A Comprehensive Guide to Managing Multiple Chemical Sensitivity with Naturopathic Medicine

2023 update to [this article(https://pannaturopathic.com/multiple-chemical-sensitivity) on treatment options for multiple chemical sensitivity. Much of the information is the same, but a few different perspectives are added.

Multiple chemical sensitivity patients have an abnormal, exaggerated response to normal, or slightly higher than normal, chemical triggers in the environment. These reactions make it difficult to live in a modern urban environment.

Multiple chemical sensitivity is a condition that usually falls under the realm of those who practice environmental medicine. As you can infer from its name, environmental medicine looks at the impact of the environment and how it affects a patient's wellbeing.

However, the vast majority of the patients that we see in our clinic with MCS have a large component of inherent reactivity and sensitivity that has to be addressed. The patients are usually hypersensitive from a neurological and autonomic sense, and sometimes immunological sense (eg allergy or air way responsiveness etc) to what would normally be considered a "normal" level of exposure. In most cases, some of the neurological hyper-reactivity involves central sensitivity syndrome.

If we can understand unique triggers that may affect an individual patient with MCS, appreciate and manage their neurologic hypersensitivity, identify and treat psychiatric and mood co-morbidities, and work on both immune system balance as well as detoxification if needed, then it is more likely that a patient can function with less fear of everyday, usually normal, chemical exposures.

What is Multiple Chemical Sensitivity?

MCS likely would sometimes be classified in ICD10 (International Classification of Diseases) under T78.4. This classification actually refers to "Other and Unspecified allergy" which may only be correct for some patients with MCS, if we believe and can demonstrate that there is an allergy component.

Sometimes, it is not a direct classical allergy per se but is more of a neurologic reaction. This can be in the periphery, for example an episodic rash, but often has more systemic symptoms.

Multiple Chemical Sensitivity is a condition where individuals experience adverse reactions to various chemicals at lower levels than most people. It is characterized by symptoms such as headaches, fatigue, dizziness, and difficulty breathing. Cognitive impairment may occur as well.

Very often, when the central nervous system is hypersensitive, patients report other previous diagnoses as well as poor experiences with health care systems. This has been shown in this study to correlate with severity as well, and that many of these patients have been told that it is all in their head. Thus, sometimes MCS is classified in ICD10 as a somatoform disorder F45. I don't think this would be a completely accurate description either though.

You can see that there is a lot of debate in how to classify and "diagnose" multiple chemical sensitivity syndrome, as it is considered controversial and there are not clear, definitive criteria similar to illnesses such as diabetes.

From a practical, patient-centered approach though, this is less important. It is more important to recognize that multiple chemical sensitivity is likely multi-factorial.

The approach for one patient may differ wildly to the approach for another patient with identical symptoms - depending if those patients had different triggering events, current toxin exposure, hormone balance, etc.

The Idea of Total Body Burden

I often use the analogy of a "bucket" in my patients. We were all born with a bucket that we use to throw "junk in". This could be toxins, stress, infections, etc. However, it is only when that bucket "overflows" that our total body burden is overloaded, and it is only then that we have symptoms.

We may be able to inquire into and investigate "triggers" for the MCS, or a triggering event. In some patients, as an example, there may have been a slow leak that over the years, resulted in water damage to a patients home. Mycotoxins then have "filled up the bucket" - and if we can identify this as an increased burden we can work to identify both the source of the exposure as well as work on detoxification.

Detoxification of mycotoxins in this example would be an example of "draining the bucket" and lowering the total body burden. This in many cases will reduce the overall reactivity.

Typically, depending on the history, investigations for what is contributing to the total body burden is important. This can be the above mentioned mycotoxins, heavy metals, occupational exposure, organic toxins such as glyphosate, or even chronic, but persisting infections.

Once identified, we try to see if the source is persisting (and thus can be treated), or if the focus should be mainly on detoxification alone.

Hormone optimization in Multiple Chemical Sensitivity

The hypothalamic-pituitary-adrenal axis is one of the ways in which our body's adapt to any stressor. The stressor could be physical or emotional. When this system's adaptive capacity is compromised, some practitioners call this "adrenal fatigue". It is a controversial label as it is often confused with Addison's disease, where the adrenal gland fails.

Most importantly, HPA axis dysfunction or adrenal fatigue is usually secondary to some other trigger. However, identifying if there is an HPA dysfunction is important, as some of the target symptoms of MCS (cognitive impairment, fatigue, dizziness) are often tremendously helped by therapies targeted at this.

There is not much data at all directly between MCS and HPA axis issues, aside from this study on mice - but it is something I come across in my practice very, very frequently.

Support is often with herbal or with hormone precursors. In some rare cases, if hormone deficiencies are identified, we will treat with hormones temporarily.

Central Sensitivity and its Impact on MCS

The treatments detailed on this post and this post on central sensitivity apply here.

I have found that most patients do well with "nondirective meditation" such as found in the relaxation response or taught through the app especially 1GiantMind to be tremendously useful.

More costly, but targeted specifically to the limbic system and deeper structures in the brain, are programs targeted to work with neuroplasticity. Two examples are the Dynamic Neural Retraining System or the Gupta Program.

Infection and Toxin Management in MCS

In my practice, I have a population of patients who have been ill since infection, and in many cases it was after exposure to lyme. In a small proportion of these cases, they seemed to become more reactive to their environment, and eventually became reactive to chemicals.

The infection triggers chronic inflammation, which then sets up the stage in a subset of patients for neurological changes as a result.

My experience with these patients has been that it has been more related to the central sensitivity and neurological patterns, as opposed to a true directly immune related allergy.

In some patients, treatment of the infection with antimicrobials was effective at lowering their overall MCS symptoms as well, but most of the time it was other symptoms such as joint pain, muscle pains, sweats, that seemed to improve with infection treatment.

Tools to manage central sensitivity were more important in helping to tame the MCS.

Importantly, looking for end points in infection treatment has been crucial. Often, the majority of the benefit comes from the initial periods of treatment, and then progress with this tool alone becomes quite slow or plateaus altogether. Endpoints might be a careful monitoring of any symptom improvement, but usually involves some sort of testing - often looking for any resolution or reduction of antibody titres or a reduction to normal of T cell reactivity.

The Role of Acupuncture in Managing MCS

Acupuncture has a tremendous immune modulating effect.

I often use acupuncture in the treatment of pain, but on occasion in very sensitive patients that may not tolerate therapies such as ozone major autohemotherapy, acupuncture is a gentle way to both calm the sympathetic fight or flight nervous system as well as modulate the immune system.

Nutritional Approach to Managing MCS

An anti-inflammatory diet usually forms the basis for most patients. However, certain patients find benefit from a more dramatic shift from their usual diet. This may be due to simply exposure to different, new, food antigens that the immune system or mast cells are not already sensitive to.

In some cases, a switch to a vegan or vegetarian diet helps. The opposite, a temporary switch to a carnivore diet, helps a smaller subset of my patients. However, the most common thing that I see is that patients have a very limited food group choice that does not make them react.

They often theorize that it is the chemicals on the foods that they are reacting to, but more times than not, we have found that stabilizing their mast cells in the gut with nutrients and medications allows them to tolerate these foods again.

This would suggest that it is more their reactivity, vs something in the food itself, that is causing limited dietary choices.

Heavy Metal Toxicity and its Role in MCS

As a sole treatment, chelation therapy or heavy metal reduction would not likely be effective for MCS; but it likely does reduce the body burden. Since such treatment is quite costly, usually we assess the body burden of metals first, alongside measuring the whole blood levels of the metals.

The whole blood metals, without "provoking" is the most reliable way to rule out heavy metals as a primary cause. Usually, I look for the metals to simply not be in the top quintile of the normal range, especially for lead (there is not really data on this for other metals, aside from some on mercury).

A provoked challenge test is more controversial because the reference ranges used in the test are for "nonprovoked samples". Thus, when we use a medicine to mobilize metals, the levels excreted in the urine are going to be higher than a baseline, non-provoked sample.

Some practitioners look for a 5 fold elevation in the provoked vs nonprovoked sample, but I prefer also looking at the absolute value on the provoked sample. Often, there is a 5 fold increase, but because the absolute value is still quite low compared to what I have seen in many other patients, we don't assume that the metals are contributing much to the total body burden.

Ozone Therapy for Managing MCS

I have written on ozone therapy quite a bit in the past, as it is one of the more commonly utilized therapies that I find helpful for patients.

With the pandemic, there has been more data recently published on ozone therapy recently with respect to both outcomes as well as immunomodulatory mechanisms.

In my patients, we will often go through a course of major autohemotherapy of about 6-8 treatments. This is a process where a small amount of blood is treated with an equivalent volume of ozone to temporarily stress the white blood cells and act as a cytokine inducer. Thus, cytokines that are too high (and of course too low) are temporarily stimulated, and we are looking for a reset to occur.

As with any IV treatment, there are risks with such a therapy - although even in the most sensitive MCS patients it tends to be very well-tolerated.

Vitamin Infusions for Managing MCS

There had been a lot of interest, and then controversy, in the use of intravenous vitamins in acute care situations such as sepsis. The theory of how it may benefit was the concept of metabolic resuscitation.

Multiple chemical sensitivity patients do not have obviously the acute, emergency, presentation that sepsis patients have, but especially when patients present with severe rain fog, poor muscle stamina, I tend to think about supporting the function of the mitochondria.

Often this takes place with oral supplementation of the nutrients that are usually used at higher dosages. The nutrients I often find most often effective in mitochondrial support have some data in both the migraine prevention literature as well as fibromyalgia, and cardiovascular literature:

• magnesium (especially the glycinate forms, sometimes threonate)
• coq10
• riboflavin
• thiamine
• ribose

Infusions of both glutathione, as well as vitamin C, help some patients reduce their oxidative stress burden and treat symptoms especially of fatigue.

Conclusion: Managing Multiple Chemical Sensitivity with Naturopathic Medicine

In this 2023 update on treatment options for Multiple Chemical Sensitivity (MCS), we can emphasize the challenges faced by MCS patients in modern urban environments due to their hypersensitivity to chemical triggers.

The approach to managing MCS is discussed, focusing on identifying unique triggers, addressing neurologic hypersensitivity, managing psychiatric co-morbidities, and promoting immune system balance and detoxification.

We utilize the concept of "total body burden", highlighting the importance of identifying and reducing burdens like mycotoxins, heavy metals, and infections.

Various treatments including acupuncture, nutritional approaches, and ozone therapy are considered, emphasizing their potential in modulating the immune system and reducing symptoms.