The Environmental Medicine Approach to Neurobehavioral ...

1. The EnvironmentalMedicine Approach toNeurobehavioral Disorders ALBERT F. ROBBINS, D.O.,MSPH Allergycenter.com Fellow, American Academy of Environmental Medicine Board Certified in Occupational/Environmental Medicine & Preventive Medicine

3. 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.

4. 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 !

5. 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

6. Neurotransmitters Specialized chemical messengers that allow brain cells to �communicate� or talk with one another.

7. 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.

8. 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

9. 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

10. An EnvironmentalApproach Find what is missing in the internal environment; Eliminate what is toxic or infectious in the internal environment; Determine what to avoid in the external environment; Unmask and treat hidden allergy.

11. 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! Is It Genetic or Environmental?

12. Basic Principles of EMfrom Theron Randolph, MD Allergic Load �Masking� Competitive inhibition-between nutrients and chemicals Bioaccumulation Maladaptation

13. 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

14. 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

15. Playing Sherlock Holmes What was the patient exposed to? A search for environmental clues or triggers Observe where, when , and what causes symptoms

18. Focus on Tourette Syndrome, Tics and PANDAS

19. 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

20. 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 ___Foods __Inhalants __Chemicals

21. 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

22. 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

23. 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)

24. 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.

25. 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

28. Focus on Depression

29. 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

30. What to Avoid Pollutants Allergens Chemicals & toxins Drugs Excititoxins Trans fats infections

31. 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

32. Inflammation and the Brain

33. 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

34. 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.

35. 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.

36. 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

37. 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

40. 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

41. How to Unmask the Illness Identify and avoid allergic & environmental triggers Create environmental controls Learn stress reduction techniques Allergy evaluation and treatment

42. 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

43. Bioaccumulation 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

44. Maladaption 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.

45. 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

46. 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

47. 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�

48. 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)

49. 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.

50. 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

52. Allergy

53. Allergy 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!

54. Defining Allergy A hypersensitivity to a specific substance which in a similar quantity doesn�t bother other people. Webster�s Dictionary

55. 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

56. 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.

57. 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.

58. 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

59. Food Additives Artificial colorings Benzoic Acid Brominated vegetable oil BHA and BHT Parabins EDTA MSG Saccharin, Splenda Sulfites Nitrites Silicates Phosphates Carreagan Caffeine Artificial flavorings

60. 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

61. 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

62. 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

63. Be Aware: Chemical Triggers Plastic water bottles Cleaning products Aerosol sprays Scented products and tobacco smoke on other people Gas heat Mothballs Scented candles Incense Fabreze Dry cleaning fluids

64. 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.

65. 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

66. 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

67. 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

68. 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

69. 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

70. Mold Allergy Associated with movement disorders Irritability, itching, respiratory problems, and fatigue are common symptoms Neurologic symptoms are commonly seen in mold sensitive patients

71. 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.

72. MOLD RELATED FOODS Pickled & fermented foods Mushrooms Honey Cheese Baked goods Fruit juices Sweets & maple syrup Breads Wine and beer

73. 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

74. 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

75. Good & Bad Genes A negative environment can activate bad genes and prevent good genes from being turned on. Rx: Create a positive environment!

76. 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

77. 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

78. 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

79. Neutralization

80. 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

81. 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

82. 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

83. 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

85. Foods, Nutrition & Food Allergy

86. 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

87. 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

88. Hypoglycemia 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

89. 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

90. Carbohydrates 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

91. 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

92. 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

93. 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.

94. 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

95. The Body Mind Connection

96. 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.

97. 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

98. Causes of Insomnia Too much caffeine Smoking Inadequate exercise Thyroid or other metabolic disorders Alcoholism Stress Certain drugs�. legal and illegal

99. ZENVIRONMENTAL 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.

100. Wisdom for Health Maxim: Wisdom is avoiding all thoughts that weaken you. Wayne Dyer, PhD Corollary: It is wise to avoid all negative environmental factors that weaken you. Albert Robbins, DO Wisdom is knowing the correct path to take, integrity is taking it. Steven Covey

101. Smile! Some studies suggest that laughter really is the best medicine.

102. ZENVIRONMENTAL HEALING 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

103. Resources

104. Environmental Resources www.Allergystore.com www.AllergySolution.com www.missionallergy.com www.NEEDS.com American Environmental Health Foundation, Dallas www.aehf.com

105. Hypoallergenic Nutrients Wellness Health & Pharmacy www.Wellnesshealth.com www.NEEDS.com 800-634-1380 Abrams Royal Pharmacy, Dallas 800-458-0804; www.AbramsRoyalPharmacy.com New Beginnings Nutritionals 913-754-0458 www.nbnus.com Continued

106. More Hypoallergenic Nutrients www.kirkmanlabs.com www.klaire.com www.AllergyResearchGroup.com www.nordicnaturals.com 800-662-2544 www.nutritionals.com 800-530-1982