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Supporting references for DetoxificationAlthough we do not agree with all the statements contained in the following references, these citations do indicate that serious and informed clinicians subscribe to detoxification as a viable adjunct in approaching cancer. Ralph Moss, Ph.D. is one of the most respected researchers on the Cancer Industry in general. The following article captures well the issues surrounding the use of coffee enemas. Be sure to visit Dr. Moss's website at http://www.cancerdecisions.com/ http://swiftweb.com/ha/enema.html From The Cancer Chronicles #6 and #7 Ralph W.
Moss, Ph.D. is the author of eight books
and three documentaries on cancer-related topics. He is an advisor on
alternative cancer treatments to the National Institutes of Health,
Columbia University, and the University of Texas. He researches and writes
individualized Healing Choices reports for people with cancer. For
information on Healing Choices, you can contact coordinator Anne Beattie
in the following ways:
Dr Nicholas Gonzales is conducting a clinical trial funded by the National Cancer Institute. Dr. Gonzales utilizes coffee enemas as a part of his program. Read the interview with Dr. Gonzales at the following link: http://www.dr-gonzalez.com/clinical_pearls.htm
...The use of coffee in enemas for detoxification purposes has been a well known and used practice for many years. There is no better stimulant for bile production and its subsequent flushing out than coffee. This is due to a number of pharmacologically acting substances in the coffee. The combination of theobromine, theophylline and caffeine stimulates the relaxation of smooth muscles causing dilatation of blood vessels and bile ducts. Hence bile flow is increased. Also increased are the number of toxins which are conjugated in the bile. This is due to the activity of other substances in the coffee, the palmitates, which activate the enzyme system, glutathione-S-transferase, seven-fold. This enzyme system, which is selenium-dependent, is responsible for grabbing toxins, free-radicals and bilirubin (breakdown product of red blood cells) and delivering them to the bile where they are carried out in the bile acids. The mopping up of free-radicals effectively inhibits the formation of carcinogens and therefore this enzyme performs a protective role against cancer... Read the entire article here: http://www.getalife.on.net/ENEMA2.htm The following excerpt is from Hospital Practice Magazine:http://www.hosppract.com/cc/1999/cc9908.htm#10 This article demonstrates
the physiological effect of certain components of coffee. Coffee for
Gallstones In
an attempt to correct these limitations, Harvard University
epidemiologists analyzed the data of the Health Professionals Follow-Up
Study, in which the participants were 46,008 men, aged 40 to 75 years and
without a history of gallstone disease as of 1986. At baseline and during
the ensuing decade, the subjects' intake of coffee and other caffeinated
drinks was assessed three times. Newly symptomatic gallstone disease was
diagnosed by ultrasonography, x-ray, or cholecystectomy. Of 1,081 subjects
in whom symptomatic gallstone disease developed, 885 required
cholecystectomy. The adjusted relative risk for those who consistently
drank two to three cups of regular coffee per day was 0.6. For those who
drank four or more, it was 0.55. All coffee brewing methods showed
decreased risk. The risk of symptomatic gallstone disease also declined
with increasing caffeine intake (p=.005). In contrast, decaffeinated
coffee was not associated with decreased risk.
Leitzmann MF et al: A
prospective study of coffee consumption and the risk of symptomatic
gallstone disease in men. JAMA 281:2106, 1999 COMMENT: Finally, some evidence of a concrete health benefit for coffee lovers, who have long been willing to trade its alleged--and mostly unsubstantiated--evils for its blessed boost to alertness and efficiency through a long day, and often night. But let's see the data for the fair, fat, and forty opposite sex. While we certainly do not agree with much of L. Ron Hubbards teachings, the following contains documented references to certain detoxification procedures. A Review of
Scientific Literature Supporting the Table of Contents I. Contamination with Synthetic Chemicals II. Reduction of Bioaccumulated Compounds III. The Detoxification Program Developed by L. Ron Hubbard A. Exercise Niacin D. Sufficient liquids to offset the loss of body fluids through
sweating IV. Studies Regarding the Detoxification Program A. Safety of the Program V. Summary References I. Contamination with Synthetic Chemicals Human exposure to toxic chemicals has dramatically increased in the last century. Millions of compounds have been formulated and some 50,000 are now in commercial use. The environmental persistence of many of these compounds is cause for concern. In addition, many of these synthetic compounds accumulate in biological organisms ("bioaccumulation"), storing in bone, fat, or another compartment of the body. Hundreds of these compounds are found in U.S. citizens, with many present in each of us (1). In addition to commercial compounds, many drugs -- both pharmaceutical and so-called recreational -- can remain in the body for an extended time. Drugs such as LSD (2, 3), PCP (4), cocaine (5), marijuana (6) and diazepam (7) are found in fat. These drugs can be retained for extended periods, especially under conditions of chronic use (5,8-11). Adverse health effects have been shown for some of these compounds. Health effects from most compounds have not, however, been studied in detail. Further, the health effects from combinations of chemicals are unknown. It is clearly preferable to have low levels of foreign compounds rather than high. II. Reduction of Bioaccumulated Compounds While we still do not fully understand the bio-active mechanisms or the kinetics of many toxic substances, physicians have known for centuries that health problems can ensue as a result of accumulations of xenobiotics (foreign chemicals) and have looked for ways to safely and effectively reduce body burdens. Ramazzini, in his 1713 work, Diseases of Workers, notes that writers of works on poisons at that time "advise, in general, remedies that have the power of setting the spirits and blood mass in motion and of provoking sweat" (12), a recommendation which aligns well with current knowledge of the kinetics and metabolism of foreign compounds. Approaches to handling bioaccumulation of harmful chemicals depend on increasing the rate of removal of these compounds. This is accomplished by either altering the compound to a non-toxic form or by enhancing the rate of elimination. This philosophy has been applied in many ways. In acute poisoning, purging is a key means of removing the toxic compound before adverse effects arise. For this reason, a strong purgative is included in the highly toxic pesticide, paraquat. Ingestion of compounds known to bind to the contaminating compound has been used in some cases. This increases the rate of removal of the toxic compound because it cannot be reabsorbed as it passes through the intestine. In this manner, cholestyramine was successfully used to reduce levels of Kepone (13), and Prussian blue was used to reduce levels of radioactive Cesium (14). A fasting technique has been used to enhance the mobilization of fat-stored compounds. This approach resulted in improved symptoms in 16 PCB-exposed Taiwanese patients (15), although the levels of PCBs in the blood of these patients increased. Ethylenediaminetetraacetate (EDTA) has been used for many years in the treatment of lead toxicity. EDTA binds to lead and other compounds in the blood, the resultant complex then being eliminated. (16,17) Reduction of fat-stored chemicals must be aimed at mobilizing chemicals from fat stores, distributing the mobilized chemical to routes of elimination, and increasing the rate at which these routes are utilized. This is the design behind the detoxification procedure developed by Hubbard. III. The Detoxification Program Developed by L. Ron Hubbard This program was designed to mobilize and enhance the elimination of fat-stored xenobiotics. The Hubbard program was specifically developed to reduce levels of drug residues but has proven to be applicable to the reduction of other fat-stored compounds. The program has gained widespread support due to its effectiveness and the fact that it is well supported by the medical literature. Each component of the program is in alignment with current research on the mobilization of fat stores and the facilitation of toxin elimination. The components of this program are: A. Exercise: Fat is stored throughout the body, with significant deposits not only in adipose tissue but in cellular reserves, membranes, etc. Exercise is aimed at both promoting deep circulation in the tissues and enhancing the turnover of fats. Numerous studies have shown that exercise promotes the circulation of blood to tissues (18) and also promotes mobilization of lipid from storage depots (19-24). Mobilization of fat stores is accompanied by mobilization of the toxins stored in the fatty tissue (25-27). B. Sauna: Mobilization of chemicals is not desirable if routes of elimination are not enhanced. Chemicals are excreted through many routes including feces, urine, sweat, sebum, and lung vapor. The purposes of the sauna aspect of this program are two-fold. Heat stress is a means of increasing circulation (28) and of enhancing the elimination of compounds through both sweat and sebum. It is documented that methadone (29), amphetamines (30), methamphetamines and morphine (31), copper (32), mercury (33), additional metals (34) and other compounds appear in human sweat. Enhancement of this elimination route is a key purpose of the sauna aspect of this program. In addition to an increase in sweat production, increased body temperature results in heightened production of sebum, the material produced by the skin's sebaceous glands (35). In patients exhibiting "chloracne", a specific skin disorder caused by chemical exposure, the causative compounds may be detected both in adipose tissue and in sebum of the skin (36). Though not a major route of elimination for polychlorinated biphenyls (PCBs), PCBs may be found in sebum of exposed individuals (37). Both the concentration of PCBs and the quantity of sebum produced have been shown to increase during the detoxification program developed by Hubbard (38). C. Supplements: Niacin Effects of specific vitamins are utilized as well. Niacin has a long-term effect of reducing the mobilization of fatty acids (39). However, the initial reduction in mobilized fatty acids following a single dose is followed by a transitory increase in free fatty acid mobilization (40,41). Mobilization of free fatty acids by other mechanisms has been shown to result in concurrent mobilization of the fat-stored chemicals (26,27). This also appears to occur during this detoxification program. The increased turnover of fat results in mobilization of fat-stored chemicals and the opportunity to eliminate them from the body. Polyunsaturated Oils One means of excretion of chemicals is through the bile. However, such bile excretion results in elevated levels of chemicals in the intestine, providing an opportunity for reabsorption of these compounds (42,43). It has been known for many years that addition of unsaturated oils to the diet can increase the excretion rate of certain compounds. This is due either to blocking the reabsorption of the chemical or to altering the rate at which the compound is excreted (45). Supplementation with unsaturated fats also affects the content of the stored adipose tissue (45). Apparently, as the stored fats are mobilized and re-stored, the dietary supplements replace some of the mobilized fats so that an exchange is effected. Vitamin Supplementation Vitamin and mineral supplementation is included for several reasons. Replacement of vitamins and minerals lost through sweating is one reason. Correction of any deficiencies is necessary as well. Extensive sweating is a component of this program. As significant levels of vitamins and minerals appear in sweat, their loss through sweating could create deficiencies were they not replaced. Deficiencies may already be present. Specific vitamin, mineral and amino acid deficiencies are known consequences of alcohol and drug abuse, due either to poor nutrition or to the action of the drugs themselves (46-48). PCB poisoning in animals has been shown to result in a significant decrease of vitamin A in the liver and serum (49,50). Further, research in animals has demonstrated that vitamin deficiencies retard the metabolism of drugs (51). Changes in nutrient levels, with consequent adverse effects on metabolism, may occur with other chemicals as well. Supplementation with vitamins is anticipated to assist the individual in several ways. Such supplementation will certainly assist in correction of nutritional deficiencies. It might also be expected to aid in the metabolism of chemicals. D. Sufficient liquids to offset the loss of body fluids through sweating: This is a logical necessity during any extended period of sweating. In addition to liquid supplementation, sodium, potassium, calcium-magnesium solution and cell salts are taken on an individual basis. Patients undergoing this detoxification program are monitored to ensure signs of heat exhaustion or salt depletion do not appear. E. Regular diet supplemented with plenty of fresh vegetables: This program is not a dietary program. The only change in diet required by patients on this program is that they eat plenty of fresh vegetables. This ensures that bowel movements remain regular. F. A properly ordered personal schedule which provides the person with the normally required amount of sleep: The detoxification program is intensive. The mobilization and elimination of stored chemicals can put a stress on the individual's body. Therefore, it is imperative that individuals ensure that they are well-rested during the program. IV. Studies Regarding the Detoxification Program Developed by L. Ron Hubbard A. Safety of the Program An initial study of 103 individuals demonstrated the safety of this program. Medical complications associated with the program occurred in less than 3% of the individuals and were minor in nature. There was one case of pneumonia, one of ear infection, and one case of diarrhea during the approximately 3 weeks of program delivery. Reductions in blood pressure and cholesterol were benefits of the program. The program also resulted in improvements in psychological test scores. (52) This program is designed to mobilize and eliminate fat-stored chemicals. During any such program in which xenobiotics are deliberately mobilized from fat stores, it is important that elimination keep pace with this mobilization process. Otherwise it is possible that mobilization will result in heightened blood concentrations of the mobilized compounds. Blood levels of chemicals were monitored in a study of electrical workers conducted by Schnare & Robinson (53). They showed that blood levels of both PCBs and pesticides were fairly consistent over the course of treatment. Thus, elimination of compounds appeared to keep pace with their mobilization during this study. B. Results of Detoxification The detoxification method developed by Hubbard has been shown to reduce levels of several fat-stored chemicals. Studies of this method have focused on individuals who have accumulated fat-soluble compounds through either occupational or environmental exposure. In 1983, Roehm reported reductions in DDE and PCBs and clearing of symptoms in a Vietnam vet with a range of symptoms (54). A 1984 study demonstrated statistically significant reductions of from 10.1 to 65.9 percent for sixteen fat-stored compounds. The compounds tested included polychlorinated biphenyls (PCBs), polybrominated biphenyls (PBBs) and chlorinated pesticides. The study population had been specifically exposed to PBBs approximately 10 years prior to treatment. Reductions in PBBs were 58.7 percent (p<0.O5) when treated with the Hubbard method. (55) According to independent evaluation, the chemical levels for PBBs had not reduced during the five years prior to treatment (56). In a controlled study, electrical workers exposed to hexachlorobenzene (HCB), PCBs and other compounds, were treated with the Hubbard method. Statistically significant reductions of 30% for HCB and 16% for PCBs were observed. These reductions were stable at follow-up observations 3 months subsequent to treatment (53). Further documentation of PCB reduction was reported in the case of a female factory worker from Yugoslavia. Her excessive PCB levels (102 mg/Kg in adipose and 512 ug/L in serum approximately 50 times higher than the general population) were reduced by 63% in adipose and 49% in serum following treatment. In addition, a spontaneous breast discharge containing PCBs ceased during treatment. This woman's symptoms also improved over the course of treatment. (38) Improvements in this woman led to a controlled study of a group of male co-workers. Again, reductions in PCB levels were observed and improvements in symptoms noted for the group treated with the Hubbard method. (57,58) As the number of toxic chemicals in the workplace increases, it is sometimes difficult to identify the exact nature of a toxicant. Such was the case for a woman exposed to both the residues trapped in filters from the exhaust stacks of an oil-fired electrical generator and the contaminated water used to clean these filters. She became ill following 6 months of such exposure and was unable to work. During treatment with the Hubbard method a black substance began oozing from her pores. This abated late in treatment. Both her objective and subjective complaints were reduced following treatment and she was able to return to work. (59) Firefighters are often exposed to toxic compounds in the course of their work. Such was the case for a group of firefighters responding to a fire involving transformers filled with PCBs. Several of these men became ill following the fire. Neurophysiological and neuro-psychological tests were conducted on 14 of these firefighters 6 months after the fire. This battery of 22 tests demonstrated that the firefighters who had been involved with the fire were significantly impaired in both memory and cognitive functions when compared to coworkers from the same department who had not participated in fighting this fire. (Scores for 13 of the 22 tests were significantly worse in the exposed firefighters.) Following treatment with the detoxification method developed by Hubbard, significant improvements in 6 of the 13 tests originally showing impairment were noted. (60) These firefighters were also tested for peripheral nerve damage. Five of the seventeen firefighters tested showed significant peripheral neuropathy. All showed improvement following treatment with the Hubbard method, with two of the five returning to normal range. (61) Many people have experienced adverse health effects after exposure to compounds whose identity is unknown. The detoxification program has been shown effective in alleviating symptoms in such patients. In one study, the selected patient population reported symptom profiles prior to treatment that were in alignment with chemically exposed individuals reported by other authors (not statistically different). Following treatment, their symptom profiles had improved significantly and were now not significantly different from a healthy population. (62) V. Summary This body of peer-reviewed literature substantiates the effectiveness of the Hubbard program in reducing levels of foreign compounds stored in fat and in improving the symptom profiles of chemically exposed individuals. Health benefits of this program are not limited to symptomatic improvements. In the case of documented impairments in neurological function, these impairments were shown by two independent approaches to be significantly improved by detoxification treatment. This program has proven to be a safe and effective addition to clinical practice. As the quantity and variety of chemicals employed in our society increase, it can be expected that this program will become increasingly relevant. REFERENCES 1. Stanley JS (1986) Broad Scan Analysis of Human Adipose Tissue; Volume 1: Executive Summary EPA 560/5-86-035. 2. Axelrod J, Brady RO, Witkop B and Evarts EV (1957) The distribution and metabolism of lysergic acid diethylamide. Ann NY Acad Sci 66:435-444. 3. Stolman A (1974) The absorption, distribution, and excretion of drugs and poisons and their metabolites. ln:.Progress in Chem Tox, Vol. 5, A Stolman, ed., Academic Press, pp 1-99. 4. James SH and Schnoll SH (1976) Phencyclidine: Tissue distribution in the rat. Clin Tox 9:573-582. 5. Nayak PK, Misra AL and Mule SJ (1976) Physiological disposition and biotransformation of [3H]cocaine in acutely and chronically treated rats. J Pharmacol & Exper Ther 196:556-569. 6. Rodger L Foltz, Ph.D., Personal communication. 7. Friedman H, Ochs HR. Greenblatt DJ and Shader RI (1985) Tissue distribution of diazepam and its metabolite desmethyldiazepam: A human autopsy study. J Clin Pharmacol 25:613-615. 8. Dackis CA, Pottash ALC, Annitto W and Gold MS (1982) Persistence of urinary marijuana levels after supervised abstinence. Am J Psychiatry.139:1196-1198. 9. Martin BR (1982) Long-term disposition of phencyclidine In mice. Drug Metabolism and Disposition 10:189-193. 10. Weiss RD (1988) Protracted elimination of cocaine metabolites In long-term, high-dose cocaine abusers. Amer J Med 85:879-880. 11 Cone EJ and Weddington Jr. WW (1989) Prolonged occurrence of cocaine in human saliva and urine after chronic use. J Analytical Toxicol 13:65-68. 12. Ramazzini, B (1713) Diseases of Workers, New York Academy of Medicine, History of Medicine Series, Vol. 23, Hafner Publishing Co., New York, 1964. 13. Guzelian PS (1982) Chlordecone poisoning: A case study in approaches of detoxification of humans exposed to environmental chemicals. Drug Metab Reviews 13:663-679. 14. Ricks A et al. (1989) The Radiological Accident In Golania, Unipub Publications, Lanham, MD. (Reported by Hixson JR in Medical Tribune, Thursday, September 22, 1988) 15. Imamura M, Tung T-C (1984) A trial of fasting cure for PCB poisoned patients in Taiwan. Am J Ind Med 5:147-153. 16. Chisolm Jr. JJ (1968) The use of chelating agents in the treatment of acute and chronic lead intoxication In childhood. J Pediatrics 73:1-38. 17. Wedeen RP, Batuman V and Landy E (1983) The safety of the EDTA lead-mobilization test. Env Research 30:58-62. 18. Bulow J (1983) Adipose tissue blood flow during exercise. Danish Medical Bulletin 30(2) :85-100. 19. Frledberg SJ, Harlan Jr. WR, Trout DL. Estes Jr. EH (1960) The effect of exercise on the concentration and turnover of plasma nonesterified fatty acids. J Clin Invest 39:215. 20. Carlson LA and Pernow B (1961) Studies on blood lipids during exercise. J Lab and Clin Med 58:673-681. 21. Friedberg SJ, Sher PB, Bogdonoff MD and Estes Jr. EH (1963) The dynamics of plasma free fatty acid metabolism during exercise. J Lipid Research 4:34-38. 22. Horstman D, Mendez J, Buskirk ER, Boileau R and Nicholas WS (1971) Lipid metabolism during heavy and moderate exercise. Med and Sci in Sports .3:18-23. 23. Taylor AW, Shoemann OW, Lovlin R and Lee S (1971) Plasma free fatty acid mobilizatlon with graded exercise. J Sports Med 11:234-240. 24. Wirth A. Schlierf G and Schetler G (1979) Physical activity and lipid metabolism. Klin Wochenshri 57:1195. 25. Findlay GM and de Freitas ASW (1971) DDT movement from adipocyte to muscle cell during lipid utilization. Nature 229:63. 26. de Freitas AS and Norstrom RJ (1974) Turnover and metabolism of polychlorinated biphenyls in relation to their chemical structure and the movement of lipids In the pigeon. Can J Physiol Pharmacal 52:1081-1094. 27. Mitjavila 5, Carrera G and Fernandez Y (1981) Il. Evaluation of the toxic risk of accumulated DOT in the rat: During fat mobilization. Arch Environ Contam Toxicol 10:471-481. 28. Seba DB (1990) Thermal chamber depuration: A perspective on man in the sauna. Clinical Ecology 7:1 -12. 29. Henderson OL and Wilson BK (1973) Excretion of methadone and metabolites in human sweat. Res Comm Chem Path & Pharmac 5:1-8. 30. Vree TB, Muskens ATJM, and Van Possum JM (1972) Excretion of amphetamines in human sweat. Arch Int Pharmacodyn 199:311-317. 31. Ishlyama I, Nagai T, Nagal T, Komuro E, Momose T and Akimori N (1979) The significance of drug analysis of sweat in respect to rapid screening for drug abuse. Z Rechtsmed 82:251-256. 32. Sunderman Jr. FW, Hohnadel DC, Evenson MA, Wannamaker BB and DahI DS (1974) Excretion of copper in sweat of patients with Wilson's disease during sauna bathing. Ann Clinic Lab Sci4:407. 33. Stopford W (1979) Industrial exposure to mercury. In: The biogeochemistry of mercury in the environment, Elsevier/North-Holland Biomedical Press, pp 367-397. 34. Hohnadel DC, Sunderman FW, Nechay MW and McNeely MD (1973) Atomic absorption spectrometry of nickel, copper, zinc, and lead in sweat collected from healthy subjects during sauna bathing. Clinical Chemistry 19:1288-1292. 35. Abe T, Mayuzumi J, Kikuchi, Arai S (1980) Seasonal variations In skin temperature, skin pH, evaporative water loss and skin surface lipid values on human skin. Chem Pharm Bull 28:387-392. 36. Kimbrough RD (1974) The toxicity of polychlorinated polycyclic compounds and related chemicals. CRC Critical Rev Toxicol 2:445-499. 37. Kimbrough RD (1980) Occupational exposure. In: Halogenated biphenvls. terphenyls, naphthalenes. dibenzodioxins and related products, Kimbrough RD, ed., Elsevier/North-Holland Biomedical Press, Amsterdam, pp 373-399. 38. Tretjak Z, Shields M and Beckmann SL (1990) PCB reduction and clinical improvement by detoxification: An unexploited approach? Human and Experimental Toxicology 9:235-244. 39. Carlson LA (1970) Nicotinic acid: its metabolism and its effects on plasma free fatty acids. In: Metabolic Effects of Nicotinic Acid and Its Derivatives, Gey KF and Carl-son LA, eds., Hans Huber, Switzerland, pp 157-165. 40. Carlson LA, Oro L and Ostman J (1968) Effect of a single dose of nicotinic acid on plasma lipids In patients with hyperlipoproteinemia. Acta med scand 183:457-465. 41. Nye ER and Buchanon B (1969) Short-term effect of nicotinic acid on plasma level and turnover of free fatty acids in sheep and man. J Lipid Research 10:193-196. 42. Smith RL (1973) Implications of Biliary Excretion (Chapter 8), In: The Excretory Function of Bile, Chapman and Hail, Ltd., London. 43. Parker RJ, Hirom PC and Miliburn P (1980) Enterohepatlc recycling of phenolphthalein,, morphine, lysergic acid diethylamide (LSD) and diphenylacetic acid In the rat. Hydrolysis of glucuronic acid conjugates in the gut lumen. Xenobiotica 10:689-703. 44. Moore RB, Anderson JT, Taylor HL, Keys A and Frantz ID (1968) Effect of dietary fat on the fecal excretion of cholesterol and its degradation products in man. J Clinical investigation 47:1517-1534. 45. Shepherd J, Stewart JM, Clark JG and Carr K (1980) Sequential changes In plasma lipoproteins and body fat composition during polyunsaturated fat feeding in man. Br J Nutr 44:265-271. 46. Bonjour JP (1980) Vitamins and Alcoholism. InternatJ Vit Nutr Res 50:215-230;307- 338; 51:166-177. 47. Russell AM (1980) Vitamin A and zinc metabolism in alcoholism. Am J Clin Nut 33:2741-2749. 48. Roe, DA (1984) Nutrient and drug interactions Nutrition RevIews 42:141 -1 54. 49. Innami S, Nakamura A, Miyazaki M, Nagayarna S and Nishide E (1977) Further studies on the reduction of vitamin A content in the livers of rats given polychlorinated biphenyls. J Nutr Sci Vitaminol 22:409-418 50 Kato N, Kato M, Kirnura T and Yoshida A (1978) Effect of dietary addition of PCB, DDT or HGT and dietary protein on vitamin A and cholesterol metabolism. Nutr Rep Int 18:437-445. 51. BrIn M and Roe 0 (1979) Drug-diet Interactions. J FIorida M A 66:424-428. 52. Schnare DW, Denk G, Shields M and Brunton S (1982) Evaluation of a detoxification regimen for fat stored xenobiotics. Med Hyp 9:265-282. 53. Schnare DW and Robinson PC (1986) Reduction of human body burdens of hexachlorobenzene and polychlorinated biphenyls. in Hexachlorobenzene: Proceedings of an International Symposium, CR Morris and JRP Cabral, eds., International Agency for Research on Cancer, Lyon, France, pp 597-603. 54. Roehm D (1983) Effects of a program of sauna baths and megavitamins on adipose DDE and POBs and on clearing of symptoms of Agent Orange (dioxin) toxicity. Clin Res 31(2):243a. 55. Schnare DW, Ben M and Shields MG (1984) Body burden reductions of PCBs, PBBs and chlorinated pesticides In human subjects. Ambio. 13:378-380. 56. Wolff MS, Anderson HA and Selikoff IJ (1982) Human tissue burdens of halogenated aromatic chemicals in Michigan. JAMA 247:2112-2116. 57, Tretjak Z. Beckmann S, Tretjak A and Gunnerson C (1989) Occupational, environmental, and public health in Semic: A case study of polychlorinated biphenyl (PCB) pollution. In Post-Audits of Environmental Programs & Projects, C Gunnerson, ed., ASCE, New York, NY, pp 57-72. 58. Tretjak 7, Root DE, Tretjak A, Slivnik R, Edmorndson E, Graves R and Beckmann SL (1990) Xenobiotic reduction and clinical improvements in capacitor workers: A feasible method. J Env Sci and Health, A25:731-751. 59. Root DE and Lionelli GT (1987) Excretion of a lipophilic toxicant through the sebaceous glands: A case report. J Toxicol - Cut & Ocular Toxicol 6:13-17. 60. Kilburn KH, Warsaw RH and Shields MG (1989) Neurobehavioral dysfunction in firemen exposed to polychlorinated biphenyls (PCBs): Possible Improvement after detoxification. Arch Env Health 44:345-350. 61. Shields M, Beckmann SL and Cassidy-Brinn G (1989) Improvement In perception of transcutaneous nerve stimulation following detoxification In firefighters exposed to PCBs, PCDDs and PCDFs. Clinical Ecology 6:47-50. 62. Root DE. Katzin OB. Schnare DW (1985) Diagnosis and treatment of patients presenting subclinical signs and symptoms of exposure to chemicals which bioaccumulate in human tissue. In: Proceedings of the National Conference on Hazardous Wastes and Environmental Emergencies, May 14-16. The following article is about multiple chemical sensitivity, but has good information on detoxification http://www.aehf.com/articles/treatment_options_mcs.html Treatment
Options in Multiple Chemical Sensitivity Source: This article was originally published in 1992 in Toxicology and Industrial Health, 8(4), 87-94. It is part of the Proceedings of the Multiple Chemical Sensitivity Workshop, Washington, D.C., of the Association of Occupations and Environmental Clinics (AOEC), with support from the Agency for Toxic Sensitivities and Disease Registry (ATSDR). Correspondence: Address all correspondence to Dr. Gerald H. Ross, Environmental Health Center-Dallas, 8345 Walnut Hill Lane, Suite 205, Dallas, TX 75231. Introduction Multiple chemical sensitivities (MCS), a condition that probably has been present for hundreds of years in various manifestations, is gaining increasing recognition in medicine (Hileman, 1991). At the same time, the prevalence of classical allergy like asthma and hay fever is growing, and paralleling this is an increase of symptoms that some patients exhibit from exposure to commonly-encountered chemical substances. Simply defined, MCS is a significant intolerance to low-dose components in the patient’s personal environment, which most other people tolerate quite well. Because of the complex nature of this condition, it is important to keep in mind the concept of total load or the total environment. This involves the complex interplay of genetic endowment, nutritional status, emotional stress, and exposure to foods, chemicals, microbes, inhalants, and even electromagnetic fields. How health is expressed is obviously a function of the cumulative effect of these factors on the patient. Treatment options for MCS center
around education, avoidance of allergens (including those in air, food,
water), environmental clean-up procedures, rotational diets, enhancement
of nutritional status, immunotherapy, immune stimulation, detoxification
where appropriate, and addressing the patient’s social and emotional
health. In addition, he emerging awareness remains that electromagnetic
fields may play a significant role in certain situations (Fitzgerald,
1990). It is vital to establish a relationship whereby patients feel that
physicians take their complaints (though perhaps myriad and long standing)
seriously and in an atmosphere of mutual respect and trust. Within such a
context, patients will more readily accept education about things they
potentially can do to help themselves. Treatment Surely the basis of treatment for
any allergic or sensitivity problem is to avoid the sensitizing agent.
This can be done whether the primary problem is in air, food, water, or
physical surroundings, and it may even apply to electromagnetic fields to
a certain extent. Avoidance Because MCS patients frequently have wide varieties of allergies or sensitivities, they usually benefit from programs that minimize their contact with potentially sensitizing substances. Glass-bottled spring water is frequently helpful because it is much purer and does not contain the chlorine, fluorine, and other contaminants usually found in domestic drinking water supplies. Unfortunately, water bottled in plastic containers may pick up the phthalate, solvents, or plasticizers used to manufacture the plastic itself (Kailin and Brooks, 1963); for this reason the author recommends water bottled in glass. One of the largest and best-recognized sources of contact we have with chemical contaminants is our food supply (Davies, 1986), which frequently contains pesticides and other chemical residues potentially harmful to everyone’s health, and especially to persons with chemical sensitivity. Consequently, MCS patients often do much better clinically by consuming organically grown, less chemically contaminated food products. Because of the massive incidence of indoor air pollution, which is often 100 times that of outdoor air (Nero, 1988; NRC, 1981), air-filtration devices that remove both particulate and chemical substances from breathable indoor air usually benefit MCS patients considerably. In addition, steps to minimize indoor pollution by removing carpeting and combustion products from the home (such as natural gas, heating oil, or wood-burning stoves) usually bring about substantial improvements as well (Barron, 1990; Drerup et al., 1990). Indoor air pollution is generally
lower in homes that have hardwood or tile floors, with natural wood rather
than fiber board, plywood, or other pressed-wood products that contain
substantial amounts of glues, solvents, and other chemicals (including
formaldehyde). The latter will offgas and contaminate indoor environments
for months or even years (Levin, 1989). Similarly, synthetic fabrics and
other materials made from petroleum will slowly offgas volatile organic
compounds (VOCs) and other chemical substances used in their manufacture,
thus adding to the total load of indoor pollution. These latter substances
frequently trigger symptoms and health deterioration in patients with MCS.
An intelligent program of minimizing this kind of exposure usually has
substantial therapeutic benefit for these patients. Nutrition Shandra (1980), a widely recognized international nutrition expert, has called undernutrition the most frequent cause of immunodeficiency. Because human enzymatic, metabolic, and detoxification pathways are largely dependant on adequate vitamins, minerals, and other essential co-factors, the nutritional status of patients with MCS is of obvious importance and concern (Jacoby, 1980). A survey of more than 330 patients at the Environmental Health Center-Dallas showed widespread vitamin deficiencies (including a B6 deficiency in almost 58% of these patients) even in the presence of oral supplementation (Ross et al., 1990). A rotational diet is one way to minimize exposure to food substances to which the patient may be sensitive, and the diet can be readily designed by competent personnel within the context of nutritional adequacy (Radcliffe, 1987). A rotational diet does not repeat the same food or beverage item within the rotational cycle, and such diets can be constructed in several ways. To illustrate a 4-day, monorotational diet (one food per meal): On Day 1, the patient might consume eggs for breakfast and would not again consume any egg products until the morning of Day 5, thereby minimizing contact with potentially sensitizing foods. A rotational diet is relatively simple to institute, even before the foods to which the patient is actually sensitive are known. Such a diet minimizes over-exposure to any foods, and when properly constructed, can provide good nutritional adequacy and wide variety. Patients with MCS are known to have a higher likelihood of nutritional imbalances (Ross et al., 1989), especially magnesium deficiency (Rea et al., 1987a). Because many patients with MCS seem to be nutrient deficient despite oral supplementation, intravenous infusions of certain vitamins and minerals (especially vitamin C and the B vitamins, magnesium, and trace minerals) can have excellent therapeutic benefits. The exact mechanism of benefit is not known but may be through enhancing both immune function and detoxication pathways. The Nova Scotia Environmental
Medicine Clinic is currently engaged in a collaborative pilot study with
the government of Nova Scotia in Canada on intravenous infusion of
nutrients, including magnesium, for patients with chronic fatigue
syndrome. In the author’s experience, these patients also frequently have
intracellular magnesium deficits. Candida Sensitivity. One aspect of the total-load or the total-environment concept might include the possibility of Candida sensitivity or overgrowth (Kroker, 1987). Although this issue is controversial, many of the author’s patients with MCS have substantial elevations of antibodies against Candida and may have had recurring vaginal or oral yeast infections. An anticandida program involving dietary modification, nutritional support, the replenishment of healthy gut flora, and possibly an antifungal medication may prove very beneficial. Moreover, present knowledge about the potential adverse effects of Candida on susceptible individuals appears far from complete. It seems reasonable to keep an open mind on this topic because the author has seen many patients who benefitted from such an approach, within a context of evaluating and lowering the total load. Testing Intradermal and Sublingual Testing. A vital question remains: How does one evaluate and confirm chemical sensitivity? As in all medicine, initial reliance is primarily on history. Two main types of confirmatory testing, involving intradermal and inhalation challenge, are currently available. Most patients with a history of MCS have widespread sensitivities to chemicals, foods, and, to a lesser extent, inhalants (Rea and Ross, 1989). The testing antigens used for intradermal food testing at the Environmental Health Center-Dallas are prepared from organically grown products, with no preservatives in the vaccines. This is in distinction to most testing antigens on the commercial market, which have either phenol or glycerine as stabilizers. Many patients with MCS cannot tolerate antigens that contain these substances for either testing or treatment. A variety of well-known, skin-testing techniques are available, including scratch or prick testing. Serial-dilution, end-point titration (SDET) and provocation-neutralization also give reliable data for use in a treatment program (King and King, 1990). With provocation-neutralization, potential treatment vaccines may be drawn up for foods, chemicals, inhalants, microbial substances (like mixed respiratory vaccine and fluogen), and individual bacteria produced from autogenous vaccines; the latter are particularly helpful in patients with chronic rhinitis or sinusitis. Sensitivity to a variety of chemicals may also be tested directly in the same way. Subsequent immunotherapy treatment with very low-dose, subcutaneous or sublingual vaccines can proceed in conjunction with avoidance of the offending agent (Scadding and Brostoff, 1986). Testing and treatment are also possible with neutralizing doses to neurotransmitters, like serotonin, dopamine, methacholine and others, which can produce substantial improvement in the patient’s symptomatology. Intradermal testing involves not only evaluating the skin whealing response but also assessing symptoms and signs that may be produced from the testing itself. Sublingual testing, which relies almost exclusively on symptoms or signs, can nevertheless be a valuable testing technique. Inhalation. One of the most scientifically rigorous evaluations of chemical sensitivity is specific challenge with low-dose chemical exposures. These take place inside in an enclosed glass and anodized-aluminum booth, under controlled circumstances (Rea et al., 1990). When done properly, these can help determine whether the patient is sensitive to a variety of chemical substances. Appropriate dilutions of chemicals are vaporized in the booth to achieve concentrations that are below odor thresholds and that approximate levels found in everyday settings (Rea et al., 1990). These tests are performed on a double-blind basis, using placebos of water or saline. The booth is evacuated and washed after each challenge to prevent any potential contamination. The absence of intake pipes or tubes that direct gas into the booth also prevents potential contamination and subsequent invalidation of subsequent tests at a later date. Chemical testing performed in such a booth must be done with the patients in the deadapted state for reliable results (Rea et al., 1990). The ideal location for this type of low dow-dose, chemical challenge is a hospital-based, environmental control unit (ECU) (Sprague, 1987) in which the patient is housed in a very clean environment for several days before testing begins. The principles of total load and deadaption must be understood and followed with low-dose, inhaled, challenge testing, because incidental outpatient exposures to perfume, traffic exhaust, cigarette smoke, or other substances may trigger delayed responses that will cause inconsistent results. Transfer Factor. Another potential treatment for patients with MCS is immune stimulation, especially in view of the frequent occurrence of immunosuppression with this illness (Levin and Byers, 1987). The use of transfer factor may prove very helpful in these cases (Youdim et al., 1991). Transfer factor is an extract of white blood cells with known immune-stimulating properties. It is especially helpful in cases of leukopenia or in reduced leukocyte-killing capacity, which may contribute to recurring infections. Pupilography. An additional method being developed to evaluate patients with MCS is the assessment of autonomic nervous function by pupilography (Shirakawa et al., 1992). Hamamatsu Photonics in Japan, in cooperation with the Department of Ophthalmology at Kitasato University, has developed a sophisticated optical device called the binocular iriscorder, that scans the eye surface in the infrared spectrum and measures the pupilographic response to a specific light stimulus by very precise, computerized measurements. These are then compared with a standard reference range. The change in pupil size, velocity of contraction and dilation, recovery time, and other parameters are measured in milliseconds following the light stimulus. These measurements are usually quite stable in each individual, with a slight diurnal variation. Patients with MCS have frequent deviations from baseline and exhibit considerable instability of autonomic function, usually in a sympatholytic pattern (Shirakawa et al., 1992). Many patients, whom the author has tested in blind, intradermal challenges with agents to which the patient is known to be sensitive, show distorted autonomic stability. Further research with this computerized analysis is pending. Posturography. Another
technique for evaluating patients with MCS is posturography testing, which
essentially evaluates the neurologic integration of the nervous input from
the eyes, ears, and peripheral nervous system by computerized methodology.
Frequently, the author finds disorders of balance in patients with
chemical sensitivity, and especially patients with histories of
significant chemical exposures. When these patients undergo detoxification
programs to enhance metabolism and the elimination of toxic chemical
substances from their bodies, substantially improved measurements of these
specific, neurologic balance function usually result. Adipose and Nerve Tissue Toxic chemical substances may be stored for long periods in adipose and nerve tissue; many xenobiotics are direct neurotoxins (Seba et al., 1987). Indeed, DDT-type compounds and many others are often found in adipose tissue at much higher levels than would be found in blood under steady-state conditions. Certain individuals appear to have an impaired ability to detoxify effectively some of these exogenous substances. The chemicals may then build up over long periods following repeated exposures, especially in industrial settings (Seba et al., 1987). Levels of potentially toxic chemical substances at 10-40 times the population average, or even greater, are not unusual in MCS patients. With such toxic loads, it is perhaps not surprising that patients are unwell with various neurologic and other symptoms. Detoxification. One method
that is gaining considerable interest for reducing this total toxic load
is a detoxification program using an integrated regimen of graduated
exercise; nutrient replacement; and sauna-chamber, heat depuration therapy
(Schnare et al., 1982). The heat chamber at the Environmental Health
Center-Dallas is built with ceramic tile on all inside surfaces and
untreated wooden benches; it uses relatively low temperatures, in the
range of 140° F. Patients first
exercise and then spend time in the sauna to induce profuse perspiration.
Under these conditions, stored xenobiotics appear to mobilize
substantially (Schnare et al., 1982) and can then be metabolized,
primarily through the liver and the gut, but also through the breath,
urine, and perspiration. The clearance rate of stored xenobiotics from the
body may be quite variable, and the author’s experience shows that styrene
and chloroform come out most easily. 1,1,1-Trichloroethane is ubiquitous
and seems to be the most difficult to clear (Rea et al., 1987b). If,
however, such a detoxification program proceeds too quickly, the patient
may worsen for a time, usually in conjunction with a rise in liver
transaminases, which suggests a significant strain on hepatic function.
With caution, however, these xenobiotics can be substantially reduced in
MCS patients, usually with marked improvement in the patient’s overall
chemical sensitivity and general health (Rea et al.,
1987b). Amalgams Another area of
growing interest and potential treatment is the controversial issue of
amalgams and their adverse consequences on health. The television program
60 Minutes reported on the hazards of silver/mercury tooth fillings
and raised many questions about the safety of this heretofore
well-accepted dental material. Although this subject is controversial and
consensus is lacking, sensitization to mercury is a real phenomenon.
Removing amalgams is an option that certainly requires investigation,
especially for chemically sensitive patients. Summary The essential features of treatment for chemical sensitivity are the following: (1) Encouraging the provision of clean air, food, water, and surroundings. (2) Identifying substances to which the patient is sensitive, with subsequent (A) enhanced avoidance, or (B) specific immunotherapy to reduce the patient’s reactivity to those substances.
(3) Assessing and enhancing the patient’s nutritional status to maximize
the body’s ability to detoxify and
to
(4) Addressing concurrent problems such as infections, immunosuppression,
and other medical conditions in
an
(5) Evaluating the patient’s psychologic status and addressing any social
and emotional problems in
a The author
believes that multiple chemical sensitivity is a real condition with
documented physiologic abnormalities. It is not a functional or
psychologic illness or a belief system of the patient. Second, this
condition is diagnosable and treatable by various means. These treatment
options not only make common sense but usually result in significant
improvement for these unfortunate patients, who deserve the very best
effort of their health care providers. References Barron, S. R. (1990, Apr. 30). Survey of the medical impact on environmentally hypersensitive people of a change in habitat. Canadian Mortgage and Housing Corporation. Davies, K. (1986, Dec.). Human exposure to selected persistent toxic chemicals in the Great Lakes Basin: A case study of Toronto and Southern Ontario region. City of Toronto Dept. of Public Health. Drerup, O., Matlock, C., Rousseau, D., & Salaris, V. (1990, July). Housing for the environmentally hypersensitive (survey and examples of clean air housing in Canada). Canadian Mortgage and Housing Corporation. Fitzgerald, K. (1990, Aug.). Electromagnetic fields: The jury’s still out. IEEE Spectrum, Vol. #, 22-35. Hileman, B. (1991). Multiple chemical sensitivities. Chem. And Eng. News, 69(20), 26-42. Jacoby, W. B. (1980). Detoxification enzymes. In W.B. Jacoby (Ed.), Enzymatic basis of detoxication: Vol. 1, (pp. 1-6). New York: Academic Press. Kailin, E. W., & Brooks, C. R. (1963). Systemic toxic reactions to soft plastic food containers: A double blind study. Med. Annals of the District of Columbia, 32, 1-8. King, W. P., & King, H. C. (1990). The evolution of otolaryngic allergy practices. Ear Nose Throat J, 69, 11-26. Kroker, G. F. (1987). Chronic candidiasis and allergy. In J. Brostoff and S. Challacombe (Eds.). Food allergy and intolerance. (pp. 850-872). Philadelphia, PA: Bailliere Tindall/W.B. Saunders. Levin, A. S., & Byers, V. S. (1987). Environmental illness: A disorder of immune regulation. In M. R. Cullen (Ed.). Workers with multiple chemical sensitivities. Occup. Med.: State Art Rev., 4(4), 669-682. Levin, H. (1989). Building materials and indoor air quality. In J. F. Cone (Ed.). Problem buildings: Building associated illness and the sick building syndrome. Occup. Med.: State Art Rev., 4(4), 667-693. National Research Council (NRC). (1981). Indoor pollutants. Washington, D.C.: National Academy Press. Nero, A. (1988). Controlling indoor air pollution. Scientific American, 258(5), 42-48. Radcliffe, M. J. (1984). Diagnostic use of dietary regimes. In J. Brostoff and S. Challacombe (Eds.). Food allergy and intolerance (pp. 806-822). Philadelphia, PA: Bailliere Tindall/W.B. Saunders. Rea, W. J., Johnson, A. R., & Smiley, R. E., et al. (1987a). Magnesium deficiency in patients with chemical sensitivity. Clin. Ecol., 5(1), 17-20. Rea, W. J., Pan, Y., & Johnson, A. R. (1987b). Clearing of toxic volatile hydrocarbons from humans. Clin. Ecol., 5(4), 166-170. Rea, W. J., & Ross, G. H. (1989). Foods and chemicals as environmental incitants. Nurse Practitioner, 14(9), 17-40. Rea, W. J., Ross, G. H., Johnson, A. R., et al. (1990). Confirmation of chemical sensitivity by means of double-blind inhalant challenge of toxic volatile chemicals. Clin. Ecol., 6(3), 113-118. Ross, G. H., Rea, W. J., & Johnson, A. R. (1989, Feb. 23-26). A prospective cross sectional study comparing environmentally-sensitive patients and controls, measuring biochemical, hematological, immunological and toxicological parameters. Proceedings of the 7th Annual International Symposium on Man and His Environment in Health and Disease. Dallas, TX. Ross, G. H., Rea, W. J., & Johnson, A. R. (1990). Evidence for vitamin deficiencies in environmentally sensitive patients. Clin. Ecol., 6, 60-65. Scadding, G.K., & Brostoff, J. (1986). Low-dose sublingual therapy in allergic rhinitis due to house dust mite. Clin. Allergy, 16, 483-491. Schnare, D. W., et al. (1982). Evaluation of a detoxification regimen for fat storage xenobiotics. Med. Hypothesis, 9, 265-282. Seba, D. B., Milam, M. J., & Laseter, J. L. (1987). Uptake, measurement and elimination of synthetic chemicals by man. In J. Brostoff and S. Challacombe (Eds.). Food allergy and intolerance (pp. 401-415). Philadelphia, PA: Bailliere Tindall/W.B. Saunders. Shandra, R. K. (1980). Immunology of nutritional disorders. In who’s the editor? (Ed.). Current Topics in Immunology, Series 12 (pp. 1-7). London: Edward Arnold. Shirakawa, S., Rea, W. J., Ishikawa, S., & Johnson, A. R. (1992). The evaluation of the autonomic nervous system response by pupilographical study in the chemically sensitive patient. (In press). Sprague, D. (1987). The concept of an environmental unit. In J. Brostoff and S. Challacombe (Eds.). Food allergy and intolerance (pp. 947-960). Philadelphia, PA: Bailliere Tindall/W.B. Saunders. Youdim, S., Rea, W. J., & Liang, H. (1991). Treatment of environmentally sensitive patients with transfer factor, Part 1: Immunologic studies. Clin. Ecol., 7(3), 55-61.
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