Who is Looking After Our Kids?
CHAPTER 12
Multiple Chemical Sensitivity:
Causes, Mechanisms and TreatmentIn its advanced stages, patients with multiple chemical sensitivities (MCS) must live in the proverbial "glass house" which must remain virtually free of air-borne or fugitive chemicals. For these sufferers, even traces of vapors from perfumes, petrochemicals, cleaning solutions, tobacco smoke, paints, varnishes, and many other commercial products can cause illness. Chemical odors which an ordinary person would scarcely notice can be incapacitating to patients with MCS. Considering that MCS is poorly understood and its very existence questioned by some medical authorities, the lot of MCS patients is often singularly lonely and difficult.
Although MCS remains controversial at some levels, this syndrome is now recognized as a disease by several federal agencies including The Social Security Administration, the Department of Housing and
Urban Development, and in the Americans with Disability Act of July 26, 1990. It has been the object of intense Congressional interest and investigation as a result of large numbers of veterans from the Persian Gulf conflict returning with many symptoms consistent with MCS syndrome.
What are the causes of multiple chemical sensitivity?
The prime cause of MCS must be attributed to the massive increase in private and public use of volatile organic compounds (VOCs) in the past 50 years. VOCs have several unique characteristics. They tend to be volatile and escape into the air as fugitive chemicals. Being lipid or fat soluble, they have an affinity for the lipid tissues of the body. The brain is a prime target because of its high lipid content and rich blood supply. Cell membranes, being largely made up of lipids, are also subject to attack.
Before World War II, less than one billion pounds per year of volatile organic compounds were produced by the United States. By 1976, production had soared to 163 billion pounds per year, (1) confirming the prevalence of these chemicals. A study of 400 residents of New Jersey, North Dakota, and North Carolina found traces of up to 10 volatile organic compounds in exhaled breaths of the subjects. (1)
The increasing stress on energy efficiency in modern buildings combined with increasing use of commercial chemicals stand as the prime causes of MCS.
The mechanism for multiple chemical sensitivity?
The liver has been referred to as the chemical factory of the body. One of the offices of the liver is that of chemical detoxification. Although the process is complicated, the detoxification process is centered around two enzyme systems.
The first is centered around an enzyme system called cytochrome oxidase P450. This enzyme converts (by an oxidative process) the lipid-soluble state of volatile organic compounds into a more water-soluble form, in which they can be more readily excreted by the kidneys.
There is an adverse side to this process in that the water-soluble forms of the VOCs may be more toxic than their parent compounds.
If the second phase of detoxification, conjugation, does not keep pace with the increased volume of VOCs processed by the first, oxidative phase, the result may be heightened toxicity.
Nature never designed these enzyme systems to process the massive burden of volatile organic compounds with which they are now commonly confronted. There is evidence that the P450 system becomes weakened in patients with Multiple Chemical Sensitivity, (2-3) as a result of prolonged exposures or a single massive exposure to VOCs. By a process of "suicide inactivation," these enzymes may become progressively weakened and crippled by toxic exposures so the liver is less able to clear these chemicals from the system.
The age at which exposures take place is an important consideration. It has been estimated that children and fetuses are up to 10 times more vulnerable to toxic chemicals than adults. (4,5) It is increasingly common for environmental physicians to see children with MCS, and unless current exposure levels to volatile organic compounds are rapidly reduced, this pattern is bound to increase.
Frequency of multiple chemical sensitivity
MCS was reviewed on a recent television program entitled "The Nature of Things: Allergies, Nothing to Sneeze at" The host of the program, David Suzuki, reported on his investigations of environmental illness. Some environmental centers, according to Suzuki, estimate that 30 million North Americans suffer from some degree of chemical sensitivity. Of these, 1% develop intolerance to virtually all chemicals.
Diagnosis of multiple chemical sensitivity
Two types of studies are useful in confirming MCS in patients exposed to such chemicals as pesticides and/or solvent vapors.
The first is the triple-headed SPECT brain scan, which involves the intravenous injection of radioactive glucose. This is taken up by the brain and photographed by scintigraphy.
A research study, with sponsors including the US Department of Health and Human Services, found that SPECT scans of patients exposed to neurotoxic chemicals indicated a "random thinning of cortical gray matter" (tissue in the cortex of the brain). (6)
The authors of the study concluded that symptomatic patients with a history of chemical exposures had significantly diminished cerebral blood flow and that "significant impairment of brain function may last for years after exposure to neurotoxic chemicals has ceased."
The second approach is to evaluate patients with MCS for disorders of porphyrin metabolism. Because many patients with MCS demonstrate neuro psychiatric symptoms similar to the porphyrias, well over 50% of patients with MCS have been found to have abnormal porphyrin tests in pilot studies. One such study is now being conducted at the Mayo Clinic in Rochester, Minnesota, not yet published.
Treatment of multiple chemical sensitivity
It may be just an educated guess, but it is probably not far from wrong to say 90% of treatment of MCS is the avoidance of fugitive chemicals. Much like radiation, the adverse effects of chemical exposures are probably cumulative. Once the process of chemical sensitization begins, each additional exposure may result in further cascading of the problem.
In our experience, many employees who became ill with MCS due to occupational chemical exposure may lead perfectly normal and active lives in controlled conditions where fugitive VOCs are absent or minimal. However, if and when they attempt to return to former conditions in the workplace, they quickly become ill again.
This raises a very interesting question: Why don't we clean up schools and the workplaces to a level of air purity that can be tolerated by patients with MCS? These unfortunates may be thought of as the miners' canaries. The canaries, being more sensitive to toxic gases, quickly died when gases escaped into the mines, thus warning the miners of danger. Patients with MCS may serve the same warning role for the rest of us. Unless we clean up indoor environments to a level of safety that they can tolerate, there may be many more victims.
Additional treatments include the antioxidant vitamins (vitamins E and C and beta carotene), chemical-free and pesticide-free foods, and other nutritive measures to enhance the detoxification pathways of the body. Some centers use intensive sauna programs for detoxification. Patients may do something similar by taking Epsom salt baths at home. However, this should be done cautiously, and under professional supervision.
If there is significant illness from chemical exposures, treatments should not be attempted without professional supervision.
References
1. Multiple Chemical Sensitivities. Washington, DC: National Research Council, National Academy Press; 1989:52.
2. Rea WJ. Chemical Sensitivity. Vol 1. Boca Raton, FL: Lewis Publishers; 1993;65: 71-73.
3. Beaune P, et al. Autoantibodies against cytochrome P450; role in human disease. Adv Pharmacol. 1994;30: 199245. (Note This article uses the term "suicide inactivation" as a mechanism whereby foreign chemicals may damage and deactivate the P450 enzyme system.)
4. Pesticides in Diets of Infants and Children. Washington, DC: National Research Council, National Academy Press; 1993:3.
5. Neurotoxicity: Identifying and Controlling Poisons of the Nervous System. Washington, DC:Superintendent of Documents, Government Printing Office; April 1990:49. GPO Stock#052-003-01184-1.
6. Heuser G, Mens 1, Alarrios F. NeuroSPECT Findings in patients exposed to neurotoxic chemicals. Toxicol Industr Health. 1994 (4/8) :861 -871.
Recommended reading
Ashford NA, Miller CS. Chemical Exposures, Low Levels, and High Stakes. New York:Van Nostrand Reinhold;1991.
Multiple Chemical Sensitivities. Washington, DC: National Research Council, National Academy Press; 1992.
Rea Wl. Chemical Sensitivity. Vol I, II and III. Boca Raton, FL: Lewis Publishers; Vol 1, 1992; Vol 11, 1994, Vol.III,1995 .