Posts tagged ‘masking’

Gulf War Research Misses the Point (Again)

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.

Photo of Civil War soldiers

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.

Why TILT Matters

Scientists who discovered the Higgs boson chased shadows and silhouettes for months. Enduring skepticism, they finally produced proof that led on March 14, 2013, to official confirmation of the mysterious and coveted “God particle.”

The quest “was like seeing a person in the fog — you knew there was a person there, but you weren’t sure who it was,” Andy Parker, a Cambridge professor and Higgs investigator, said.

Physics: There are 12 different matter particles — 6 quarks which make up protons and neutrons and 6 leptons, which include electrons and neutrinos. These are the basic building blocks of all matter. Then there are the 4 fundamental forces of the universe — gravity, electromagnetic, strong and weak forces. Each of the fundamental forces is thought to have its own boson, or carrier particle. The Higgs boson may transfer mass and it gains mass by passing through the invisible Higgs field, which extends across the entire universe.

Parallel to these important theories in physics, in medicine there are thousands of different named diseases but a very limited number of theories of disease under which they fall: the germ theory, immune theory and carcinogenesis (mutations leasing to cancer) being most recognizable by laymen.

Toxicant-induced Loss of Tolerance, like the Higgs boson, has remained in the shadows awaiting confirmation by the right researchers with the right tools. It is a transformative disease paradigm hidden by the ever present but elusive phenomenon “masking.” Masking is something we all experience but most are unaware of. It is related to addiction: If we are unmasked and go into withdrawal, e.g. from caffeine, favorite foods or alcohol, we may deliberately ingest a little hair of the dog that bit us to curtail unpleasant withdrawal symptoms.

What exactly is TILT? TILT is not simply an acronym — like the Higgs boson, it is a radical discovery that has the potential to transform medical science and neighboring fields of addiction, toxicology, psychology/psychiatry. Theories of disease affect how we think about underlying causes for illness, what researchers study, and suggest new ways to diagnose and treat conditions as diverse as fever, cancer and asthma. TILT joins a tiny handful of existing theories of disease, taking its place alongside the germ theory (infection), the immune theory, carcinogenesis and endocrine disruption. Currently we are in the germ theory stage in terms of our understanding of TILT, somewhere near the same stage as the germ theory of disease was in the 1890s or the immune theory of disease in the 1960s before the discovery of IgE.

Why has TILT come to light so late in human history — 120 years after the germ theory and 50 years after the immune theory of disease? It’s really no surprise: The causative agents for the germ theory and the immune theory have been with us since humankind began. On the other hand, the synthetic organic chemicals that have led to the 2-step TILT process are new since World War II. Doctors today don’t recognize the huge impact of indoor air. We spend 90 percent of our day indoors and exposed to tens of thousands of evolutionarily novel synthetic organic chemicals.

In science new theories emerge when we observe new patterns that point to an underlying structure we do not understand. Compelling anomalies spur the search for new theories. Observations that don’t fit prevailing paradigms point to the existence of new rules. A period of uncertainty and debate precedes the emergence of a new paradigm.

As with the Higgs boson, enough evidence currently exists to dispel doubts about TILT, but scientific inquiry is the key to advancing our understanding.

Air Pollution’s Harm Reaches into the Cradle

Chemically intolerant patients have for years moved from cities and other pollution sources, e.g., locations that burn wood to heat homes in winter, like parts of the Pacific Northwest, because of air pollution.

Where is the nation’s worst particulate pollution? In 2011, the American Lung Association published a list:

1. Bakersfield-Delano, Calif.
2. Fresno-Madera, Calif.
3. Pittsburgh-New Castle, Pa.
4. Los Angeles-Long Beach-Riverside, Calif.
5. Salt Lake City-Ogden-Clearfield, Utah
6. Provo-Orem, Utah
7. Visalia-Porterville, Calif.
8. Birmingham-Hoover-Cullman, Ala.
9. (tie) Hanford-Corcoran, Calif.; Logan, Utah; Sacramento-Yuba City, Calif.

Smog cloaks Salt Lake City’s skyline in 2011. (Photo: U.S. Environmental Protection Agency)

But this is new: Now couples are being advised to avoid air pollution when they try to conceive a baby. See the Salt Lake Tribune story “Docs: Wait – or get out of Utah’s bad air – to conceive.”

Cities in Utah endure days and even weeks of concentrated air pollution created by temporary atmospheric inversions. Common in winter, inversions trap air pollution close to the ground and push it to unhealthy levels. Utah is not alone. Los Angeles and Pittsburgh live with an even higher risk according to the American Lung Association.

If concentrated pollution can endanger a fetus, think about its overall threat to public health.

Exposures like those in Utah have the potential to initiate TILT, or Toxicant-induced Loss of Tolerance — the two-step disease process that is affecting growing numbers of people in the United States and abroad. Unfortunately, these people may not recognize their illness because of “masking.” Masking? Think of a frog placed in boiling water. Legend has it that the frog immediately jumps out, but if the water is slowly heated, the frog remains and boils to death. He adapts but to his detriment, even demise.

Masking is why we need doctors to screen patients with the QEESI, or Quick Environmental Exposure and Sensitivity Inventory, a medical questionnaire to detect loss of tolerance. And the rise in TILT shows the need for EMUs, or environmental medical units, to isolate the masking elements in patients. Then we can begin to “see” what these exposures are doing to us. The QEESI and EMU are important modern-day tools much like the microscope and physician Robert Koch’s 19th-century postulates, which helped “prove” the germ theory a century ago.

Salt Lake City is rightfully concerned about a new study in the journal Environmental Health Perspectives. It showed the risk of having a baby of low birth weight jumps 10 percent in areas with higher concentrations of particulate matter, including PM2.5. That’s the pollution that spikes in winter inversions and leads to Utah’s pollution. Ultrafine particles easily enter human airways and can travel through the nose to the brain’s limbic system, which regulates mood, behavior, short-term memory and a host cognitive functions.

There are no good choices to avoid the inversion threat, but inaction is the worst of them.

Are we going to become like China, where wealthier individuals equip their cars and homes with sophisticated air filtration devices? Where children wear masks in cities to filter air? What about the vast majority of families who cannot afford this?