue Syndrome. Dr. Blondell also told me in a telephone conversation "You can be poisoned by a pesticide and not realize it. You can just experience a mild [or bad] case of the flu." Think how many people remember a flu as the start of their Chronic Fatigue Syndrome! An article in a CFIDS Chronicle published by The CFIDS Association of America stated that "Cognitive function problems have been cited as one of the most disruptive and functionally disabling symptoms of CFS, with up to 85% of patients reporting impairments in attention, concentration and memory abilities." And people diagnosed with Fibromyalgia complain about "fibro-fog."
Study Shows Renovation Products and Pesticide Cause Symptoms of Chronic Illness
The following chart shows that people who became chemically sensitive from exposure to chemicals in construction/renovation products or from exposures to pesticides experience fatigue as the most serious symptom along with cognitive function problems and pain. Also, just like the symptoms suffered by people with CFS and Fibromyalgia! It seems to me that the only difference between the three illnesses is that the people diagnosed with chemical sensitivity have had their food and chemical sensitivities revealed to them through testing while those diagnosed with CFS and FM do not yet know about their sensitivities. As discussed in the CFS and Fibromyalgia section of this web site, people can be sensitive to foods, chemicals, mold, dust, etc. without being aware of it.
Table reprinted from Volume III and Volume IV of Chemical Sensitivity with permission of author William J. Rea, M.D. Copyright CRC Press, Boca Raton, Florida. (Chemical Sensitivity, Volumes I-IV can be purchased from the American Environmental Health Foundation, 800-428-2343.)
Miscellaneous Causes of Sensitization and Chemical Exposure
There are many more areas where we are being exposed to low levels of chemicals in our daily lives. Natural gas for heating and cooking can be a major source of chemical irritation for many. Natural gas is also on California's Proposition 65 list of substances known to cause cancer or reproductive harm. Chronically ill people often feel worse in the winter time when they shut their doors and windows and turn on the heat. They are then exposed to a more concentrated level of indoor air pollution and to natural or propane gas.Many people report becoming chemically sensitive due to a gas leak in their home.
While the automobile has been cited as a major contributor to outdoor air pollution, it is just now being recognized as an "indoor" air polluter as well. A recent study by the Australian research branch CSIRO has shown that the new car smell from chemicals which emanate from materials used in the car interior is able to cause illness. Supposedly, American car manufacturers have taken notice and are developing materials which will emit less chemicals.
Another way we are exposed constantly to low levels of chemicals is in our clothing and bedding. Chemicals are used in producing fabrics. Popular polyester fabrics are 100% synthetic. "Hypoallergenic" pillows are made with polyester! With foam pillows and the advent of no-iron clothing and sheets, we are exposed to formaldehyde even while we sleep. And, companies like Orvis and REI are selling outdoor clothing saturated with pesticide to deter mosquitoes!
A last, very important, route of ongoing exposure to chemicals is in our food and water. Foods contain preservatives, dyes, and pesticides, and are often wrapped in plastic. Tap water is clorinated and is often contaminated with pesticide or industrial waste chemicals. Bottled water comes in plastic which can leach chemicals into the water. ( See the Bare Basics section for solutions.)
Examples of Groups of People Becoming Sensitized in a Shared Toxic Exposure
People with Environmental Illness predicted that Gulf War troops would get ill from potential toxic exposures at the beginning of the war. They, also, predicted that many of the employees, firemen and other workers, as well as nearby residents of the World Trade Center would develop chemical and food sensitivity due to exposure to chemicals in the dust and the fumes from burning chemicals when the buildings fell on 9/11. They said the exposure would result in chronic illness with a myriad of symptoms beyond the diagnosed lung and eye problems, and Post Traumatic Stress Disorder.
Indeed, according to the Spring 2002 The Chemical Sensitivity News, Dr. Steven Levin of the Occupational Health Clinic at Mount Sinai Medical School "reported on his evaluation of many firefighters or ironworkers who were particularly heavily exposed because of their work at Ground Zero" at the Hunter College forum on March 14th. "Dr. Levin announced that he was seeing a 'provocability' among these people. He explained what he meant by that awkward term...by saying that these Ground Zero patients found that their asthma attacks could be provoked by exposure to things like vehicle exhaust, cleaning products, or 'perfume in a closed elevator.'" As predicted, they were exposed to sensitizing chemicals in the air pollution following the collapse of the buildings and became chemically sensitive.
We know from animal studies that stress plus chemical exposure can cause a greater degree of illness than either one on its own. Nevertheless, all sick 9/11 World Trade Center rescue workers and nearby residents should be tested for sensitivities by Environmental Medicine Physicians. And, the hundreds of Katrina Hurricane survivors who became sick while living in government built trailers which contain high levels of formaldehyde should be tested for sensitivities. If they were found to be sensitive to particular foods and chemicals and could avoid them, their health could improve.
Phenol, a chemical used in a myriad of chemicals is also a sensitizer. Two policemen were conducting air surveillance over an oil refinery at the time when a leak of phenol occurred. Both men became ill in the plane and remained ill thereafter. Their story was told on the KQED television broadcast Bad Chemistry in December of 1990. Even though the exposure was obvious and they were immediately treated to prevent injury from a toxic chemical, their subsequent chronic illness was not acknowledged. They had no clue that they had become sensitive to chemicals in toiletries such as after shave lotion and lawn care chemicals, but were finally correctly diagnosed by an Environmental Medicine Physician. They were on the road to better health when they were told to go back to the company doctor. He did not believe they had become sensitive. One policeman chose to believe the Environmental Medicine Physician. He followed the doctor's order regarding avoidance of phenol and other chemicals such as fragranced products and left work on disability. When his health improved he went back to work in a security position. The other policeman chose to continue working for the police department doing air surveillance even though he became ill whenever he flew the phenol-contaminated airplane. He ended up crashing the plane, killing himself and his co-pilot.
Summary
In summary, Environmental Illness can be caused by exposure to sensitizing chemicals which are found in everyday products. Then, health symptoms can be caused by reactions to common foods, chemicals, mold, pollen, fabric, dust, etc. to which the ill person has become sensitive and to which he may be totally unaware.
Environmental Illness, sensitivity to the environment including foods, chemicals, molds, etc. could be prevented by not manufacturing sensitizing chemicals and/or avoiding them. For someone who has become sensitive, better health resides in finding out which foods, chemicals, etc. they have become sensitive to and avoid them.
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