Environmental medicine

Bioaccumulation, environmental factors, stressors.

Environmental medicine is an approach of preventing and treating disease using methods that most people would not see in a routine doctor's visit. This approach links medical problems and diseases to environmental factors. These factors include chemical, physical, and biological influences on the place where a patient works, lives, and plays. Environmental medicine is known as a multidisciplinary field of medicine. It combines environmental science, chemistry, urban planning, ecology, and medicine.

The key idea behind environmental medicine is that long-term exposure to mildly irritating substances (such as common household fungi) or other factors (such as noise) may trigger a variety of physical, mental, and emotional disorders. These mildly irritating substances are known as stressors. Chronic exposure to stressors may result in long-lasting symptoms and even disease.

Environmental medicine has increased in popularity since the environmentalism movement became popular in the United States during the 1970s. Most notably, Rachel Carson's book, "Silent Spring," was famous for bringing public attention to the influence that pesticides had on the health of birds. People began to realize that the chemicals in their environments may also negatively impact the health of humans.

Advocates link environmental factors, such as chemical sensitivities, developmental delays, and some forms of cancer, to contaminants that infiltrate the patient's body. Environmental medicine claims that stressors may play a role in the development of obesity and cancer in some patients. Environmental medicine sometimes connects exposure to contaminants to the development of diseases of the following body systems: Cardiovascular system problems such as migraine headaches, arrhythmias (abnormal heart rate), vasculitis (inflammation of vessels), thrombophlebitis (inflammation of veins), hypertension (high blood pressure), angina (chest pain), myocardial infarctions (heart attacks), edema and fluid retention syndromes (swelling); skin problems such as eczema, urticaria, angioedema, scleroderma, and dermatitis herpetiformis (itchy skin eruption); endocrine problems such as thyroid dysfunction, premenstrual syndrome, and fibrocystic breast disease; gastrointestinal problems such as aphthous stomatitis, gastric and duodenal ulcers, chronic gastritis, irritable bowel syndrome, infantile enterocolitis, eosinophilic gastroenteritis, regional ileitis, ulcerative colitis, certain malabsorption syndromes, gut flora dysbiosis, and laryngeal edema; genitourinary problems including glomerulonephritis, nephrotic syndrome, chronic cystitis, recurrent vaginitis, enuresis, dysmenorrhea, infertility, and vulvodynia; hematologic problems such as certain types of anemia, and thrombocytopenia; musculoskeletal problems such as lupus erythematosus (chronic autoimmune disease), scleroderma, myalgia and arthralgia, fibromyalgia, rheumatoid arthritis, and other arthritic conditions; neurological and central nervous system problems such as fatigue, certain seizure disorders, sleep disorders, Parkinson's disease, Alzheimer's disease, multiple sclerosis, and various cognitive and memory disorders; eye and ear disorders such as conjunctivitis, eczema of the eyelids, blurring of vision, photophobia, Meniere's disease, recurrent otitis media, vertigo, hearing loss, tinnitus, and pressure in the ear; breathing disorders such as asthma, certain pneumonias, rhinitis, frequent colds, sinusitis, and chronic bronchitis; psychiatric/emotional problems such as attention deficit disorder, alcoholism, bipolar disorder, somatoform disorders, sexual dysfunction, eating disorders, schizophrenia, panic disorders, irritability, anxiety, "spaciness," and chronic fatigue.

Government environmental agencies as well as medical organizations have increasingly recognized the role that a person's environment may play in the development of disease. However, many of the sub-clinical symptoms that environmental medical practitioners attribute to contaminants in the environment are not recognized by most mainstream doctors. The term sub-clinical is used to describe medical signs and symptoms that may not appear significant enough to warrant medical investigation and diagnosis.

Environmental medicine is an increasingly popular system of medical therapy, in part because treatment may involve modifying the patient's living and working spaces, rather than subjecting them to medicines, which may significantly impact the quality of life.

Each patient encounters a particular allergic and/or chemical load. Unlike conventional Western medicine, most practitioners of environmental medicine believe that each person has a stressor threshold, and once this level has been reached, illness occurs. The load is determined by factors such as air quality, diet, living arrangements, and leisure activities.

The model of environmental medicine is based on the growing appreciation that the human body is constantly coping with its dynamic environment by means of a number of built-in, complexly interacting, and usually reversible biologic mechanisms and systems. Many of these systems involve the endocrine and immune systems. According to this model, substances in the diet or environment are potential stressors that are capable of contributing to destabilization of "homeodynamic functions"; therefore, causing disease. The term "homeodynamic functioning" is preferred because it reflects that the maintenance of health and function is an active process rather than a passive one. Categories of potential external stressors include organic inhalants such as dust, mold, pollen, and dander; the myriad of manufactured and naturally occurring chemicals; diet and the many substances in it; infectious organisms; and physical phenomena, such as radiation, heat, cold, humidity, vibrations, noise, and electromagnetic fields. Categories of potential internal stressors include psychological stresses, genetic limitations, malnutrition, dysfunctional biological mechanisms, etc. Treatment strategies are customized for each patient.

The basic theories of environmental medicine include the "total load" concept, individual susceptibility, and adaptation. The "total load" concept is that multiple and chronic environmental exposures in a susceptible individual contribute to a breakdown of that person's homeostatic mechanisms. Rarely is there only one offending agent responsible for causing a diseased condition. Multiple factors co-exist, usually over a prolonged period of time in bringing about the disease process. Individual susceptibility to environmental agents occurs for a variety of reasons including genetic predisposition, gender, nutritional status, level of exposure to offending substances, infectious processes, and emotional and physical stress. Adaptation is defined as the ability of an organism to adjust to the gradually changing sustained circumstances of its existence. Maladaptation is a breakdown of the adaptive mechanism.

Environmental medicine is a broad field, but there are a few issues that are currently prominent which include: the effects of ozone depletion and the resulting increase in ultraviolet (UV) radiation on humans with regards to skin cancer; the effects of nuclear accidents or the effects of a terrorist dirty bomb attack and the resulting effects of radioactive material and radiation on humans; the effects of chemicals on humans, such as dioxin, especially with regards to cancer; radon gas exposure in individuals' homes; air and water pollution on the health of individuals; mercurypoisoning and exposure through fish and seafood.

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Agency for Toxic Substances & Disease Registry. .

American Academy of Environmental Medicine (AAEM). .

Occupational Health & Safety Organization. .

Treatment by environmental medicine involves a collaboration between the practitioner and the patient. The practitioner considers all of the patient's symptoms seriously even if the some of the symptoms may not appear to be related to any medical diagnosis. Usually, the patient maintains open communication with the practitioner and follows all treatment instructions.

Evaluation: An evaluation is the first step in treating a patient. In order to assess a patient according to the values of environmental medicine, the physician evaluates the patient as well as the environment where they spend a considerable amount of time. The physician seeks out clues in the environment surrounding the patient that may affect that patient's individual body chemistry. The physician then deduces clinical patterns of symptoms and illness as they relate to contact with the stressors. In addition, other methods of patient evaluation may occur. These other methods may include a physical examination, blood tests, magnetic resonance images (MRIs), computed axial tomography (CAT) scans, and surgeries that are performed to make sure that the diagnosis is correct.

Management: After the stressors have been identified, the doctor uses a variety of modalities to assist the patient in reaching a state of better health. Modalities are chosen based on their cost effectiveness, likelihood of success, disease stage, and the extent to which a patient will be comfortable during the treatment. There are a number of short- and long-term therapies that are used in environmental medicine. Each treatment regimen is customized to the needs and circumstances of the patient. Environmental medicine draws on a variety of alternative, complementary, and mainstream treatment strategies to help the patient recover or manage their symptoms.

Patient education: Patient education is the foundation of treatment in environmental medicine. The patient's understanding of the nature of the illness is critical and may include education on: ways to correct unusual metabolic, nutritional, and psychological problems; immunotherapy; ways to eliminate stressors; and symptomatic drugs and surgery where appropriate. Patients also learn ways to prevent the return of symptoms in the future.

Detoxification therapy: This is a variety of modalities intended to remove toxins that have built up in and contaminated the body. These therapies may involve nutrition protocols, heat therapy, massage, and exercise. Examples of toxins include pesticides, heavy metals, and volatile organic hydrocarbons.

Diet: At times, the patient is advised to follow a specific diet. Patients may eat organic foods to eliminate pesticides, or they may eat foods which are rich in a vitamin that improves the body's ability to cope with the stressors. Some foods, called nutriceuticals, may be taken in order to behave as food and medicine simultaneously. Sometimes food groups or types of foods are given to correct specific nutritional deficiencies. Patients may avoid certain foods due to a sensitivity, intolerance, or allergy. Regardless, nutrition is a concept that is a key part of the patient's recovery.

Environmental controls: This is aimed at minimizing or eliminating a patient's exposure to specific environmental stressors, such as contaminated ground water. The goal is to create an environment of clean air, water, and food. For instance, a patient may be instructed to put tap water through a water filter before drinking it. An air purifier may be purchased for the household or filters on air circulation systems may be changed.

Immunotherapy: Conventional Western immunotherapy may occur in allergy shots or pills. Homeopathic remedies may also be used. This treatment approach is thought to boost the body's ability to encounter and deal with increasing amounts of a stressor without overwhelming or irritating the immune system.

Nutritional supplements: A patient may take supplements to improve the performance of the body or organ systems as well as to correct cycles of cell energy production, metabolism, and excretion. Supplements may consist of amino acids, fatty acids, minerals, or vitamins.

Pharmaceuticals: The practitioner may prescribe drugs to temporarily relieve the patient of symptoms while the deeper underlying causes are identified and treated.

Psychotherapy: It is thought that individuals with underlying emotional problems will experience a more complete recovery and stave off further illnesses if they resolve these issues. Individuals whose environment may have played a role in the deterioration of emotional wellbeing also benefit. Overall, environmental medicine makes use of psychotherapy, also known as talk therapy, to help the patient attain and sustain neurological, cognitive, emotional, social, and spiritual health.

Prevention: Prevention is the ultimate goal of environmental medicine. The patient prevents further disease by adopting a lifestyle within their financial, geographic, and occupational means to minimize their exposure to identified stressors that result in illness.