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The Ecological Approach

What is Environmental or Ecological Medicine?
Environmental or Ecological Medicine is the branch of medicine which attempts whenever possible to find the causes of people's chronic or recurrent ill health and to help them find ways to become well and stay well. Most patients who have been helped in this way find they can control their symptoms and may even become symptom-free without medication. Many are surprised to find that they also feel positively well, often for the first time for years. For best results the approach usually needs to consider three facets - chemical exposure, allergy and nutrition. These all interact because chemical exposure tends to induce sensitivities, and both sensitivities and the detoxification of chemicals that have been absorbed into the body use up nutrients, and nutrient deficiencies make symptoms worse.

What is covered by the term allergy?
Allergies have been increasing in what has been called an epidemic fashion during the last 50 years and now affect a third to half the population. A lot of other chronic ills have increased over the same period which most people have come to accept as part of normal life. The true allergies - hay fever, acute food allergy etc - are mediated by the special allergy antibody IgE and offer few difficulties in diagnosis, but there are a host of other symptoms which are not generally understood. Although the IgE antibody is not involved in these symptoms, in many people they respond to the same sort of managements as allergies, and may be entirely prevented by relatively modest changes in lifestyle, such as avoiding perfumes or smelly cleaning products or food additives. They behave like allergies and it is a bit pedantic to say that they are not. It is very poor medicine to deny their existence when their detection can be so effective.

How do you find the triggers?
Symptoms are how your body tells you that something is wrong. Sometimes we have to accept them and just get on with it, but it is foolish to accept frequent symptoms as normal without trying to find the underlying reason. It is foolish partly because you cannot enjoy life properly, or work efficiently, when you are having a headache, or feeling constantly tired or depressed or hyperactive, or have wind or aches and pains, or an itch or wheeze or whatever. It is also foolish because knowing what causes your symptoms gives you power over them. And finally it is foolish because, if your symptoms really are due to this kind of allergy, they will tend to get worse if you go on provoking them, and are then likely to spread so that you develop other symptoms as well. Living or working in a poorly ventilated space in which volatile organic chemicals are regularly given off (as in most houses nowadays) will, in time, make a proportion of well people become chemically sensitive, and start to have symptoms even if they did not have them initially, especially if someone puts down new carpet, or decorates, or uses the photocopier. No-one knows what proportion of people are susceptible, but it could well be at least a third. It is important to remember that indoor pollution is usually worse than outdoor pollution, the indoor pollutants being added to what come in from outside.

Sorting out the factors provoking your symptoms may be straightforward, but is often not. This is because there is no constant pattern linking together the provoking agent and the symptom in different people, so no automatic prescription. The question you need to answer has to be "What provokes my symptom(s)?", and your trigger may be quite different from the trigger of a friend who appears to have an identical condition. For instance, pollen usually provokes either hay fever or asthma in sensitive individuals but I have also known it provoke migraine, or eczema, and there are reports that it may give kidney and bowel complaints. Rhinitis in the hay fever season alone is probably due to pollen sensitivity, but could be due to a food you only eat at that time of year. Rhinitis throughout the year is often due to house dust mite (particularly in a poorly ventilated house where moisture builds up) but may equally be evidence of food intolerance - avoiding wheat or milk may work a seeming miracle. However, it may also be due to any other food or foods, particularly the ones you eat several times a day; I do not know of any food which is safe for everyone. Joint pains may be provoked by pollutant chemicals or by gas fumes or by foods, or even by moulds. And so on.

If you have a lot of symptoms you may be reacting to a number of foods, and to aeroallergens (mites, moulds, pollens etc) or to volatile chemicals, and if you are only looking for a single solution you may fail. With foods the detection work is made more difficult because reactions are often masked and may only be apparent when you eat the food after avoiding it and other potential triggers for a week or so. The same may be true of inhaled triggers so, if you are still uncertain, pay particular attention when you go back to your house after a break.

Food additives are a common trigger in children (and in adults). This was remarked on spontaneously by one of the primary school staff in the TV programme Jamie's School Dinners on 16.3.05. She had noticed that she used to have a queue of children coming for asthma inhalers after school lunch every day, but that since the junk food was cut out none of the children needed them! On another real-life programme the week before a family spontaneously said that their previously uncontrollable children were much quieter and more amenable after they started to eat real food. However, it isn?t always additives that are the triggers; hyperactivity can be provoked by a food or foods as well.

How can you get help?
If you just want help with true allergies your GP may be able to arrange some tests or refer you to one of the NHS allergy clinics, although there are not many and it will probably take a fairly long time. A lot of these do not treat non-IgE types of allergy. If you are bothered by other symptoms which you think may be due to sensitivity it is more difficult to get help because most of the NHS clinics which practised this sort of medicine have had to close down: mostly because they were oversubscribed!! Sometimes the NHS will fund treatment by a recognised private doctor. Otherwise it is a choice of going privately or seeking help from a book. The website www.bsaenm.org may be a help and Allergy UK (020 8303 8525) will give you some support. Because there was such a gap in provision, three colleagues and I wrote a textbook to try to make it possible for GPs and other doctors without special training to help these patients. It is written with a minimum of technicalities and many patients have also bought it and find it helpful. If you get it, start to read at chapter 5 and dip into the first and last sections later: there are instruction sheets in an appendix which you may find helpful. A number of other books have been written especially for the general population and one of these might suit some of you better.

Why the allergy epidemic?
This is an interesting question to which no-one has a firm answer but there are some interesting pointers. There are writings from as early as the 12th century which clearly show that foods were recognised to provoke asthma, not widely accepted today except by ecological doctors. The allergy that is now the most obvious, hay fever, was first recognised only in 1819, in England, after the start of the Industrial Revolution, which also started in this country. This was probably a causal association because Japan's equivalent pollen allergy was not noted in Japan until 50 years after the much later start of their industrial revolution. It looks as if very small particulate pollution (PM2.5 and smaller) released by engines plays an adjuvant role in the induction of allergies, potentiated by the heavy metals that get adsorbed to their surfaces. The chemical industry has grown enormously during the last 50 years and may have contributed to the recent increase in allergies; in individual cases this certainly seems to occur. Protecting babies from minor infections has also seemed to increase allergies, but perhaps this might be due to the greater use of chemical cleaning products in excessively clean households.

We cannot be sure that any actions we take will prevent further increases in the prevalence of allergies, but it would be sensible to apply the precautionary principle and try to expose ourselves and particularly our small children to as little pollution as possible, and to use as few man-made chemicals as possible in foods, drinks, and the home, particularly around the young. We, jointly, are responsible for the growth of the synthetic chemical industry because we have wanted their products. We could also be responsible for them starting to shrink if we were to stop buying inessential synthetics. Would that slow the growth of allergies? I think it is the best chance we have, and that it would also benefit our long term health.

Dr Honor Anthony
Environmental Medicine in Clinical Practice. Honor Anthony, Sybil Birtwistle, Keith Eaton and Jonathan Maberly. BSAENM Publications. IBSN 0952339722.
www.bsaenm.org website of the British Society for Ecological Medicine (previously the British Society for Allergy, Environmental and Nutritional Medicine) P.O. Box 7, Knighton, LD7 1WT, information line 0906 3020010. Charity Commission Registration Number 326372.