Who is our average patient?
Our average patient at “The Center”:
- Has been to 10 or more doctors
- Has had a chronic illness for anywhere from months to decades
- Feels that other doctors have not listened to their full history or concerns
- Has been told it’s all in their head
- Has already spent thousands of dollars on laboratory and other testing
- Is afraid of going to yet another doctor
- Is looking for a doctor to understand and treat the root causes of their illness, rather than just alleviating symptoms
- Has heard of the Center through a physician, other patient, or support group who is familiar with the Center’s approach
- Has personally researched our Center on our Website and has validated that the information is credible
- Lives anywhere in the U.S. or now may live in Europe, Asia, or the Middle East
- Is often one of two or three generations of a family who become patients
- Feels like they’ve found a partner is us, one who is committed to improving their health
- Is surprised that we present an estimate of costs based upon an understanding of what their medical needs are, which enables them to prioritize treatments within their budget
- Finds great value in time and money invested at the Center, especially as compared to all they’ve spent in their previous attempts to improve their health
- Appreciates the thorough education they receive in how to manage their own health
- Sees a significant improvement in their health in a relatively short period of time
The Effects of Our Environment on the Endocrine System
Dr. Lieberman’s Note: We are sorry to see that people generally have so little understanding of the adverse effects of using so many toxic chemicals in their daily lives and that they are equally unaware of effective, safer alternatives. Our goal in continuing to present the information given here is to encourage each reader to take responsibility for his or her own actions and possible consequences in choices of products to use for pest control, home and garden maintenance, food containers and preparation, etc. We can’t change the whole world at once, but we can each make our own best choices.
We have been concerned about problems of infertility, impotency in males, and overt falling sperm counts. To this must be added an increasing incidence of endometriosis and breast cancer, and this is just the tip of the iceberg. Is there a unifying explanation for all this? The data seems to confirm there is.
The culprit can be summed up in one word–xenoestrogens–or endocrine disrupters, but the problem is undoubtedly more complex.
Basically, many synthetic chemicals to which we are exposed mimic estrogen, which results in feminization of our male population and causes multiple disease syndromes related to estrogen dominance, or too much estrogen relative to the levels of other hormones in our bodies. Since all hormones are inter-related, when hormonal balance is disrupted, every endocrine organ suffers, including not only our reproductive organs, but the thyroid, pituitary, adrenals, etc. The function of the entire body is under the regulation of hormones, so we can see why profound adverse effects can result from deregulation of the endocrine system by xenoestrogen chemicals.
Speaker after speaker at this conference emphasized our excessive exposure to multiple chemicals which fall in this category of xenoestrogens or estrogen mimics, including pesticides, plastics, and many additives. As early as the 1960’s, Rachel Carson warned of the dangers of DDT in her book, Silent Spring. Even then it was too late to prevent the damage done by widespread application of this pesticide, and now traces of DDT are found in the tissues of every living being–human, animal, and plant–throughout the world. Hundreds of other pesticides have since been used and continue to be used with reckless abandon, all of which are not only toxic but also estrogen mimics.
Soft plastics, another potent source of xenoestrogens, are ubiquitous in our environment. [Soft plastics are “bendable” plastics such as are used in making most bottles in which bottled water, juices, and sodas are sold; many bottles in which cooking oils are sold, and other food containers too numerous to list.] The use of soft plastics in packaging of our foods has contributed to the contamination of our food supply with estrogen mimics. The combined use of pesticides in growing the food and soft plastics in transporting and packaging the food raises our exposure to endocrine disrupters.
Several speakers at this conference discussed the effects of xenoestrogen exposure. In women, we see the greatly increased incidence of breast cancer, endometriosis, severe menopausal symptoms, and premenstrual symptoms. In men, we are seeing earlier and more severe andropause, which is the male equivalent of a female’s menopause and is due to low levels of testosterone in the male.
Normally, andropause, like menopause, is genetically programmed. However, other factors besides normal aging can bring on andropause, including infection of the testes (orchitis), autoimmunity, and now we see, chemical exposures. Not only can chemicals directly injure the testicular tissue, they can and do act as androgen hormone blockers, thus blocking the effect and uptake of testosterone.
The pesticide DDT and its metabolites, as well as the plastercisers such as Bisphenol A (a common ingredient in the lining of cans), can act as androgen hormone blockers at levels as low as 2-5 parts per billion. DDE, the metabolite of DDT, is equal to the drug Flutamide in its effect as an androgen blocker, and Flutamide is such a powerful androgen blocker it is used to treat prostate cancer! The significance of this is our pollutant exposure is literally equal to the taking of powerful drugs which have the same effect on our hormones, but which are unwanted in the bodies of normal people.
Andropause is occurring prematurely in many men, and therefore is not being recognized by most patients and their physicians. Severe andropause is characterized by fatigue, depression, irritability, anxiety, lack of initiative and self-confidence, loss of libido, impotency, loss of neurocognitive function, decreased muscle mass, weakness, aches, pain, stiffness, and increased cardiovascular events (heart attack). There is a re-distribution of body fat, which gives that characteristic paunch of older men. Of great significance, the low levels of testosterone found in andropause are also associated with insulin resistance, and insulin resistance in itself is the cause of the syndrome associated with obesity, hypertension, high cholesterol and triglycerides. Thus, premature andropause brings many health risks to younger and younger men.
There was also one paper presented at this conference on the levels of toxic chemicals being found in breast milk–levels so high that if the breast milk were to be put on grocery store shelves, it would be banned by the EPA. The fatty tissue of the breast is a primary store house or waste dump site for many of these xenobiotics to which the adult female is exposed. Levels of DDE (the metabolite of DDT) and Dioxins and Furans (highly chlorinated hydrocarbons) are especially elevated in breast milk. The latter are considered to be among the most toxic chemicals known. In the first six months of life, a breast fed baby has already been exposed to many times the accepted lifetime level recommended as safe for these chemicals by the EPA.
Based on studies performed in Egypt by Accuchem Laboratories, Dr. John Lasiter reported that a population of women exposed to xenobiotics had, surprisingly, the lowest levels of these chemicals in their blood. Upon further investigation, it was determined that these women had breast fed their babies, and the more babies mothers had breast fed, the lower the xenobiotic level in the mothers. Breast milk had thus become a route of excretion of toxic chemicals from the nursing mothers. The mothers were being detoxified, but the chemicals were going into the mouths of their babies.
Knowing that breast milk is so contaminated raises the question: Is it still safe to breast feed our babies? The American Academy of Pediatrics has recently recommended that mothers breast feed for one year, up from the previous recommendation of breast feeding for the first six months of a baby’s life. While we could normally whole-heartedly recommend breast feeding, now, unfortunately, we need to think about this as a source of toxic chemicals for our children. Analysis of breast milk can be readily obtained for any nursing mother and may be advisable.
Another featured speaker at the conference, Dr. William Rea of Dallas presented data, published in the Journal of Nutrition and Environmental Medicine, demonstrating that when patients are challenged or exposed to toxic chemicals at common ambient levels, they have physiologic effects equal to the effects of drugs and hormones. Whereas it is accepted that small doses of drugs and hormones have profound effects on the body, it is also true, but not readily accepted, that synthetic chemicals can also cause overt signs and symptoms at seemingly low levels. Although the levels of exposures to chemicals are low, they are equal to the physiologically active doses at which drugs are often prescribed.
In summation, many of the disease processes and unusual syndromes we physicians are seeing in our offices, in patients from infancy to old age, appear to be the result of our patients’ increasing exposure to toxic chemicals. The impact of these chemicals, especially the estrogen mimics which we call xenoestrogens, is profound and is threatening the health, welfare, and even survivability of the human race. It was the opinion of many of the speakers that biodetoxification may need to play a greater role in both prevention and treatment of disease for many of our patients.
If you are a nursing mother and wish to obtain an analysis of your breast milk from our Center, please see our Website section titled New Patient Information.
Organophosphate Pesticide Exposure
Dr. Goran Jamal of Glasgow presented a most important paper on Organophosphate pesticide exposure.
Most physicians recognize only the existence of acute Organophosphate Pesticide Poisoning (OPP) and believe that once the immediate exposure is removed, the injury subsides.
There are, however, three other recognized major manifestations of toxicity: an intermediate syndrome, a delayed syndrome, and a long term delayed neuropsychological disorder.
The Center for Occupational and Environmental Medicine has had great interest in the effects of OPP poisoning and has long concurred with Dr. Jamal’s review that people suffer very prolonged effects of exposure that are often disabling them for life. These compounds are profoundly neurotoxic which means they have serious effects on the brain and nervous system.
We have treated several OPP injured patients in our Biodetoxification Program with very encouraging results.
Low Level Carbon Monoxide Poisoning Association with Fatigue and Fibromyalgia
Another interesting paper was that of Debbie Davies and Sue Jaffer who stated that many cases of chronic carbon monoxide poisoning are missed because of the failure of physicians to consider this diagnosis when seeing patients manifesting chronic fatigue and fibromyalgia.
One of the most common symptoms of chronic low level carbon monoxide exposure is severe muscle pain or a flu like illness associated with memory loss, headaches, and dizziness.
A study of 77 cases of diagnosed chronic carbon monoxide poisoning revealed that the average length of exposure was four years. On average, symptoms of headaches and dizziness were experienced for nearly two years prior to carbon monoxide being identified as the problem. These symptoms continued to persist for two to three years or more after exposure ceased. Memory loss actually increased after exposure ceased. Pain was the most prominent symptom and the most persistent after exposure.
Failure to consider the diagnosis of carbon monoxide poisoning was the greatest error made by most physicians.
Gulf War Research on Illness Induced by Chemical Toxicity and Biologic Exposures
Related to the above paper, the Nicholsons presented their research on Gulf War illnesses. They believe that chemical toxicity and biologic exposures combined to produce these illnesses. It has now been documented that both chemical and biological warfare were used in the Gulf War.
The Nicholsons believe the biological organisms involved were Mycoplasmas, especially Mycoplasma fermentans, an intracellular bacteria. The Nicholsons stated that this particular organism was isolated by the Nazis in their biologic warfare program during World War II. At the end of that war, several Nazi scientists were brought to the United States by the CIA, but their story has never been released. President Clinton has signed into law an order requiring the CIA to release all information concerning these activities.
The presence of this organism in infected individuals is difficult to pinpoint. The organism can only be identified by forensic PCR and gene tracking. Further complicating the diagnosis process, false positive HIV tests are related to this organism because, like the HIV organism, it exhibits the GP 120 envelope.
There is a significant overlap between the symptoms of Gulf War illness and CFIDS/fibromyalgia. In patients diagnosed with CFIDS, the incidence of Mycoplasma fermentans has been found to exceed 70 percent. Gulf War veterans and their families show approximately a 40 percent incidence of Mycoplasma fermentans, which is about the same incidence rate as found in patients diagnosed with rheumatoid arthritis.
For treatment of Gulf War illness, CFIDS, and fibromyalgia syndromes, the Nicholsons have advocated the use of specific antibiotics, specifically Doxicycline (200 mg/day) or Biaxin or Azithromycin (500 mg/day) for 6 months. The positive improvement seen with this protocol has further convinced them of their correctness as to the cause of these illnesses.
Here again we see exemplified one of the basic principles of Environmental Medicine: the concept of the total stress load resulting in increased susceptibility to infection and illness.
Reference: Nicholson GL, Nasralla M, Haier J, Nicholson NL. Treatment of systemic mycoplasmal infection in Gulf War illness, chronic fatigue and fibromyalgia syndromes.
Chronic Fatigue Syndrome and Toxic Chemical Exposure
Dr. Dunstan of Australia presented an interesting paper on the relationship of toxic chemical exposures to infection – specifically asking if toxicity was related to CFIDS (Chronic Fatigue Immune Dysfunction Syndrome). He pointed out that one year after DDT was introduced into the United States in 1945, the rate of polio doubled. Similarly, in 1950, when Israel introduced the use of DDT, the rate of polio increased in their country from two cases per month to 150 per month.
Laboratory studies of CFIDS patients confirm a significant increase of organochlorine pesticides, especially hexachlorobenzene in their tissues.
These findings are in agreement with our total experience that susceptibility to infection is increased whenever the body’s total stress load is increased and this includes the total body burden of toxic chemicals.
Reference: Dunstan RH, McGregor NR, Roberts TK, Butt H. Biochemical and microbiological anomalies in chronic fatigue syndrome: the development of laboratory based tests and the possible role of toxic chemicals.
Biochemical Abnormalities of Autism
The biochemical abnormalities of autism were brilliantly presented by Rosemary Waring. She emphasized the complex manifestations of autism which include not only the altered behavior, but also:
- Altered gastrointestinal tract function and gut permeability
- Decreased appetite control
- Immune system dysfunction (increased susceptibility to infection)
- Idiosyncratic reactions to drugs and altered catecholamine and neurotransmitter levels (dopamine/noradrenalin and serotonin), with increased dopamine being responsible for stereotypic movements and behavior
She explained that markedly low levels of sulfates are found in children with autism, as low as one-eighth of normal levels. There seems to be many factors causing these low sulfate levels, such as:
- A deficiency of sulfotransferase enzyme, the essential enzyme in sulfation
- Poor oxidation of cysteine to sulfates
- Poor absorption of inorganic sulfates (only 5-15 percent) because of altered gut permeability
- Increased excretion of sulfates by the kidneys
The low sulfate levels, in turn, perpetuate the abnormalities. Sulfates are necessary for maintenance of the slipperiness of gut mucins, which support proper gut permeability. Sulfates are also cofactors in certain hormones such as cholecystokinin (the sulfate molecule activates the tyrosine in the peptide chain). This may be the key to understanding the role of secretin, which when given to autistic children has resulted in marked improvement. (The Center for Occupational & Environmental Medicine is actively studying the effect of secretin for treatment of autism).
Interestingly, sulfotransferase, the essential enzyme in sulfation, is also inhibited by several foods that have incidentally been recognized as migraine inducing foods. These foods include: amine-containing foods (cheese, chocolate, banana), citrus (especially orange), cranberries, pumpkin, radish, spinach, and peppers. Gluten and casein are also involved. Understanding at least one of the mechanisms of food sensitivity involved in autism helps explain the food-sensitive profile so often seen in autistic children.
Reference: Waring RH. The biochemical basis of autism.
Role of Food Sensitivities in Asthma and Inflammatory Bowel Disorders
Michael Radcliff and other speakers emphasized the importance of food in unexplained illness. 50-60% of brittle asthmatics will improve when their food sensitivities are addressed. Pediatric asthma is an epidemic occurring in one in four to one in seven children. However, breast feeding for a minimum of 15 weeks and not introducing solid foods before this time can reduce its occurrence.
Double blind food challenge studies have shown beyond doubt that idiosyncratic food reactions can provoke a wide range of symptoms in patients suffering from a wide variety of illnesses.
Also supporting the important role of food was a paper by Elaine Gottschall. She has developed a low disaccharide diet for treatment and elimination of chronic inflammatory bowel diseases, including Crohn’s disease, ulcerative colitis, and celiac disease. This diet eliminates not only glutens, but most starches with a high disaccharide content, such as all cereal grains (including corn, rice, etc.), potatoes, soybeans, and many others. The specifics of this diet are explained in her newly revised book. [We have recently made this book available to our patients at COEM.]
The Center for Occupational and Environmental Medicine has used a similar protocol for many years and has found food to be a major critical factor in these diseases.
Reference: Radcliffe M. Unexplained illness: the role of the reproducible idiosyncratic food reaction.
There is a growing concern over latex sensitivity. Latex is very strongly allergenic and is nearly everywhere. It is estimated to occur in 20,000 substances, with exposure beginning at the time of birth, from contact with the latex rubber gloves worn by medical personnel. There are three major clinical manifestations of allergic reaction to latex: local skin irritation, a delayed contact dermatitis, and classical atopic or allergic disease including life-threatening anaphylaxis.
Associated with latex sensitivity is the Latex Fruit Syndrome. Here we have an example of the principle of Concomitancy, whereby diverse substances may share a similar molecular pattern and exhibit cross-reactivity. Some fruits have components which are molecular mimics of latex and provoke similar reactions in latex-sensitive individuals. Avocado, banana, kiwi, chestnuts, melon, and walnuts all cross-react with latex.
For latex-sensitive individuals, avoidance of latex and the above concomitant fruits is critical.
Neutralization does appear helpful, and the Center for Occupational and Environmental Medicine has been studying neutralization in this area.
Reference: Frankland AW. Editorial Latex Allergy. Clin Exp Allergy 1995;25:199-201
Attention Deficit Hyperactivity Disorder Conference
Dr. Lieberman’s note: The following is my report on a meeting I attended that was sponsored by Georgetown University, the International Center for Interdisciplinary Studies of Immunology, and the International Health Foundation. It is regrettable that although these findings were reported nearly a decade ago (in 1999), very few doctors or parents today understand that there really are effective alternatives to drugs for children with ADHD.
This meeting was a breath of fresh air as leaders were chosen for their ability to present new and old, yet more unaccepted, ideas on the causes of this ever-growing problem seen in children. In California the data shows a greater than 2000% increase in ADHD. This figure stresses the importance of this problem. Although genetics play an important role in the cause of ADHD, environmental factors are also important in its expression and it’s here that I was especially interested.
One very important paper was that of Drs. Bellanti and Sabri who showed that the presence of patches of lymphoid hyperplasia in the ileum or small bowel of these children was identical to that reported by Andrew Wakefield of England in children with Autism. Dr. Sabri said it mirrored that of Crohn’s Disease or inflammation disease of bowel.
Their studies showed also a decrease in the cytokines IL-2 and interferon gamma. The importance here was that this set the immune system up for T-Helper 1 cytokine deficiency pattern also seen in celiac disease and food allergy of non-IgE origin. All of their children had ADHD.
What researchers are finding and reporting in 1999 only supports what older physicians and members of the American Academy of Environmental Medicine have been saying for years — food sensitivity is a major factor in the behavior and learning of not only children but adults as well. Billy Crook, one of the co-sponsors of the meeting and author of several books on the role of yeast in the cause of behavior and learning problems, was finally vindicated.
The mechanism for all this does appear to come from the massive use of antibiotics in early childhood, which alters the normal bacterial flora and allows for a super abundance of yeast and pathogenic bacteria to predominate. This dysbiosis or floral imbalance creates increased permeability of the gut allowing food in larger and more allergy-provoking form to enter the blood stream.
An incidental, though pertinent, paper was sited by Wickens, K., Clinical Experience in Allergy 1999; 29:766-771 showing that the greater the number of antibiotics given in the first year of life, the greater the risk ratio for onset of asthma and hay fever later in life. What is becoming much more obvious though certainly not expected is the overt relationship between the gut and the brain. The pieces of the puzzle now fall together and explain what was obvious to physicians of open minds — food sensitivities can alter brain function, affecting thinking, perception, mood, and behavior. Those foods that were most frequently eaten were also the ones causing adverse reactions. These included milk, wheat, corn, cane sugar, etc. Randolph taught years ago that food addiction was food allergy and vice versa. Additives, also, are more commonly associated with adverse reactions.
Michael Jacob Ph.D. presented his paper on food, food additives and behavior recommending that parents consider dietary changes (along with behavior therapy) as the first treatment for children with behavior problems, before turning to drugs. We here at the Center for Occupational & Environmental Medicine strongly agree because in our experience food has always been the most common cause of adverse reactions, though certainly not the only factor.
The presentation by Steven Schoenthaler added more fuel to the fire in demonstrating the role of inadequate nutrition on behavior. His studies were done on inmates of prisons and juvenile delinquency programs. When fresh fruits, vegetables and supplementary vitamins and minerals were added to diets of the prisons there was significant reduction in bad behavior. Of interest also was an increase of 16 points in I.Q. on average in this population.
Marvin Boris presented a short but important review of the literature on: Food and Chemical Intolerance – Placebo controlled studies in ADD. He pointed out that despite many scientific articles showing a clear relationship between the Attention Deficit Disorders with foods, artificial colors and additives, many professional health organizations have denied the existence of any association. He cited 26 references which are included here as a useful reference. In 7 controlled studies (19-26) results were positive. Blinded challenges, crossover protocols were highly statistically significant in over 390 children with ADD.
It was good to hear our friend Nicholas Ashford of M.I.T. review the importance of toxic chemical exposures, especially low level exposures to adverse biological effects including endocrine disruption, chemical sensitivity and cancer. There is hardly a day that we don’t observe the effects of low dose chemical exposure in patients that we see at our Center.
The presentation by John Wargo on childhood exposure to pesticides affecting the nervous system only re-enforced what our Center has been saying for years. The Government has allowed 8627 additives to our food, with 1800 pesticides and inert ingredients to remain as residues within the nation’s food supply. Wargo stressed the vulnerability of a fetus and growing children to these chemicals. People interested in learning more can read his book: J. Wargo, Our Children’s Toxic Legacy: How Science And Law Fail To Protect Us From Pesticides. Yale University Press 2nd edition.
Theo Colborn then spoke on effects of chemicals but especially of organochlorines. She makes the comment that, ” …everyone will have more than 500 measurable chemicals in his or her body, many of which will be organochlorines”. She was especially alarmed at the finding that biologists cannot find a top predator fish in the Great Lakes that does not have enlarged thyroid glands and abnormal ratios of T4, T3 and TSH. She paralleled the poisoning of the thyroid in fish with that of a developing fetus. The brain’s development is dependent on thyroid hormone as is the ear’s cochlea. Without the hormone, low frequency hearing loss occurs along with motor incoordination. The interference from organochlorines polluting our environment, she warned, was interfering with the fetus and child’s development. Ironically, she was basing her warning on animal models. However, PCBs have been reported to injure the brains of babies born to mothers exposed to PCBs.
Colborn concluded with, “… it’s time to practice prevention and focus more on the development of our children while they are in the womb, keeping in mind that damage to the brain during development is irreversible, intractable, and untreatable.” Readers wishing to learn more about Colborn’s research may want to read her book Our Stolen Future.
The “piece de resistance” of the two and a half day meeting, for me, was hearing my old friends and teachers Drs. Sidney Baker and Bill Crook. Dr. Baker had the ability to make the most complicated subject understandable and he did it again with his talk – ADHD in the Nosologic Tree: A clinician’s view from the end of the limb. I often quote Dr. Sidney with his simple paradigm that most patients may have a need for something (a deficiency) or a need to avoid something (an allergic or toxic substance or an infectious disorder).
To sum up his experience, which is certainly similar to mine, he concludes that the most common biomedical solutions to the ADHD problem are:
- avoidance of delayed reaction food allergens.
- treatment of fungal overgrowth consequent to use of antibacterial agents, and
- correction of deficiencies or special needs for magnesium and essential fatty acids.
The highlight of the meeting was the standing ovation given to 82 year old Dr. Billy Crook , author and teacher, who over the last 15 years pushed the hypothesis that yeast secondary to antibiotic use was at the heart of so many health problems, including ADHD. It took many sophisticated lab tests that we can now do to finally vindicate this great clinician. I was very happy to have attended and participated from the floor of this outstanding conference.
The establishment of the Center for Occupational & Environmental Medicine grew out of my years of experience treating ADHD children. I saw a need for a different approach than the established use of stimulant drugs. This led me to the American Academy of Environmental Medicine and the teachings of Dr. Billy Crook, Dr. Joseph Miller, Dr. Theron Randolph, Dr. Doris Rapp, and the many others who taught me the basics of allergy, nutrition and toxicology. At the Center for Occupational & Environmental Medicine, we have been able to effectively treat many children with these disorders, but instead of using stimulant medication, we identify and treat the cause.
Summary of the Fifth International Meeting of the British Society of Allergy, Environmental Medicine and Nutrition, Sustainable Medicine
Oxford University, England, Sept 7-10, 1998.