Environmental Medicine as Primary Medicine

While emergency medicine receives high marks, the health care system is being buried under an avalanche of chronic disease. Chronic disease accounts for 70% of deaths. Heart disease, cancer and stroke are responsible for over 50% of adult deaths. Diabetes is on the rise among children, and one in ten adults has a major chronic disability. Life expectancy has increased over the past several centuries, largely due to advances in sanitation1. Now, however, progress is projected to reverse course2. Children are no longer expected to live as long as their parents, and while expensive end-of-life care keeps millions alive, quality of life has deteriorated.

Why the rise in chronic illness? Multiple factors such as diet and exercise are receiving ample research and clinical attention. Treatment of environmental toxins, however, while supported by a growing body of research, has not reached the average clinician’s office.

In a very real sense, attention to environmental toxins is an extension of the sanitation movement of the last several centuries. Just as clean drinking water and hygiene extended the health and lifespan of millions, medical detoxification promises similar results in the future. Unfortunately, it is being largely ignored.

To change this paradigm, it is imperative that the medical field embrace environmental medical research and incorporate detoxification as a routine measure of primary care medicine. Currently it is an under-utilized modality, seen as a specialty rather than integral to the daily practice of medicine.

Current medical practice
The drug model for treating disease is rooted in a history where science was not advanced enough to ask probing questions regarding the origins of disease. Our early medical tools were sight, smell, and taste (ex. the sweet urine of diabetes) for discovering signs of disease, and dialogue (“How do you feel?”) to elicit symptoms. Later more sophisticated equipment – the stethoscope, reflex hammer, electric light, etc. – emerged to determine signs of disease and treatments tended to focus on alleviating outward signs and symptoms.

Physiology has been well-understood for several hundred years. But biochemistry – where the underlying causes of disease germinate – was not part of medicine until recently. The understanding of complex biochemical processes in the body is expanding on a daily basis, yet the everyday treatment of chronic disease revolves around a narrow focus on drug-symptom and drug-sign prescribing. The busy practitioner must keep up with a steady stream of pharmaceutical developments, allowing little time to step back and fundamentally question the origins of a specific patient’s ill health.

Moving toward a deeper practice of medicine
While the daily practice of medicine has stayed rooted in the past, hindered by limited imagination and question asking, science has opened broad vistas, including the investigation into the causes of disease. Thousands of research articles have been published on the disease-inducing effects of environmental pollution – from excess noise causing hearing loss, to plastics initiating hormonal imbalances. In daily practice, however, doctors pay attention to symptoms such as high blood pressure, yet scarcely ponder reasons for the elevation, finding expediency in prescribing pharmaceuticals and rarely considering the role of environmental pollutants such as lead3. This oversight constitutes practicing 20th Century medicine – relying on fingers to find the pulse, a sphygmomanometer to measure blood pressure, and an electric light to visualize ocular blood vessels – and ignoring 21st Century advances.

Understanding how environmental toxins affect health and the application of detoxification therapies is as fundamental to 21st Century medicine as germ theory was to the 19th. Toxins are part of the terrain we inhabit. We live in a polluted environment and involuntarily incorporate environmental toxins into our bodies. Numerous studies have failed to find people who do not harbor toxic metals, solvents, plastics, fuels and other synthetic new-to-nature molecules4. These toxins increase oxidative stresses that in turn trigger chronic disease5.

If doctors are to apply current science to the practice of medicine, then they must embrace all factors generating disease. One 20th Century influence – genetics – received massive research funding, has been fully accepted into daily medical dialogue. On the other hand, the 21st Century science of epigenetics is receiving scant attention. Epigenetics reveals that while our genetic code is important, the expression of that code is determined by post-genetic influences such as exercise, nutrition, and environmental toxins. In spite of the profound implications of epigenetics, patients are unlikely to hear references to it from their physicians. One might hear a passing plug to include more exercise or watch one’s diet, but while the real business of medicine is being conducted – writing a prescription – there will be no mention of environmental toxins.

To ignore the reality of environmental toxins and their association with chronic disease is analogous to the age when microorganisms were first emerging as a source of disease and surgeons refused to wash their hands between surgeries.

Environmental toxins and therapeutic detoxification must become part of the everyday practice of medicine – primary modalities in the treatment of chronic disease6.

Detoxification in daily practice
When I attended Bastyr University in the late 1970s and early 1980s, detoxification was advocated but nutrition was emphasized. Nutrition could be shown to intersect with the expanding field of biochemistry, while detoxification seemed dated and quaint. Certainly our teachers supported treating the “gut and liver” as fundamental for health, but the biochemical processes were not well understood. At the time, “toxic building syndrome” and “environmental sensitivity” were terms known by much of the literate public, but people who reacted to everything from car exhaust to perfume were often thought to be suffering from a psychological problem rather than an environmental illness.

During this time, my own view was that nutrition meshed with the exciting new age of experimental science, while detoxification relied primarily on empirical science, utilizing saunas, hydrotherapy, and herbs with little more than anecdotal support. Through nutrition, protein, fats, carbohydrates and micronutrients could be measured, even taken apart and reassembled, while detoxification was a less-precise treatment modality. Individual nutrients could be plugged into metabolic pathways, while toxins were difficult and expensive to measure. Because of the erosion of the food supply, nutrition applied to everyone, while detoxification seemed esoteric and a specialty therapy for a very small number of patients not fitting neatly into other diagnostic categories.

There were a few brave pioneers like Walter Crinnion, ND, who tested and treated toxic illness in a time when testing was very expensive and the supporting literature rudimentary, but most NDs were more focused on nutrition, herbology, and physical medicine.

Today, nutrition remains a cornerstone of naturopathic education while detoxification has gained a place as an elective subject and specialty after graduation. My contention, based on post-graduate education, is that the study of environmental pollution and the application of scientific detoxification should be moved next to nutrition as a foundation element of all medical practice, MD and ND.

My belief in moving detoxification to the daily practice of medicine is based on several factors:
Numerous studies have found that everyone tested harbors toxic chemicals. Pesticides, jet fuel, artificial hormones, solvents, and a multitude of other synthetic chemicals are measurable in blood, hair, urine and even breast milk samples7. It is an appalling statement about our environment when chemicals that never existed in nature until the scientific revolution of the 19th Century have now permeated into people all over the world, even in remote areas. We ignore this fact at our own peril.

Research into the effects of toxic chemicals and metals has continued to emerge, despite lack of funding, linking toxins to chronic degenerative diseases: cancer8, high blood pressure9, diabetes10, asthma11, thyroid abnormalities12, developmental disorders13, hormone disruption14, depression15, anxiety/panic disorders16, immune disruption,17, allergy18, reproduction19, and virtually all chronic diseases20. If you broaden the definition of toxin to include mal-digestion and stress-induced chemicals, then it is almost impossible to name a chronic disease that isn’t related to toxins.

The parallel between the rise of environmental contamination and the increasing incidence of chronic health problems over the last 150 years is compelling. Heart disease did not skyrocket to epidemic levels in 2012 for no reason. Nutrition, stress, and lack of exercise are all contributing factors, but available evidence demonstrates that toxic challenges to our cardiovascular systems are part of this deadly shift. Testing for toxins has become much more accurate and affordable, although still not covered by most insurance plans. Heavy metal testing, for example, which used to cost hundreds of dollars, is now available for less than $100 (or a month of espresso).

Detoxification treatments are now better understood and safely administered. Some treatments have been practiced safely and effectively for thousands of years (saunas, mud baths, herbs, etc), while more recently developed therapies (glutathione, N-acetyl cystine, alpha-lipoic acid, glutamine, etc) are based on a broadened understanding of the biochemical pathways involved in liver and cellular detoxification. These new therapeutic modalities are widely available and affordable. Yes, some patients may require expensive IV chelation, but most achieve measurable improvement with oral chelation and nutritional support. Counseling on avoidance strategies is easily folded into appointments and there is ample written support available.

Walking the talk
We live in a time of exciting scientific discovery. Unfortunately, the practice of medicine lags behind. Controlling the signs and symptoms of disease is not adequate in a world where experimental science is opening opportunities to treat the underlying causes of disease. Doctors are beginning to see the value of introducing nutrition, stress management, and other lifestyle factors to their patients. It is now time for the daily practice of medicine to catch up to and incorporate environmental science and the role of detoxification in reversing chronic disease. This change in focus will involve the overhaul of medical education for both MDs and NDs.

Abundant research supports the role of toxins in generating chronic disease. Ignoring toxins as part of every patient’s health/disease milieu is ignoring the reality of the 21st Century. Doctors better serve their patients by breaking with the old symptom/sign-treatments and applying cause-treatment science. Toxins are a primary concern and detoxification must come to occupy a primary place in medicine. [Reference list available upon request.]

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