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The Environmental Medicine Approach to Neurobehavioral Disord ers. ALBERT F. ROBBINS, D.O.,MSPH Fellow, American Academy of Environmental Medicine Board Certified in Occupational/Environmental Medicine & Preventive Medicine. ?. Environmental Medicine. What is it?

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the environmental medicine approach to neurobehavioral disord ers
The EnvironmentalMedicine Approach toNeurobehavioral Disorders


Fellow, American Academy of Environmental Medicine

Board Certified in Occupational/Environmental Medicine

& Preventive Medicine



Environmental Medicine

  • What is it?
  • Who practices it?
  • Why is it a growing field?
the environmental investigation
The EnvironmentalInvestigation

Environmental factors…what we are exposed to…as causes of conditions and as triggers of symptoms—are investigated as part of a comprehensive medical workup.

shift happens
Shift Happens!
  • Instead of just seeing a neurologist or a psychiatrist, consider an environmental physician
  • Some neurologic conditions such as OCD, tics and depression, improve when environmental factors are addressed
  • Many chronic illnesses may improve with an environmental medical PARADIGM SHIFT !
causes of ocd ts and depression
Causes of OCD, TS and Depression
  • Dysfunction of the neurotransmitter systems
  • Multiple other neurochemical systems are implicated
  • Genetic factors most likely increase susceptibility
  • Environmental factors play a larger role than is currently recognized

Specialized chemical messengers that allow brain cells to “communicate” or talk with one another.

effect of neurotransmitters
Effect of Neurotransmitters
  • Neurotransmitters are tied to mood; serotonin, dopamine, acetylcholine, endorphins and histamine are affected;
  • With every thought the brain releases neuro-chemicals;
  • Emotions are felt in the body.
some key neurotransmitters
Some Key Neurotransmitters
  • Dopamine: feel good--marijuana, cocaine, speed
  • GABA: needed in depression; a natural relaxant
  • Endorphins: Sense of well being; improved with running and aerobic exercise
  • Serotonin: optimism; Prozac and SSRI’s
  • Acetylcholine: memory and alertness; pesticide exposure
  • Histamine: Found in many bodily systems
neurologic disorders as environmental illnesses
Neurologic Disorders as Environmental Illnesses

A neurologic disorder is considered an environmental illness if it is “triggered by environmental factors.”

Principles & Practice of Environmental Medicine, Tarcher

an environmental approach
An EnvironmentalApproach
  • Find what is missing in the internal environment;
  • Eliminatewhat is toxic or infectious in the internal environment;
  • Determinewhat to avoid in the external environment;
  • Unmaskand treathidden allergy.
is it genetic or environmental
Is It Genetic or Environmental?

If genes load the gun, then the environment pulls the trigger. Sidney Baker, MD

We can change our environmental exposures, our diet and habits. . . and change our health!

basic principles of em from theron randolph md
Basic Principles of EMfrom Theron Randolph, MD
  • Allergic Load
  • “Masking”
  • Competitive inhibition-between nutrients and chemicals
  • Bioaccumulation
  • Maladaptation
the goals of environmental medicine
The Goals of Environmental Medicine
  • Find the environmental causes and aggravating factors of disease
  • Develop a treatment protocol to eliminate symptoms and stop the progression of the disease
  • Create a positive healing environment
disease resistance vs susceptibility factors you can control
Disease Resistance vs. Susceptibility Factors you can control
  • Develop a good mental attitude
  • Create a healthy environment
  • Learn to handle stress well
  • Establish health habits
  • Do things that turn on good genes
  • Use safe medications
playing sherlock holmes
Playing Sherlock Holmes
  • What was the patient exposed to?
  • A search for environmental clues or triggers
  • Observe where, when , and what causes symptoms

Think Outside the Box!

Man with a new idea is a crank until the idea succeeds.

Mark Twain

Nothing is more powerful than an idea whose time has come. Victor Hugo


Case Report #1

Tourette syndrome: Thinking outside the box in a search for triggers and successful treatment…Role of allergens

non genetic contributions
Non-Genetic Contributions

The individual variations in character, course and degree of severity by which TS is manifested cannot be explained by genetic hypotheses alone

Tourette Syndrome Association

total allergic load
Total Allergic Load

The total of the factors contributing to the production of allergic disease and symptoms such as tics, depending on patient susceptibility.

The allergic load staircase to reactions:

___ Emotions




allergic threshold
Allergic Threshold
  • Each factor adds to the total allergic load until a final stress causes allergic symptoms…the threshold effect
  • Infections, emotions, exposures, and metabolic disease add to the allergic load intolerance
  • The cumulative effect pushes the patient closer to reactions or symptoms

James C. Breneman, MD

asthma and tics
Asthma and Tics
  • Asthma & tics may occur together
  • Underlying allergies and chemical sensitivities are common triggers
  • An environmental approach with Neutralization Immunotherapy works well for both asthma and tic disorders, decreasing the need for medications
tic triggers
Tic Triggers
  • Stress factors and emotions
  • Food allergies and eating behavior
  • Chemicals and drugs
  • Allergens to pollens, dust, molds, animals
  • Odors, fragrances, smells, fumes
  • Seasons
  • Polluted Indoor air environments
  • Sensory stimulation (light, touch, sound)
cat allergy
Cat Allergy
  • Exposure can cause tics and other neurologic symptoms; headaches common
  • May need to remove the cat from house
  • It may take up to 6 months to remove all cat dander from the home
  • Furniture and clothing are contaminated
  • Dander floats through the air.
chronic stress
Chronic Stress

Stress depletes brain nutrients and affects hormone balance

Chronic exposure to stress hormones can disrupt the production of neuro-transmitters in the brain including serotonin, dopamine, and acetylcholine. David Perlmutter, MD



  • Special diets
  • Cow’s Milk
  • Food additives, colorings, flavorings
  • Hidden infection-strep and
  • Nutrient benefits
  • Chemical exposures

Case Report #2

Help for mood swings, OCD, and tics with environmental medicine.

Chemical exposures

Inhalant and food allergy treatment

causes of depression

Causes of Depression

Hidden allergy: food, mold and more

Chronic stress; Lack of sleep

Hidden infection: fungal, viral, bacterial

Toxic exposures

Drugs-medication effects

Poor diet

what to avoid
What to Avoid
  • Pollutants
  • Allergens
  • Chemicals & toxins
  • Drugs
  • Excititoxins
  • Trans fats
  • infections
foods depression
Foods & Depression
  • Food allergy causes and contributes to depression,irritability,ADHD, tics, OCD
  • Determine what you are allergic to
  • Foods & food additives
  • Yeast allergy and infection
  • Address nutritional deficiencies
inflammation allergy
Inflammation & Allergy

All chronic illness involves inflammation at some level that cuts across many medical specialties.

Signs and symptoms of illness in one part of the body can be a clue to a more widespread multisystem generalized disease throughout the body (ex: allergic fatigue).

William Meggs, MD

the missing link
The Missing Link

Inflammation is the common thread linking many of the chronic (allergic) diseases and autoimmune diseases

Uncontrolled inflammation is bad;it causes the immune system to overwork

It is like a car without brakes. . . It can’t be stopped

William Meggs, M.D.

Inflammation is influenced by many environmental factors: what we eat, breathe, drink, use, do, think and feel.

Its effect “ripples” and can be felt throughout the body.

brain inflammation
Brain Inflammation

Dr. Meggs reports that brain inflammation is thought to be related to:

Depression Anxiety Allergy

Chemical hypersensitivity Irritability

Tremors Seizures Fatigue

Headaches Brain fog & spaciness

Memory disturbances

Strokes Autoimmune diseases

c reactive protein crp
C-Reactive Protein (CRP)

This test measures generalized inflammation in the body

Inflammation is a sign your brain neurons are under attack from excessive free radicals


Chemical Sensitivity:

The Silent Epidemic


There’s a silent epidemic out there guys,

it’s a masked illness wearing a disguise.

The Musician/Physician

a masked illness
A Masked Illness
  • Repetitious exposures to allergic foods, inhalants and chemicals can lead to a masking effect
  • Once masked, symptoms become chronic
  • The link between the exposure and the symptoms cannot be determined until there is a break in the exposure pattern
how to unmask the illness
How to Unmask the Illness
  • Identify and avoid allergic & environmental triggers
  • Create environmental controls
  • Learn stress reduction techniques
  • Allergy evaluation and treatment
competitive inhibition
Competitive Inhibition

Nutrients and chemicals compete for receptors at the cellular level

Nutrients are important for chemical detoxification, immune system support and optimal cellular and neurologic function

  • When toxic, infectious or allergic substances accumulate in the body, they can set off biological regulatory system abnormalities which can trigger symptoms anywhere
  • The body’s enzyme and detoxification systems may be adversely affected
  • Lead and mercury are neurotoxic
  • The body’s attempt to adjust to an offending, allergic or irritating environmental agent one is exposed to.
  • Symptoms are the result of the body’s attempt to adapt …or more precisely a “maladaptation.”
  • With maladaptation, symptoms becomes chronic and masked.
effects of toxic chemicals
Effects of Toxic Chemicals
  • Decrease the nutrient pool
  • Damage and overload biological regulatory pathways and systems
  • Interfere with detoxification pathways
  • May adversely affect neurotransmitter function

Example: some drugs, formaldehyde products, pesticides, food additives, cosmetics, VOC’s

many chemicals drugs are
Many Chemicals & Drugs Are:
  • Stored in lipid cell membranes
  • Damage detoxification pathways
  • Activate the immune system
  • Aggravate allergies
  • Adversely affect the brain and nervous system

Chemicals can have a pharmacologic” effect

american chemical dream
American ChemicalDream

We are the first generation on earth to be exposed to toxic chemicals from the womb to the grave. Rachel Carson Silent Spring, 1952

We’ve become the prozac nation seeking chemical gratification. The “Musician/Physician”

toxic metal overload can increase chemical sensitivity
Toxic Metal Overload Can Increase Chemical Sensitivity
  • Mercury is a neurotoxin The Mad Hatter who made felt hats in Alice in Wonderland; use caution with fish and dental amalgams, some paints
  • Lead is a neurotoxin Paints and lead pipes in old homes, some ceramic dishes
  • Blood, hair and/or urine tests are available for testing these and other toxic metals (i.e. cadmium)
pesticide exposure
Pesticide Exposure
  • Delayed, persistent or latent neuropsychogical effects on the central nervous system. (Organophosphates)
  • Common symptoms include impaired memory and concentration, confusion, agitation, irritability, insomnia and nervousness
  • Pyrethroids also can cause allergic and toxic reactions.
avoid pesticides
Avoid Pesticides!
  • Say no to pesticides…they target the nervous system…and they can build up in the body
  • Pesticides are neurotoxins
  • Pesticides are linked to Parkinson’s and ALS
  • Pesticides are designed to kill living organisms
  • They promote free radical production and inflammation

Case Report #3

Chemical sensitivity as a major treatable cause of Tourette syndrome

Example: Removal of Plug Ins

and scented candles

  • Allergy is the great masquerader”
  • Allergy mimics well recognized disease entities
  • Any organ system of the body can be the target organ of allergy

Allergy can cause symptoms anywhere!

defining allergy
Defining Allergy

A hypersensitivity to a specific substance which in a similar quantity doesn’t bother other people.

Webster’s Dictionary

allergy redefined
Allergy Redefined

It’s not just IgE!

  • Immune and nonimmune mediators of allergic disease are currently recognized
  • Pharmacologic reactions to drugs and chemicals are included in the definition of allergy and labeled anaphylactoid

World Health Organization

neurologic allergy
Neurologic Allergy
  • Food & chemical allergy reactions cause neurologic symptoms. Headache, depression, irritability, fatigue & even tics can be allergic symptoms!
    • Inhalant allergens also can affect the nervous system. Examples: cat, mountain cedar, and molds.
a hive of the brain
A Hive of the Brain?

It is conceivable that any food that can cause a hive of the skin could also cause a hive of the brain. Edema in specific areas of the brain could affect the personality, motor function, reflex activity, or almost any central nervous system mechanism.

George Ulett M.D.

excitotoxins are chemicals
Excitotoxinsare Chemicals!

Some artificial sweeteners, MSG, food preservatives like sulfites, artificial food colorings and artificial flavorings can overexcite brain neurons. The Feingold Hypothesis

All studies confirmed that some hyperactive children may benefit from an additive free diet. Jonathan Brostoff, MD

food additives
Artificial colorings

Benzoic Acid

Brominated vegetable oil





Saccharin, Splenda







Artificial flavorings

Food Additives
chemical sensitivity
Chemical Sensitivity
  • A controversial diagnosis.
  • Rarely diagnosed by physicians!
  • An allergy or sensitivity to very low levels of chemicals or foods

Many variations of chemical sensitivity exist. Multiple Chemical Sensitivity (MCS) may not be one disease. Chemical Exposures, Low Levels and High Stakes, Ashford & Miller

the real controversy
The Real Controversy

No one knows where we came from, where we are going or what we are supposed to be doing here!

Woody Allen

chemical allergy product examples
Formaldehyde:wood cabinets, insulation & new clothing, beauty salons, new buildings

Latex:elastic bands, condoms, and gloves

Sulfites:food and wine preservative

Fabric softeners: sheets, towels, clothing

Fragrances & perfumes: cosmetic, personal care

Pesticides:foods, lawns, homes, offices

Phenols: Lysol & tin can linings

Benzenes: aerosol sprays, plug-ins, flea collars

and dips

Chemical Allergy: Product Examples
be aware chemical triggers
Plastic water bottles

Cleaning products

Aerosol sprays

Scented products and tobacco smoke on other people

Gas heat


Scented candles



Dry cleaning fluids

Be Aware: Chemical Triggers
what are vocs
What are VOCs?

Volatile organic compounds are gases that are released from certain products….This is called outgassing of chemicals. They can be inhaled and go directly to the brain where they can cause damage.

common sources of vocs
Common Sources of VOCs

Outgassing of chemicals from:

New building materials, carpet, paints, glues, sealers, formaldehyde wood products, gas heat and exhaust fumes, dry cleaned clothing and new clothing, beauty salons hair and nail products, smoke products, musty environments

smells and the brain
Smells and the Brain

Odors go directly to the limbic system of the brain

Odors can have a powerful effect on behavior and neurologic function

neurobehavioral disorders and chemical exposure
Neurobehavioral Disorders and Chemical Exposure

The toxic effects of chemical exposure may be heralded by depression, fatigue, and irritability long before more tangible effects appear. Tarcher

sick building syndrome
Sick Building Syndrome

Neurologic symptoms are common in the Sick Building Syndrome

National Institutes of Health

Causes of SBS:

  • Chemical, dust, moisture and mold exposures
  • Outgassing of new building materials
  • Inadequate ventilation
mold a nervous system irritant
Mold: A NervousSystem Irritant

Molds release spores, VOC’s and mycotoxins

Solution: Eliminate the moisture and mold can’t grow (CDC)…

Some people must move out of their homes to avoid mold exposure

mold allergy
Mold Allergy

Associated with movement disorders

Irritability, itching, respiratory problems, and fatigue are common symptoms

Neurologic symptoms are commonly seen in mold sensitive patients

tics a moldy home
Tics & a Moldy Home

Two children developed a severe tic disorder while living in a mold contaminated home. When their mold allergies were treated and the home was remediated , tic symptoms were significantly reduced.

mold related foods
Pickled & fermented foods




Baked goods

Fruit juices

Sweets & maple syrup


Wine and beer

molds and the fungal connection
Molds and the Fungal Connection
  • Candida Sensitivity Syndrome can occur after frequent use of antibiotics and steroids, and in mold and food sensitive individuals.
  • Common in immunosuppressed patients
  • Related to increased chemical sensitivity
  • Diagnosis by testing for both allergy and infection
  • Treatment should be comprehensive
mental or environmental
Mental or Environmental
  • Some molds produce “mycotoxins” that are neurotoxic
  • Many chemicals in common use are
  • suspected or known neurotoxins
  • Over 60,000 chemicals in common use
good bad genes
Good & Bad Genes

A negative environment can activate bad genes and prevent good genes from being turned on.

Rx: Create a positive environment!

environmental control
Environmental Control
  • Create an allergy free home & bedroom
  • Avoid dusts, molds, animals, chemical aerosol sprays
  • Use hypoallergenic personal care products : skin, hair clothing, bedding
  • Avoid common indoor chemical exposures…including fragrances, pesticides, scented products & fabric softeners
allergy free bedroom
Nonallergic bedding

Remove dust collectors

Close windows

Keep A/C on

Use an Air purifier

No fabric softeners

No scented candles

No stuffed animals or toys

Clean ceiling fan blades

Change filters

No fragrances

No air fresheners or plug ins

Allergy Free Bedroom
the ultimate avoidance
The Ultimate Avoidance

Removal of the allergic patient from the offending environment

A 9 year old girl was highly allergic to tree pollens, very prevalent in her area. When she moved from North Carolina to San Diego and was relieved of all tics; after 2 years she is still doing well

allergy neutralization what it is
Allergy Neutralization:What it is

The neutralization technique involves intradermal endpoint titration of progressively weaker dilutions of the food or inhalant allergen to find the first negative wheal or neutralizing dose.

Relief At Last, Joseph Miller, MD

neutralizating dose
Neutralizating Dose
  • The allergy neutralizing dose is usually the strongest negative wheal in serial dilution endpoint allergy skin testing
  • It is the maximum tolerated intradermal concentration measured by the Miller method
  • The homeostasis restoring dose
  • The harmonic balancing dose
  • The optimal therapeutic dose
allergy coverage
Allergy Coverage
  • Inhalant allergens must be fully treated for best results. Learn your local pollens and molds.
  • The treatment dose for inhalants is once per week, and twice per week for foods. For tic disorders, universal coverage for inhalents and foods is usually advised
benefit of neutralization
Benefit of Neutralization
  • Allows the relief of symptoms in both chronic and acute states
  • Establishes a treatment dose which when used over a period of time allows the body to approach homeostasis.

Carlton Lee, MD

(Escalation immunotherapy is not recommended for tic disorders)

Albert Robbins, DO MSPH


Case Report #4

  • Medical history shows toxic exposures to pesticides as a child
  • Severe tics not helped with medication
  • Neutralization allergy treatment very helpful
  • Nutrient intervention helped
  • Environmental controls and rotation diet were important keys to recovery
food allergy
Food Allergy
  • Hidden food allergy can lead to “leaky gut syndrome” and possible infection
  • Gut yeast infections can aggravate food allergy; secondary complications can include immune and nervous system dysfunction
  • Chemical sensitivities and food sensitivities overlap and are interrelated
phenolic compounds
Phenolic Compounds

Cross reactivity among foods and other allergens may be through their phenolic content

Phenolic compounds are found in most common foods…We can neutralize (desensitize) to phenol and this decreases both food and chemical sensitivity

  • Involves many neurologic symptoms including fatigue & irritability
  • Hidden food allergy-addiction aggravates gut ecology…and yeast
  • Food allergy causes hypoglycemia
  • Autonomic nervous system dysfunction
  • Associated with physical & psycho-logical symptoms
allergy and adhd
Allergy and ADHD
  • Doris Rapp, MD advises that many children with ADHD have hidden, undetected allergies.
    • Look for H. pylori, parasites, and gut yeast
    • Investigate for inhalant and food allergy
    • Determine if the child is chemically sensitive

The brain requires a steady source of slow burning carbs

Restriction of carbohydrates may trigger hypoglycemia, irritability, cognitive dysfunction and fatigue

Hypoglycemia and fluctuating blood glucose levels can cause concentration and attention problems, irritability and moods swings

fast foods
Fast Foods
  • eating on the run leads to the establishment of poor eating habits
  • eliminate junk foods
  • cook from scratch . . . eat organic whenever possible
  • eat at home
exorphins and foods
Exorphins and Foods
  • Exorphins are produced from certain foods that bind opiate receptors strongly and may displace neurotransmitters
  • Wheat,which produces gliadin, may affect neurologic function
  • Milk, which produces casomorphin, may affect neurologic function
gluten sensitivity
Gluten Sensitivity
  • Can cause neurologic symptoms and problems
  • May not cause GI symptoms
  • Testing for Antigliadin antibody IgA and IgG and Antiendomysial antibodies
  • Be sure to eat gluten-containing foods for a day or two prior to testing.
generally helpful nutrients for tics ocd and depression
Generally Helpful Nutrientsfor Tics, OCD and Depression
  • Magnesium and zinc
  • B6, B3, B12; B Vitamin complex
  • Taurine and other amino acids
  • Phosphatidylserine
  • Omega 3’s and probiotics
  • Zinc
  • Nutrient analysis and clinical evaluation can help determine needs
mind body healing wayne dyer phd
Mind-Body HealingWayne Dyer, PhD

If you don’t believe in the mind-body connection, how do you wiggle your toes?

Every thought can be felt and interpreted at the cellular level.

get enough rest
Get Enough Rest
  • Missing sleep can cause long term damage to your brain cells
  • Sleep is a time when our cells can concentrate on repairing themselves and making new cells
  • While sleeping levels of neurotransmitters are normalized and waste products (like free radicals) are removed from the brain
causes of insomnia
Causes of Insomnia
  • Too much caffeine
  • Smoking
  • Inadequate exercise
  • Thyroid or other metabolic disorders
  • Alcoholism
  • Stress
  • Certain drugs…. legal and illegal
zen vironmental healing
  • Learn stress reduction techniques
  • Have fun. Do what you love, love what you do
  • Get regular exercise
  • Get adequate rest
  • Use common sense . . . unclutter your life
  • Be cool . . . and calm . . . and slow down.
wisdom for health
Wisdom for Health

Maxim: Wisdom is avoiding all thoughts that weaken you.

Wayne Dyer, PhD

Corollary: It is wise to avoid all negative environmentalfactors that weaken you.

Albert Robbins, DO

Wisdom is knowing the correct path to take, integrity is taking it.

Steven Covey


Some studies suggest that laughter really is the best medicine.

zen vironmental healing102

Seek harmony between your mind, body, spirit, emotions and your environment for optimal healing.

Stay on your own path and you will feel balanced and centered and natural healing is promoted! “Zen Guitar” Philip Sudo

environmental resources
Environmental Resources
  • American Environmental Health Foundation, Dallas
hypoallergenic nutrients
Hypoallergenic Nutrients
  • Wellness Health & Pharmacy
  • 800-634-1380
  • Abrams Royal Pharmacy, Dallas 800-458-0804;
  • New Beginnings Nutritionals 913-754-0458
  • Continued
more hypoallergenic nutrients
More Hypoallergenic Nutrients 800-662-2544 800-530-1982