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Supporting references for Detoxification

Although 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
© Autumn 1990 by Ralph W. Moss, Ph.D.

The most controversial alternative procedures has to be the coffee enema. Along with other detoxification routines, the coffee enema is a central part of both the
Gerson and the Kelley programs. It is always good for a laugh: "with milk or sugar?" This bizarre-sounding treatment can also be used to scare people away from alternatives in general. No quackbusting article these days is complete without a reference to "enemas made from roasted coffee beans." So what's the story? Is the coffee enema crackpot faddism or is there some rationale behind this procedure?

An enema is "a fluid injected into the rectum for the purpose of clearing out the bowel, or of administering drugs or food." The word itself comes from the Greek en-hienai, meaning to "send or inject into." The enema has been called "one of the oldest medical procedures still in use today." Tribal women in Africa, and elsewhere, routinely use it on their children. The earliest medical text in existence, the Egyptian Ebers Papyrus, (1,500 B.C.) mentions it. Millennia before, the Pharaoh had a "guardian of the anus," a special doctor one of whose purposes was to administer the royal enema.

The Greeks wrote of the fabled cleanliness of the Egyptians, which included the internal cleansing of their systems through emetics and enemas. They employed these on three consecutive days every month said Herodotus (II.77) or at intervals of three or four days, according to the later historian Diodorus. The Egyptians explained to their visitors that they did this because they "believed that diseases were engendered by superfluities of the food", a modern-sounding theory!

Enemas were known in ancient Sumeria, Babylonia, India, Greece and China. American Indians independently invented it, using a syringe made of an animal bladder and a hollow leg bone. Pre-Columbian South Americans fashioned latex into the first rubber enema bags and tubes. In fact, there is hardly a region of the world where people did not discover or adapt the enema. It is more ubiquitous than the wheel. Enemas are found in world literature from Aristophanes to Shakespeare, Gulliver Travels to Peyton Place.

In pre-revolutionary France a daily enema after dinner was de rigueur. It was not only considered indispensable for health but practiced for good complexion as well. Louis XIV is said to have taken over 2,000 in his lifetime.Could this have been the source of the Sun King's sunny disposition? For centuries, enemas were a routine home remedy. Then, within living memory, the routine use of enemas died out. The main times that doctors employ them nowadays is before or after surgery and childbirth. Difficult and potentially dangerous barium enemas before colonic X rays are of course still a favorite of allopathic doctors.

But why coffee? This bean has an interesting history. It was imported in Arabia in the early 1500's by the Sufi religious mystics, who used it to fight drowsiness while praying. It was especially prized for its medicinal qualities, in both the Near East and Europe. No one knows when the first daring soul filled the enema bag with a quart of java. What is known is that the coffee enema appeared at least as early as 1917 and was found in the prestigious Merck Manual until 1972. In the 1920s German scientists found that a caffeine solution could open the bile ducts and stimulate the production of bile in the liver of experimental animals.

Dr. Max Gerson used this clinically as part of a general detoxification regimen, first for tuberculosis, then cancer. Caffeine, he postulated, will travel up the hemorrhoidal to the portal vein and thence to the liver itself. Gerson noted some remarkable effects of this procedure. For instance, patients could dispense with all pain-killers once on the enemas. Many people have noted the paradoxical calming effect of coffee enemas. And while coffee enemas can relieve constipation, Gerson cautioned:

"Patients have to know that the coffee enemas are not given for the function of the intestines but for the stimulation of the liver."

Coffee enemas were an established part of medical practice when Dr. Max Gerson introduced them into cancer therapy in the 1930s. Basing himself on German laboratory work, Gerson believed that caffeine could stimulate the liver and gall bladder to discharge bile. He felt this process could contribute to the health of the cancer patient.

Although the coffee enema has been heaped with scorn, there has been some independent scientific work that gives credence to this concept. In 1981, for instance, Dr. Lee Wattenberg and his colleagues were able to show that substances found in coffee–kahweol and cafestol palmitate–promote the activity of a key enzyme system, glutathione S-transferase, above the norm. This system detoxifies a vast array of electrophiles from the bloodstream and, according to Gar Hildenbrand of the Gerson Institute, "must be regarded as an important mechanism for carcinogen detoxification." This enzyme group is responsible for neutralizing free radicals, harmful chemicals now commonly implicated in the initiation of cancer. In mice, for example, these systems are enhanced 600 percent in the liver and 700 percent in the bowel when coffee beans are added to the mice's diet.

Dr. Peter Lechner, who is investigating the Gerson method at the Landeskrankenhaus of Graz, Austria, has reported that "coffee enemas have a definite effect on the colon which can be observed with an endoscope." F.W. Cope (1977) has postulated the existence of a "tissue damage syndrome." When cells are challenged by poison, oxygen deprivation, malnutrition or a physical trauma they lose potassium, take on sodium and chloride, and swell up with excess water.

Another scientist (Ling) has suggested that water in a normal cell is contained in an "ice-like" structure. Being alive requires not just the right chemicals but the right chemical structure. Cells normally have a preference for potassium over sodium but when a cell is damaged it begins to prefer sodium. This craving results in a damaged ability of cells to repair themselves and to utilize energy. Further, damaged cells produce toxins; around tumors are zones of "wounded" but still non-malignant tissue, swollen with salt and water.

Gerson believed it axiomatic that cancer could not exist in normal metabolism. He pointed to the fact that scientists often had to damage an animal's thyroid and adrenals just to get a transplanted tumor to "take." He directed his efforts toward creating normal metabolism in the tissue surrounding a tumor.

It is the liver and small bowel which neutralize the most common tissue toxins: polyamines, ammonia, toxic-bound nitrogen, and electrophiles. These detoxification systems are probably enhanced by the coffee enema. Physiological Chemistry and Physics has stated that "caffeine enemas cause dilation of bile ducts, which facilitates excretion of toxic cancer breakdown products by the liver and dialysis of toxic products across the colonic wall."

In addition, theophylline and theobromine (two other chemicals in coffee) dilate blood vessels and counter inflammation of the gut; the palmitates enhance the enzyme system responsible for the removal of toxic free radicals from the serum; and the fluid of the enema then stimulates the visceral nervous system to promote peristalsis and the transit of diluted toxic bile from the duodenum and out the rectum.

Since the enema is generally held for 15 minutes, and all the blood in the body passes through the liver every three minutes, "these enemas represent a form of dialysis of blood across the gut wall" (Healing Newsletter, #13, May-June, 1986).

Prejudice against coffee enemas continues, however. Although this data was made available to Office of Technology Assessment it was largely ignored in their box on the procedure. They dismissively state "there is no scientific evidence to support the claim that coffee enemas detoxify the blood or liver."

No medical procedure is without risk and OTA is quick to point out alleged dangers of the coffee enemas. For instance, they cite one doctor's opinion that coffee "taken by this route is a strong stimulant and can be at least as addictive as coffee taken regularly by mouth." This may indeed be true. Yet one wonders where the data is on this, and whether OTA would issue a similar warning about the perils of coffee drinking.

Another potential danger, they say, is physical damage to the rectum–"fatal bowel perforation and necrosis" which have been associated with "various other types of enema." The risk of perforation comes from the insertion device used. At the Gerson clinic, for instance, they use a short nozzle which couldn't inflict much harm; Gonzalez uses a soft rubber colon tube. In neither case would this caveat seem to apply. On thin evidence, OTA also suggests enemas can cause colitis.

The agency also cites the case of the two Seattle women who died following excessive enema use. Their deaths were attributed to fluid and electrolyte abnormalities. One took 10 to 12 coffee enemas in a single night and then continued at a rate of one per hour. The other took four daily. As OTA points out, "in both cases, the enemas were taken much more frequently than is recommended in the Gerson treatment."

In general, coffee enemas are an important tool for physicians who try to detoxify the body. This is not to say they are a panacea. They certainly require much more research. But coffee enemas are serious business: their potential should be explored by good research–not mined for cheap shots at alternative medicine or derisively dismissed as yet another crackpot fad.

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
 
Several metabolic studies suggest that coffee might affect cholesterol lithogenesis. The popular brew is known to stimulate cholecystokinin release; it increases gallbladder motility and perhaps that of the large bowel, too. For its part, caffeine inhibits biliary cholesterol crystallization, decreases gallbladder fluid absorption, and increases hepatic bile flow. The available epidemiologic studies have largely failed to assign coffee any significant benefit in preventing gallstone disease. The studies have, however, been criticized for inadequate size and control of confounders, and also for imprecise assessment of coffee consumption.

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
Detoxification Method ('Purification Program")
Developed by L. Ron Hubbard
Compiled August, 1991 by the Foundation for Advancements in Science and Education


Table of Contents

I. Contamination with Synthetic Chemicals

II. Reduction of Bioaccumulated Compounds

III. The Detoxification Program Developed by L. Ron Hubbard

A. Exercise
B. Sauna
C. Supplements

Niacin
Polyunsaturated Oils
Vitamin Supplementation

D. Sufficient liquids to offset the loss of body fluids through sweating
E. Regular diet supplemented with plenty of fresh vegetables
F. A properly ordered personal schedule which provides the person with the
normally required amount of sleep

IV. Studies Regarding the Detoxification Program

A. Safety of the Program
B. Results of Detoxification

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.

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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
by Gerald H. Ross, MD, CCFP, DIBEM, FAAEM
Environmental Health Center-Dallas, Dallas, TX

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
                          minimize the free-radical production and oxidative stress xenobiotics.

                    (4) Addressing concurrent problems such as infections, immunosuppression, and other medical conditions in an
                         appropriate fashion.

                    (5) Evaluating the patient’s psychologic status and addressing any social and emotional problems in a
                          compassionate manner.

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

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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.

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Jacoby, W. B. (1980). Detoxification enzymes. In W.B. Jacoby (Ed.), Enzymatic basis of detoxication: Vol. 1, (pp. 1-6). New York: Academic Press.

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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.

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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.

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