China’s air pollution is so bad that I can imagine doctors’ offices there are filled with sick people. And I suspect many patients have TILT, and they won’t be diagnosed correctly or get well.

China unfortunately is a perfect environment for TILT. Years of economic expansion have polluted waterways and loaded the air with contaminants.

TILT is a disorder caused by exposure to harmful chemicals. The chemical exposures can be at constant low levels, such as in China, or result from an acute event such as exposure to a pesticide.

TILT is short for “Toxicant-induced Loss of Tolerance,” and it indeed represents a breakdown in the body’s natural tolerance. People with TILT can become sick from everyday chemicals in foods, household cleaners and medications.

Sufferers may complain of fatigue, headaches, asthma-like symptoms, and cognitive disorders. But conventional treatments for their symptoms will be ineffective if they have TILT.

For this reason, I worry about the Chinese people because I suspect most health caregivers in China don’t know about TILT, or the widely used clinical screening instrument to identify it. I helped develop the instrument, called the “Quick Environmental Exposure and Sensitivity Inventory,” or QEESI, and it can lead to much better identification and treatment of TILTed patients.

It’s a free download on my website.

QEESI is a clinical assessment tool used in the United States, and it has been translated into French and Korean. Clinicians in South Korea, which also has serious pollution issues, are using the recently-translated version.

China unfortunately is a perfect environment for TILT. Years of economic expansion have polluted waterways and loaded the air with contaminants. Airlines in the past have canceled flights due to poor visibility, pedestrians in cities wear masks, household air purifiers are a status symbol, fishermen report low catches, and civil unrest has forced delay of a coal-fired power plant that residents blame for a rising number of cancer cases.

Soaring levels of pollution are driving Western business executives out of Chinese cities and dissuading others from coming, the Wall Street Journal reported in April.

What is troublesome to medical scientists is the nature of the air pollution. It’s largely unmeasured even though it blots out the sun on some days and residents have been quoted to say they can taste the air. For physicians, it’s difficult to connect an illness to pollution because the measurement of pollution is inadequate.

The Chinese government index of pollution reports only large particulate pollutants, those known as PM 10. They are 10 micrometers in diameter or larger. PM10 particulate is nowhere as dangerous as smaller particulate matter.

China’s government, acting to tighten air pollution standards, began to monitor small particles in January 2012. The state media said the government would begin to measure PM 2.5 and smaller, and publish its measurements.

Despite this, the levels of two major air pollutants rose by almost 30 percent during January-March 2013 over the same period in 2012, a Chinese news organization recently reported. The pollutants were nitrogen dioxide and particulate matter that is between 2.5 and 10 micrometers in diameter, called PM 10.

Small particles can lodge in the alveoli while large particles usually are cleared out in the nasal passages. PM 2.5 is a common byproduct of power plants and motor traffic.

China in the past has been embarrassed by discrepancies between its pollution reports and measurements published by the U.S. Embassy in Beijing. Embassy readings measure PM 2.5, and on some days the measurements have been “beyond index,” or literally off the chart, while the official reading was “light.”

The embassy publishes its measurements, taken on the office rooftop, on Twitter.

In fact, the tweets were cited as a reason the Chinese government in 2012 also recanted an earlier announcement that it would not release the newer, more precise measurements.

Until all the measurements are public, the only generally known element is that the pollution poses immediate danger to the Chinese people, and nearly everyone knows it. The New York Times has quoted a source who said more than 200 high-end air purifiers have been deployed to the office of China’s president, the Zhongnanhai compound for senior government leaders, and the Great Hall of the People.

Brain damage? That’s the latest theory from researchers trying to explain Gulf War illness. I’m skeptical of the new study and disappointed because medical research again is missing the point.

Thousands of Gulf War veterans have been sick and undiagnosed for more than decade as doctors grope for answers. No one can convincingly explain their many symptoms, which include pain, fatigue and cognitive impairment.

Things won’t change until medical science acknowledges that we are dealing with an entirely new mechanism of disease. We recognize how germs and immune-system failures cause disease. Now we need to recognize that chemical exposures cause disease, too.

The Gulf War veterans are suffering the effects of chemical intolerance probably brought on by one or many such exposures in the war zone. I said so in congressional testimony as far back as 1999.

Wartime in the past has opened new thinking on the origin of disease. The germ theory, for example, emerged from the Civil War. Photo: Library of Congress.

My conclusions are based years of study. I also served as the environmental medical consultant to the Department of Veterans Affairs regional referral center in Houston for seven years in the 1990s. I’ve evaluated dozens of ill veterans. They have what is called TILT, or Toxicant-induced Loss of Tolerance.

A single exposure or repeated chemical exposures can cause TILT. People with TILT suffer from chemical intolerances that can impair cognitive abilities and cause multi-symptom illnesses.

With the Gulf War veterans, it doesn’t matter so much which exposure caused their breakdown in tolerance — be it pesticides, smoke from the oil fires or pyridostigmine bromide pills. Those things have long since left these veterans’ bodies. It’s the aftermath of these exposures — the new-onset intolerances to low-level chemical exposures — which appear to be perpetuating their symptoms. In some cases, it may be difficult to sort out individual intolerances, or “triggers,” because of a phenomenon called “masking.” This occurs when individuals are reacting to so many exposures that they have overlapping symptoms.

How can we help these people? The single most important task is to sort out and “unmask” the causes or triggers for their symptoms. This requires an environmental medical unit, or EMU. Congress once endorsed EMU research for the Gulf War veterans but never funded it. Only a few EMUs exist in the world. They are environmentally controlled in-patient hospital units designed to isolate patients from exposures that set them off.

Once we get patients to baseline, we can reintroduce things like caffeine, foods and various substances to identify what causes their flare-ups.

This is not the first time doctors have been baffled by wartime disease. During the Civil War, doctors faced a similarly mysterious “syndrome” characterized by fever. Hundreds of thousands of soldiers died. The doctors did what good epidemiologists do today. They classified the cases. Since the hallmark symptom was fever, they classified the cases by fever type — remittent, intermittent, or relapsing. In doing so, they unknowingly lumped together dozens of unrelated illnesses — everything from typhus and typhoid to malaria and tuberculosis.

Today we face this same situation with Gulf War veterans, only this time the hallmark symptom is not as simple as fever. It’s newly acquired intolerances these veterans have been experiencing since the end of the war.

No time of year brings more changes for children and teens than the start of a new school year. They return to different classrooms and often entirely new schools. Classrooms may have been remodeled, repainted, recarpeted, or treated with pesticides.

These changes can affect children regardless of grade level — pre-kindergarten, grade school, high school and college. Amid the back-to-school excitement, some students wind up feeling sick, listless or distracted, unlike last year. And parents wonder why, and what they can do. Sometimes the school environment is the cause.

Understanding why your child feels bad is especially challenging with children who cannot tell you what may be going on at school. What to do? How about visiting the school yourself?

I have a personal example: My son was returning to fifth grade and for the first time was struggling in math and other subjects. When I visited his school on parents’ night, I was struck by the strong odor of new rubber-backed carpet that had been glued down throughout the school. The classrooms formerly had wood floors and windows that opened to let in fresh air. The goal of the remodeling was to reduce noise. But my son and many other children and teachers became ill when they returned to school after summer break. The most subtle and common symptom was difficulty concentrating and remembering, but headaches, fatigue and worsening asthma also occurred — all as a result of well-intentioned remodeling over the summer!

How can parents detect the early signs of TILT, or Toxicant-induced Loss of Tolerance? TILT is a process that starts with a chemical exposure, such as in a “sick building,” after remodeling at school or home, or from cleaning chemicals or a pesticide exposure. It can cause susceptible individuals to lose their tolerance for everyday substances that never bothered them before, frequently including foods! Intolerances people develop are not usual “allergies.” See a detailed explanation of the differences.

Here’s a 7-point guide for recognizing the early signs of TILT:

1. Over long weekends or during vacations away from school does your son or daughter feel better? Do they feel better just being outdoors? Pay particular attention to symptoms that occur when your child returns to school after a vacation. Do headaches, migraines, irritability, or other symptoms such as tics or stomach problems diminish when they are away from the school? Do the symptoms return “with a vengeance” once they return to classes? This is a useful “experiment”: avoiding the school for a week or so while on vacation, and then returning, paying close attention to symptoms. Re-exposure can evoke a “sharp response,” making it clearer which symptoms are related to a particular environment. Sometimes the return to school after the summer provides the clearest evidence — keep a symptom log on a wall calendar.
2. Did your child’s health problem(s) begin with a flu-like illness and fatigue that did not go away?
3. Does your child, and do other children from the school, report symptoms involving multiple organ systems, with a predominance of neurological symptoms such as fatigue, memory and concentration difficulties, sudden overwhelming sleepiness, headaches, confusion, unsteadiness/clumsiness, irritability or depression? But also, digestive difficulties, skin rashes, muscle weakness, sinus and nasal symptoms, recurrent infections, breathing problems (e.g. asthma) etc., that have become more frequent since school began. School nurses often have a handle on this and can be helpful if approached in a non-confrontational way.
4. Since your child returned to school, has she had any adverse or unusual reactions to medications, such as antihistamine/decongestants, antibiotics, antidepressants, injections, or general or local anesthetics (for example, at the dentist’s office)? This is particularly significant if the drug was formerly well-tolerated. It is an example of “loss of tolerance” due to exposure.
5. Does your child report feeling ill after meals, or that she is unable to tolerate foods she formerly enjoyed? Does your child have intense food cravings or feel ill if she misses a meal. Must she eat “on time” and or does she feel ill if a meal is missed? Does your child raid the refrigerator at night, e.g., for ice cream or other foods, drink large quantities of milk or sodas (corn sugar), eat chocolate or other candy, cookies, bread, popcorn/corn chips, or other foods “addictively.” Does she feel terrible the next morning from her food addictants?
6. Does your child use caffeine? What happens if she doesn’t get her usual amount each day? Is she now using increased amounts of caffeine or, alternatively, avoiding caffeine because it bothers her? Overuse and avoidance can both be signs of caffeine intolerance. Avoidance leads to withdrawal symptoms. As with drugs, overuse may help postpone/overcome caffeine and food withdrawal.
7. Is your child hypersensitive to: 1) noise (crowds yelling at sports events, vacuum cleaner); 2) bright light (closes blinds, uses sunglasses indoors); 3) vibration/touch as when someone bumps into their bed; or 4) certain odors.

Be sure to notice when symptoms occur and whether any particular exposures/odors may have preceded them. For example, do felt-tip markers, engine exhaust, fragrances, odorous cleaning products such as bleach, nail polish/remover, hair spray, and phenolic disinfectants (those whose names end in “-sol”) now make your child feel ill or trigger symptoms? Use EPA’s “Tools for Schools” to work with your school district to choose the least toxic cleaning and pest control approaches, e.g., integrated pest management where least toxic approaches are used first. Another excellent resource is the Healthy Schools Network website.

My tip to parents: Record symptoms on a calendar, along with where your child was that day, foods they ate, and symptoms such as dark eye circles (so-called “raccoon eyes”), headaches, nasal stuffiness or runny nose, fatigue, stomach ache etc., rating symptom severity on a 0-10 scale, with “5″ being moderate symptoms and “10″ severe or disabling. Seizures would be “10.”

For more information and a validated, diagnostic questionnaire on TILT, see the Quick Environmental Exposure and Sensitivity Inventory, or QEESI, that can be downloaded without charge from my website. Fill it out, score it, and take it to your doctor along with your calendar/graph of symptoms over time.

Chemical intolerance contributes to the illnesses of 1 in 5 patients but the condition seldom figures in their diagnosis, according to clinical research published July 9 in the journal Annals of Family Medicine.

(Note: I was a co-author of the paper, which is available from the Annals of Family Medicine website. The study struck a national nerve, and it has been reported widely in the news media, including highly-read Medscape.com, which ran an excellent account. You’ll need a free Medscape login and password to view it. Other accounts are published at Science Daily and Fox News.)

Here’s a summary sent to the media:

Chemical intolerance contributes to the illnesses of 1 in 5 patients but the condition seldom figures in their diagnosis, according to clinical research published July 9 in the journal Annals of Family Medicine.

Clinical tools are available to identify chemical intolerance but health care practitioners may not be using them, said lead author Dr. David Katerndahl, professor of family and community medicine at the University of Texas Health Science Center at San Antonio.

The study’s authors said physicians need to know how chemical intolerance affects certain people and understand that conventional therapies can be ineffective. Some patients would improve by avoiding certain chemicals, foods and even medical prescriptions, the authors said.

Patients with chemical intolerance go to the doctor more than others, are prone to having multi-system symptoms and are more apt to have to quit their job due to physical impairment, the authors said.

The study involved 400 patients who gave personal health information while waiting to be seen at primary care clinics in San Antonio. The researchers asked the patients to respond to 90 questions about their illnesses, mental health and ability to function.

In the end, the authors said, 20.3 percent of the patients questioned met the scientific criteria for chemical intolerance.

Researchers surveyed patients with chronic conditions such as allergies, asthma, diabetes and heart disease. They excluded patients who were at the clinics for acute conditions such as earaches, flu or bone fractures.

The origins of chemical intolerance have been the subject of much speculation, the authors acknowledge, but the condition is also understudied. People with chemical intolerance, or “CI,” are highly sensitive to common substances such as cleaning products, tobacco smoke, fragrances, pesticides, new carpet and auto exhaust.

“Apart from the debate over causality, the fact that so many patients meet the criteria for chemical intolerance holds particular relevance for primary care providers,” said Dr. Katerndahl.

Chemically intolerant individuals often have symptoms that affect multiple organ systems simultaneously, especially the nervous system. Symptoms commonly include fatigue, changes in mood, difficulty thinking and digestive problems.

Study co-authors are Dr. Claudia S. Miller, professor in environmental and occupational medicine, vice chair of family and community medicine, and director of the South Texas Environmental Education and Research (STEER) Program, among her roles; Dr. Raymond F. Palmer, associate professor of family and community medicine at the University of Texas Health Science Center at San Antonio; and Dr. Iris R. Bell, professor emeritus in the Department of Family and Community Medicine at the University of Arizona College of Medicine and research professor in the College of Nursing at the University of Arizona.

An added comment: Healthcare professionals as well as the public can assess chemical, food, drug and other intolerances using the QEESI, the Quick Environmental Exposure and Sensitivity Inventory, which I developed. It is available free for download.