The following is a part of the Foundation's efforts to pursue a mandate of "making the connections." Recovery on an antibiotic protocol may be complicated by many factors. Hidden environmental offenders surround all of us and are capable of triggering inflammation. The purpose of this article is to raise and evaluate some of these inflammation triggers and assist in the development of a strategy to reduce and eliminate them.
The Environmental Approach to Inflammatory Arthritis:
Albert F. Robbins, D.O., MSPH, FAAEM
If one is exposed to an environmental agent such as an allergen, infectious agent, toxin, chemical or drug that causes adverse effects, those effects may be seen anywhere in the body. Therefore, environmentally triggered illness may masquerade as any number of diseases or even aggravate existing illness. By eliminating offending chemical, food or infectious allergens, dramatic improvement may occur in some chronic illnesses.
Environmental approaches to health problems can be applied to most chronic illnesses, and usually some good will emerge. The reason is because many chronic illnesses are either caused or aggravated by hidden environmental factors. Without knowledge of these potential environmental offenders, one would not look for or address them. When causative agents of disease are not discovered and removed, chronic illness may progress and irreversible disease may occur. Many chronic illnesses result from multiple environmental triggers working over time. The nature of complex illness is that it arises from multiple causative factors. Environmental factors are sometimes completely overlooked in the search for causation. Physicians generally do not look for environmental causes of chronic illness, primarily because they have not been trained to do so.
The Environmental Investigation:
The environmental approach does not have to be that challenging. An environmental physician can streamline the process. Certainly, a "Sherlock Holmes" type of investigation is required to determine if an individual's chronic illness is caused by a hidden infection, toxic exposure, nutritional deficiency or allergic reaction. An appropriate medical work up is necessary. From an initial interview and physical examination, the environmental physician can evaluate whether the inflammatory condition may have allergic, infectious, nutritional or toxic manifestations. The next step is to objectively identify by diagnostic tests whether or not the individual is suffering from allergic disease, hidden infection, toxic manifestations or nutritional deficiencies.
Masking is a process of adaptation by the body to handle a toxic, allergic, infectious or irritating substance. When the symptoms caused by an offending agent goes underground, one has difficulty linking the symptoms to the causative agent. These are called masked symptoms. This masked illness can be approached by unmasking the symptoms. Avoiding an offending substance for a long enough period of time usually unmasks the substance; symptoms are relieved. Re-exposure to the substance then causes immediate symptoms Sometimes removal of one or two items from the environment or changing to another environment can completely alleviate symptoms.
A woman with joint pains and migraine headaches lived in a newly carpeted home. Removing the carpeting eliminated most of the symptoms. After avoiding milk and perfumes she managed to eliminate all of her symptoms. If one is living in a moldy or toxic home, leaving that environment and feeling better and then returning and experiencing symptoms will indicate that something in the home made your symptoms reappear.
Major Environmental Factors:
Once the physician knows what the individual's lifestyle is, a prescription for safe environmental lifestyle changes can be implemented. As a trial, removing someone from a home, school, or office may be necessary in order to determine if the environmental situation is making the individual sick. Change of climate may also be advised on a interum basis.
Any pollen, dust, molds, animal, food, chemical, or infectious agent may be capable of triggering symptoms. Allergy or sensitivity can be determined by blood tests and skin tests. Allergy elimination diets are also utilized for unmasking hidden food allergens. Chemicals allergens, irritants, and toxins can be evaluated by avoidance procedures, blood, urine and skin tests. Heavy metal toxicity can be evaluated through hair, urine, and blood tests. Hidden infection can be determined by blood, stool, and urine tests. All of this testing sounds expensive and in many cases may be unnecessary. Tests ordered are based on the individuals medical history and exam as well as the physicians suspicions.
Muscle and Joint Pains:
Muscle aches can be caused by overuse of muscles, a viral infection such as influenza, post-viral inflammation, structural problems of the spine, nutritional deficiencies, and allergy or intolerance to foods, chemicals, or inhaled allergens. (4)
Joint pains can be caused by joint overuse, hidden infection, food and chemical intolerance and allergy, and inflammatory disease. In inflammatory rheumatic disease, immune complexes are formed in the blood and then become deposited in the joint. These immune complexes consist of masses of antigens and antibodies, resulting from an allergic reaction either due to an infection or exposure to an allergen. The fluid that lubricates the joints becomes filled with these immune cells affecting the lining of the joints, which causes the inflammation and ultimately the pain, swelling and tenderness. (4)
Food and Chemical Allergens:
Some arthritic conditions are due to food allergy. The joint pains are frequently precipitated by reactions to foods or chemicals. Since provocation of the arthritic symptoms is sometimes due to food or chemical allergy, the best treatment is removal of the food or chemical allergens. Indeed, it has been reported that at least half of all arthritics experience symptomatic relief when food or chemical allergens are eliminated. (2)
Some of the more common allergic arthritic triggers in the chemical world include sulfites (preservatives in some foods and alcohols), artificial sweeteners, hair dyes, food dyes, nail polish, makeup, powders, fragrances, natural gas, chlorine, formaldehyde, paint fumes, products containing phenol, fabric softeners, insecticides, air fresheners, new carpet odors and new-car smells, scented candles, plug-ins, tobacco odors, odors emanating from soaps and shampoos and conditioners, as well as VOC [Volatile Organic Compounds] smells from moldy, musty environments.
Food allergens known to produce allergic arthritis include cows milk which is most prevalent. Wheat, egg, corn, beef, chicken, nuts, tomato, chocolate, alcohol, and citrus follow in close succession. Pork allergy is surprisingly important in the cause of arthritis of this type. Pork has a predilection for involvement of the joints. (2) Its importance has not been emphasized in the past and therefore, it has frequently been overlooked as a major cause of allergic arthritic pain. Meats in general appear to be notorious for triggering arthritic pain; that is probably why some experts in the field recommend a vegetarian type diet.
Joint pains are a very late manifestation of the food allergy reaction. Sometimes joint pains do not appear for 48 to 72 hours. Allergic arthritis may frequently manifest itself initially as low back pain. This pain is usually worse at the end of the day. The swollen and tender joints appear to be largely confined to the hips. The muscles of the low back and buttocks become spastic and edematous as well.(2)
The standard treatment for RA at present is to use drugs to suppress the inflammation. The idea that food intolerance can play a part in RA is not widely accepted among rheumatologists. However, some specialists in the field report excellent results when they try their patients on an elimination diet. Some of these patients lose their symptoms entirely- a dramatic improvement that drug treatment rarely achieves. (3)
Chemically Induced Immune Response
Chemically induced immune response (1) and allergic diseases have features in common. The border between them may at times be unclear. In both cases, genetically controlled mechanisms allow the immune system to react to chemical exposure with responses that cause tissue injury and may make one more susceptible to infection.
Chemically induced toxicity of the immune system may be reflected in allergic and inflammatory diseases. Under these conditions, inflammatory immune responses, which ordinarily play a central role in protecting the body from foreign antigens, give rise to tissue injury.
Dont Miss the Obvious: An individual eliminated her joint pains by the removal of natural gas from her home. Another individual found that her particleboard furniture released formaldehyde gasses that triggered her joint pains. A hidden yeast infection in one individual triggered joint pains. Lyme disease, chlamydia, salmonella, giardia, gonorrhea, mycoplasma, and viral infections including HIV, have all been reported to cause inflammatory arthritic disorders. Some drugs can cause muscle pain and joint inflammation.
Many studies have looked at the relationship between inflammatory disorders and environmental exposures. Foods, pollens, dusts, molds, animal dander, chemicals, toxins, and infectious agents have all been documented to cause or aggravate inflammatory conditions. Stress is also an underestimated environmental factor that can trigger inflammation. One answer does not fit everyone. Only by an intelligent environmental approach can individuals find their individual answers. Many have a remarkable recovery after eliminating several foods or avoidance of chemicals from their diet. Others do dramatically well after avoiding chemicals in their environment. Some individuals are helped by treating their allergies with clean environments and allergy injections. Others are helped by treatment of hidden infection.
A recently published book well worth reading that further explains the environmental approach to inflammatory disorders is The Inflammation Cure by William J. Meggs, M.D. It includes thoroughly researched information and general environmental and dietary recommendations to reduce inflammation.
1-Tarcher, A.B., Principles & Practice of Environmental Medicine, Plenum Medical, N.Y., 1992
2-Breneman, J.C., Basics of Food Allergy, Thomas, Springfield, Ill,1984
3-Brostoff, J., Food Allergies and Food Intolerance, Healing arts Press ,Rochester Vt,2000
4-Meggs, W.J., The Inflammation Cure, McGraw Hill, N.Y., 2004
Dr. Robbins is Board Certified in Occupational/Environmental Medicine and
Preventive Medicine and practices in Florida. His web site is www.allergycenter.com