CISRA’s Synergy Health Newsletter

Issue 6. Asthma, MCS, Syndrome X, Adrenal Stress, Estrogen and Progesterone Patterns — AAEM Presentations (2000)

A Selection of Summaries of Presentations from American Academy of Environmental Medicine (AAEM) Meetings in 1998 —
Innovative Approaches to Asthma
Oxygen Therapy for Multiple Chemical Sensitivity (MCS)
Insulin Resistance and Syndrome X: Heart Disease, Diabetes and Obesity
Adrenal Stress Index and Carbohydrates: Patterns of Cortisol and DHEA
Patterns of Estrogen and Progesterone

by J. C. Waterhouse, Ph.D.

Several Presentations on Innovative Approaches to Asthma

A talk given by Gerald Ross, M.D., (Dallas, TX) on the management of asthma gave evidence for the role of factors beyond the usual “allergic” triggers. Exposures to environmental chemicals, food sensitivities, nutrition (e.g., antioxidants) are now being recognized as being important. References from the 1970’s through the 1990’s are cited showing odors, Candida albicans, ozone and hair sprays can worsen asthma. A disorder called Reactive Airways Dysfunction Syndrome (RADS), is “usually defined as clinical asthma and bronchial hyper responsiveness that results from a one-time, high dose exposure to airway irritants.” Many other reports are now describing repeated low-dose chemical exposure prior to developing RADS (Kipen et al., 1994, J. of Occupat. Med 36: 1133-1137). Several studies are cited showing that an Environmental Medicine approach was effective in producing a large improvement in asthma.

William Shrader, Jr., M.D., (Santa Fe, NM) discussed success with treatment of asthma with intravenous (IV) nutrients. He cited literature showing IV magnesium to be effective in treating acute asthma. He believes that additional nutrients should increase the effectiveness of the magnesium in treating asthma. The additional nutrients include several other minerals, including molybdenum, B vitamins, and vitamin C. His study indicates greater success when the infusions are given weekly for several months, and then later, less frequently (95% improvement was shown in lung function measurements for 9 patients treated for over a month).

Harry Philiber, M.D., (Metairie, LA) presented information on the “infraspinatus respiratory reflex, which he believes is important in a number of respiratory diseases, particularly in bronchial asthma. He originally treated this “painful to palpation” area near the scapula of the back by injecting it with lidocaine and dilute hydrocortisone. Later, he discovered that this treatment relieved asthma in patients who also had pain in this area of the back, and that this could occur when the patient was not even aware of any pain in the area before it was palpated. Some had complete relief, others only partial. For those who had only partial relief, there was a recurrence of the tenderness to palpation in the area near the scapula. He notes that in healthy people this tenderness does not occur. Only 30% of those with the tenderness had respiratory distress, including asthma, pneumonitis, bronchitis and respiratory failure. He described a number of case histories and includes some patients with lung cancer, who, of course, were not cured, but had significant improvement in their respiratory distress.

Dr. Philiber concludes “that the Infraspinatus Respiratory Reflex stimulates the sympathetic nervous system that then causes vasoconstriction of the pulmonary arterioles of the parenchyma of the lungs and the bronchial tree.” He states that according to the medical physiology textbook by Guyton, the hypoxia itself has been shown to increase alveolar and arteriolar constriction. Philibert then states that “this in turn causes a spreading of the process throughout the pulmonary system, including the bronchiolar tree. The result is bronchial asthma and respiratory distress.” The injection of lidocaine and cortisone removes the sympathetic stimulation and the vasoconstriction and allows normalization. He also believes that the reflex induces pulmonary ischemia, which predisposes to cancer development and increases susceptibility to infections producing pneumonia. He does not regard his treatment method as a panacea, but believes that it can be a very helpful adjunct in these conditions. [Editor’s note: This area of “tenderness to palpation” sounds similar to a fibromyalgia lesion, which can respond to injections such as this, but usually does recur, as this appears to. Thus, it may be that many of these asthma patients have fibromyalgia as well and might respond to guaifenesin. If this turns out to be true, the guaifenesin might permanently remove the lesion and thus relieve the asthma. Dr. St. Amand finds that some of his patients who have asthma find their asthma improve over time using guaifenesin. Since allergies/sensitivities are often associated with asthma and are also often found in fibromyalgia, it seems that the connection with fibromyalgia may well be a valid one. Dr. Philibert may be reached at: 213 Live Oak, Metairie, Louisiana 70005, 504-837-2727. An article on Dr. Philibert’s approach also appeared in the July 2000 issue of Alternative Medicine magazine (see www.alternativemedicine.com). He apparently has trained many other doctors in this technique and offers periodic seminars.]

Dr. Adrienne Buffaloe (New York, NY) then presented some cases with asthma. She made the point that both mold spores and their toxins can be important irritants and that foods commonly exacerbate asthma, with cow’s milk and eggs as the most frequent food triggers. Many chemicals can be identified as inducers (the original cause of the development of the asthma) and as triggers for asthma attacks. She also mentioned the use of low dose, titrated, subcutaneous histamine as an alternative to commercial antihistamines.

Dr. William Meggs (E. Carolina Univ. School of Medicine, Greenville, NC) discussed the airway manifestations of chemical sensitivity. He describes two recognized pathways leading to inflammation in asthma and rhinitis. One occurs when antigens cause an IgE reaction resulting in mast cell degranulation and the release of inflammatory mediators. The second type, called neurogenic inflammation, occurs when substance P and other mediators of inflammation are released from nerve endings. Chemical irritants have been shown to produce neurogenic inflammation when they bind to chemoreceptors on sensory nerves. An enzyme called neutral endopeptidase is able to down regulate the response, however, Dr. Meggs states that “it is now known that environmental substances can inhibit neutral endopeptidase.” Thus, ongoing exposures to certain substances could worsen the airway response by inhibiting the enzyme that helps turn off the response. There is also an interaction between immunogenic and neurogenic inflammation. Mast cell mediators from IgE-related degranulation can activate sensory nerves involved in neurogenic inflammation, causing substance P to be released. Substance P released through neurogenic inflammation can also cause mast cell degranulation, with the release of histamine and other inflammatory mediators. The article explains how chemical exposures in occupational and other settings can account for many airway symptoms, like asthma, rhinitis and reactive airways dysfunction syndrome (for example, see Meggs, 1993, Environ. Health Perspectives 101:234-238, Meggs et al, Archives Environ. Health (in press), just two of many references cited). Reactive upper airways dysfunction syndrome (RUDS) is described as chronic rhinitis that is associated with exposure to an irritant, persisting after the exposure. Meggs (1993) describes biopsy results from patients with RUDS, with distinctive features and lymphocytic infiltrates.

Richard Firshein, D.O. (New York, NY), presented “Asthma: An Emerging Environmental Crisis,” in which he discussed much current research on trends, possible causes and treatments. For instance, he discussed the increasing rates of asthma mortality, possibly related to a greater consumption of more refined foods, increased polyunsaturated fats and possible alterations of prostaglandin synthesis. Other things that may contribute include tobacco and allergen exposure, deficient omega-3 fatty acids and antioxidants, excess sodium and reduced rates of breast feeding. He also discussed studies showing that fish oil, antioxidants, diaphragmatic breathing, yoga techniques and magnesium can be helpful in treating asthma. Studies from the New England Journal of Medicine show the role of exposure to dust mite, cockroach and the mold Alternaria in asthma. Other studies from a variety of journals show the role of various chemicals, including formaldehyde and volatile organic compounds from newly painted indoor surfaces, among other things.

Adrienne Buffaloe, M.D. (New York, NY) presented an account of 4 cases of environmentally-induced asthma and their substantial recovery using environmental medicine. Three critical care nurses became ill at the same time, apparently due to a combination of chemicals that were identified in their environment (all were within OSHA safety standards). The nurses were found to have elevated xylene and 3-methylpentane in their blood. A 3 year old boy (son of one of the nurses who was pregnant with him when she was being exposed to the chemicals) also had elevated xylene in his blood. He had developed asthma the year before. The author describes the detoxification pathways and points out that blood levels are only a small portion of the total body chemical load, as much higher levels are found in the fat. Double blind tests of the patients reactions to glutaraldehyde, formaldehyde, and latex were done, with normal saline as the placebo. Each patient showed an exacerbation of symptoms when the toxic chemicals were given and did not react to the placebo. The patients went through a heat depuration program, with supervised aerobic exercise, dry heat exposure and oral nutrient supplementation, including titrated doses of niacin to help the body excrete the chemicals. During the first week, there were some exacerbations experienced, and then the patients improved during the remaining 5 weeks of the treatment period, and the level of toxic chemicals in their blood also generally improved. Inhalant and food hypersensitivities were diagnosed and treated and the patients were put on a four day Rotary Diversified Diet. A SPECT scan on one patient prior to her treatment showed hypoperfusion (reduced blood flow) in multiple areas consistent with chronic solvent exposure. The patients’ gastrointestinal symptoms and neurotoxicity symptoms (e.g., memory and concentration problems) also improved during their treatment and during the next 18 months. All of the child’s symptoms have cleared and the three adults have decreased their asthma medications by more than 80%.

Oxygen Therapy for Multiple Chemical Sensitivity (MCS)

Dr. William Rea, (Dallas, TX) reported on using oxygen as an adjunct in treating the chemically sensitive. At the Environmental Health Center in Dallas, Dr. Rea and his colleagues have been doing a 5-year study of tissue oxygenation using PaO2 and PvO2 (measures oxygen in arteries and veins). He reports that they have found a subgroup of chemically sensitive patients who have high PvO2, in the range of 25-45 mmHG. Using a porcelain mask and a non-plastic reservoir while delivering 6L/minute of 100% oxygen for 2 hours per day for 18 days resulted in significant improvement in the majority of patients. The improvement was usually correlated with a drop in PvO2, though not in all patients. Most of the patients had increased energy and improved ability to detoxify toxic chemicals. As a theoretical basis for the treatment, he referred to work by Hauss on the effect of pollutant exposure on end venous microcirculation, resulting in chronic hypoxia, with increased tissue acidosis. Dr. Rea states that this may result in decreased detoxification of chemicals in chemically sensitive patients.

[Editor’s note: There is also a theory that oxygen therapy may be helpful in MCS due to a subset of patients suffering from previously unrecognized chronic carbon monoxide poisoning (CO), either due to exogenous CO or endogenous (produced by the body under severe stress) CO, see http://mcsrr.org or http://carbonmonoxide.org or contact Albert Donnay, MCS Referral & Resources, Inc., 508 Westgate Rd, Baltimore MD 21229, 410-362-6400]

Insulin Resistance and Syndrome X: Heart Disease, Diabetes and Obesity

James Scheer, D.O., M.S., (N. Charleston, S. Carolina, james@coem.com) made a presentation on dietary influences on Syndrome X, a condition of insulin resistance, which often leads to obesity, diabetes and heart disease. The human diet of Paleolithic times (during which humans evolved) was based on a hunter-gatherer mode of life, with an emphasis on fish, wild game, vegetables, fruits and nuts (Eaton, 1985, New Engl. J. Med. 312:283-289; Eaton, 1996. J. Nutr 126:1732-1740). There was no refined sugar, breads, cereals or dairy products and there was a low level of saturated fats relative to unsaturated fats. In contrast, the modern diet is very high in sugar and refined carbohydrates, with decreasing fruit, vegetable and fat intake (with high percentages of saturated, trans and omega-6 fats). There has been an extremely low level of change in our human DNA (<.01) over the last 10,000 years and thus we are likely to still be best adapted to the hunter-gatherer diet rather than the modern one. Dr. Scheer pointed to obesity, diabetes mellitus, hypertension, hyperlipidemias and their associated cancers (breast, colon, prostate and others) as nutrition-related killer diseases, related to our modern macronutrient intake pattern.

Dr. Scheer identified several current dietary myths. The first myth is that there is a dietary need for a certain amount of carbohydrates daily. The second myth is that eating high fat foods necessarily leads to getting fat. Data from a published study is used to illustrate this point (Golay, 1996. Am. J. Clin. Nutr. 63:174). Two groups were compared consuming the same level of calories. The group obtaining 53% of their calories from fat lost more weight than a group receiving 25% of their calories from fat. The group with the higher fat diet had a 6-fold greater drop in their fasting insulin levels. He cites another article in the same journal (Willett, 1998) indicating that fat intake within the 18-40% range has little effect on body fatness and points out that a substantial decline in fat intake in the U.S. has actually corresponded to a massive increase in obesity. The third myth he exposed is the idea that you can’t get fat eating carbohydrates, which he illustrated with another study (Hudgins, 1996. J. Clin. Invest. 97:2081-2091).

Dr. Scheer described how the hormone insulin plays a crucial role in weight gain. Insulin’s role in the body is to lower blood glucose and to convert glucose and protein to fat and to help store dietary fat (thus increasing body fat). It also increases cholesterol production and kidney fluid retention (which contributes to hypertension). Insulin stimulates arterial muscle cell growth and the use of glucose (not fat) for energy. Dr. Scheer then discussed a number of studies showing how elevated insulin promotes obesity, cardiovascular disease, hypertension and diabetes and how a low glycemic index and lower carbohydrate diet can reverse the negative trends. Even a study in the prestigious and mainstream, Journal of the American Medical Association found that women in the Harvard Nurses Study who ate diets high in refined carbohydrate and low in fiber were twice as likely to become diabetic as those eating less refined foods. Low magnesium intake was also found to be an independent predictor for adult onset diabetes (Salmeron 1997, JAMA 277:472-477). A 3 year study of non-diabetic males showed a direct relationship between weight gain and insulin levels and hypothesized that decreased insulin sensitivity may disrupt serotonin action in the hypothalamus leading to carbohydrate cravings and weight gain (Lazarus, 1998. Am. J. Epid. 147:173-9). A study is also cited showing that sugars may have a negative intake on the phagocytosis of bacteria by neutophils (Sanchez, 1973, Amer. J. Clin. Nutr 26:1180-4), thus impacting the immune system as well.

Other factors are known to affect insulin resistance, including age, physical activity, genetics, alcohol, smoking and dietary fatty acid imbalance. Dr. Scheer discussed how decreased omega-3 and increased omega-6 fatty acids in muscle cells make them more prone to become insulin resistant and lead to obesity. Also, greater saturated fat proportions are associated with impaired insulin action. The negative effect of trans fats (found in margarines and many processed foods) are discussed and other positive effects of more balanced levels of omega-6 and omega-3 fats. The conclusion is that most people with an average American diet need to consume greater levels of foods like fish oil, flax oil, canola oil, walnuts, brazil nuts or leafy green vegetables in order to increase their level of omega-3 essential fatty acids. The current diet is about 20:1, whereas animal studies indicate the optimal diet should probably be closer to 4:1, omega-6:omega-3 fatty acids (Yehuda, 1993, Proc. Natl. Acad. Sci. 90:10345-9). Essential fatty acids may help as a therapeutic agent in eczema, psoriasis, multiple sclerosis, rheumatoid arthritis, schizophrenia, diabetic neuropathy, allergies, depression and cancer, as well. A study is also cited which suggests that in healthy adults, it may be possible for fish oil to help compensate for a high carbohydrate diet to the extent that it may lower triglycerides (Harris, 1984, Metabolism 33:1016-9).

Dr. Scheer pointed out that the Ornish diet, which is often pointed to as an example of how a low fat diet should be used to help heart disease, may really be misleading. First, the Ornish diet allowed no refined sugar (thus probably reducing insulin), or saturated or trans fats. The diet also included exercise, stress management, stopping smoking and group support, as well as greater antioxidant intake through more fruits and vegetables. There was also a change in omega-3 and 6 levels. All these things make it hard to know to what extent the 10% fat level was the cause of the improvement. The 10% level of fat is lower than any natural diet and its long term effects are unknown. A number of other points are made and studies are cited that give strong support to the idea that a diet closer to that of our Paleolithic ancestors has widespread health benefits. The “Mediterranean Diet” is viewed as a possible model for our times. The diet emphasizes fresh vegetables (including legumes) and fruits, whole grains (rather than refined), olive oil, fish, cheese, nuts and a low use of sugar. The general guidelines he suggested for treating and preventing Syndrome X and all its related negative consequences are: 1) increase omega-3 intake (see above list of sources), 2) increase monounsaturated oils like olive and canola oils and avocados, 3) increase soy and other beans, peas & nuts, 4) decrease saturated fats (but a little butter is better than margarine with trans fats), choose low fat dairy and meat products and avoid coconut and palm oils and other trans (partially hydrogenated) oils, 5) when eating carbohydrates, eat primarily “slow,” low glycemic carbohydrates, but eat them in moderation, 6) eat more deep colored vegetables and whole fruit, 7) if you drink alcohol, choose red wine in small amounts with meals, and follow other parts of a healthy diet: clean water, aerobic exercise, etc…

one of which is related to the control of blood sugar levels, through limiting the timing, amounts and types of carbohydrates consumed. This includes 3 meals, at least 2 low carbohydrate snacks and eating within an hour of rising and near bedtime. There are other therapeutic suggestions depending on the pattern of the results. When Dr. Ilyia was asked about pregnenolone, another hormone precursor, he said it was one of the substances that they used in their “challenge” tests to determine the body’s ability to produce hormones from their precursors. He said that people often feel better on pregnenolone because it cross-reacts with their cortisol receptors, however he did not feel it generally served to rectify the underlying problems as they recommend with their suggested treatment programs based on the lab results.

Adrenal Stress Index and Carbohydrates: Patterns of Cortisol and DHEA

Elias Ilyia, Ph.D. of Diagnos-Techs Laboratory presented a very informative talk on adrenal function and stress. He showed how a more detailed functional assessment of adrenal function, where bioactive cortisol and DHEA are measured in the saliva at 4 different times of the day, can provide useful information for a number of chronic conditions. He identified several phases of the body’s response to chronic stress. The normal stress response shows high cortisol and DHEA, which then return to normal after the stress ends. In chronic stress states, both DHEA and cortisol remain elevated. A number of phases were presented that occur before the patient becomes adrenally exhausted and shows low cortisol levels. The earlier “divergent” phase occurs when cortisol is still high, but DHEA stays normal. A later phase has high cortisol and low DHEA, and the fourth phase has both low cortisol and low DHEA. The pattern of levels during the day can also provide useful information. For instance, poor glycemic control and a high carbohydrate breakfast may affect the noon cortisol level. Or high cortisol at night may explain problems with sleep. Abnormal cortisol levels can affect REM sleep, skin regeneration, “spatial thinking,” osteoporosis, pain, immune function, blood sugar, and muscle breakdown, among other things.

Much of the research done by Diagnos-Techs Lab using the Adrenal Stress Index is meant to give the doctor the ability to take much of the guesswork out of treating the adrenal malfunction common in many medical conditions involving stress. Dr. Ilyia stated that adrenal malfunction should be dealt with, in general, before hypothyroidism because adrenal malfunction is often the root cause through its effect on thyroid stimulating hormone (TSH). He said that if a patient is already taking thyroid medication, they may need to lower or at least monitor their dose of thyroid after starting DHEA and other adrenal treatments, otherwise they may be in danger of becoming hyperthyroid, as their own thyroid production recovers [Editor’s Note: Consult your doctor before making any changes in medication doses].

In the question period, Dr. Ilyia also cautioned that DHEA may be converted by the liver into estrogen or testosterone and this may worsen endometriosis and certain cancers in some people. The lab offers a DHEA challenge test to see whether this conversion is occurring. They find sublingual forms are less likely to be converted, however he believes that DHEA’s power and potential dangers would make it preferable to require a prescription for its use. Their evidence indicates that just monitoring symptom changes is not adequate.

Dr. Ilyia emphasized treating the foundations of the problem of adrenal malfunction, one of which is related to the control of blood sugar levels, through limiting the timing, amounts and types of carbohydrates consumed. This includes 3 meals, at least 2 low carbohydrate snacks and eating within an hour of rising and near bedtime. There are other therapeutic suggestions depending on the pattern of the results. When Dr. Ilyia was asked about pregnenolone, another hormone precursor, he said it was one of the substances that they used in their “challenge” tests to determine the body’s ability to produce hormones from their precursors. He said that people often feel better on pregnenolone because it cross-reacts with their cortisol receptors, however he did not feel it generally served to rectify the underlying problems as they recommend with their suggested treatment programs based on the lab results.

Patterns of Estrogen and Progesterone

Dr. Ilyia also discussed a functional approach to female hormonal dynamics. Diagnos-Techs Lab’s female hormonal panel tests saliva levels of progesterone and estradiol at 11 times during a woman’s cycle (sampling times dependent on previous 2 months of basal body temperature readings taken by the patient). Their testing has revealed two common types of abnormal patterns. The first type is characterized by double ovulations early in the cycle, with estrogen dominance and low testosterone, and is common in endometriosis. In these cases, progesterone therapy, testosterone therapy, and estrogen-reducing therapeutic suggestions may be used. DHEA is rarely used in these cases due to its tendency to be converted into estrogen.

A second pattern occurs in some patients in which ovulation is found to occur between days 5 and 7 and premenstrual syndrome symptoms occur most of the month. These patients are also estrogen dominant. Their research shows that hot flashes are often due to rapid drops in estrogen, and often are not due to low overall estrogen levels. Progesterone is often all that is needed and it may serve to stabilize the brain and the limbic system, in particular. Migraines were also observed to relate to rapid drops in estrogen causing blood flow changes.

Dr. Ilyia also noted that they have found that in some patients, anti-fungals of the type that includes Diflucan, Sporonox and Nizoral, cause an increase in estrogen and a decrease in cortisol that may last for weeks after the drug is stopped. In patients prone to cystic breasts, breast cancer, endometriosis and other estrogen-related pathologies, he suggests that an alternative anti fungal, like Amphotericin-B might be preferable. He expressed concern about the indiscriminant use of progesterone creams, since they have found that they almost invariably lead to overdoses of progesterone (see articles on this at http://diagnostechs.com or contact lab at 800-87-TESTS). Progesterone suppositories, they find, most accurately mimic natural production. He also stressed that oral hormone supplements, including DHEA will not be absorbed unless about 10 mg of fat are consumed with the meals at which they are taken. For people currently on hormone replacement therapy, he suggests doing the female hormonal panel to determine if the right levels are being given. The research shows that many women produce adequate estrogen, or may need much less estrogen, or only progesterone. This is important because excess progesterone, like excess estrogen, can increase risks of breast and other cancers.

Dr. Ilyia also gave a shorter presentation on the gastrointestinal microflora, where he discussed some general concepts and a few cases. On a personal note, I found their saliva test for Entamoeba histolytica, was the only one, out of numerous other parasite tests, that detected my infection.

[Editor’s Note: Since the time when I wrote this summary, Diagnos-Techs Lab has added some additional tests, including saliva tests for thyroid function and a urine test for Pyrilinks-D, a substance that may help assess bone loss. For more information, see the lab’s web site at diagnostechs.com or call 800-87-TESTS.]

Note:  Summaries based on information published in Conference Syllabus rather than actual talks. Tapes of AAEM presentations: 800-NOW-TAPE. AAEM information–phone: 316-684-5500 or see web site at: www.aaem.com).

Editorial Note (2008): I should mention that treatment for the amoeba did not improve my symptoms, though it appeared to eradicate the amoeba.  I later improved on an anti bacterial approach called the Marshall Protocol — http://AutoimmunityResearch.org.

Written by synergyhn

October 30, 2008 at 12:56 am

%d bloggers like this: