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.

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?