Dr. Robert F. Kidd    

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Environmental Medicine

Environmental medicine is an approach to medicine that takes into account the effect of the environment on the individual's health. It recognizes that health is optimized by an environment of clean air, clean water, nutritious food and minimal exposure to natural and synthetic toxins. When these conditions are not met, body physiology suffers in different ways and poor health or outright disease is the result.

Probably no one since the Garden of Eden has ever lived in an "optimal" environment. There have likely always been nutritional shortages from time to time, and toxins are a part of the natural ("unspoiled") environment. But nature has provided ways to deal with these problems and as long as the challenges are not too great, health can be maintained.

Problems arise when environmental conditions deteriorate to the point that the body cannot adapt. This is obvious in the case of famine, where many nutritional requirements are not met. Depending on the genetic makeup of the people involved and the type of food supply available during the famine, different diseases appear. In some cases the disease may reflect lack of calories, in others lack of certain vitamins or minerals, in yet others lack of protein or fat.

When the environment limits the supply of only certain food components, the breakdown in health is subtler. It may affect only a few people and the symptoms may not be obviously nutritional in origin. For example, fatigue or depression may result from a deficiency of vitamin B12 or even from a lack of fat in the diet. These deficiencies are harder to detect and require more skill on the part of the physician.

Similarly, toxins have always been a part of the environment and nature has provided the body with ways to contend with them. "Natural" toxins can exist in the air (hydrogen sulfide or methane from a swamp), in the water, in the soil and in the food supply. Extreme examples are poisonous mushrooms and botulism toxin in spoiled meat.

Toxins may also be produced by the body's own chemical processes. These may be by-products of normal metabolism, or the result of abnormal metabolism, e.g. gut dysbiosis or "fermentation" of undigested food in the bowel.

Nature provides the body with defenses against, and methods of eliminating, toxins. The skin is a barrier to most (but not all) toxins and the gastrointestinal tract is able to prevent many toxins from entering the blood stream. Within the body, there is a barrier (the blood-brain barrier) that prevents many substances from reaching the brain.

If toxins penetrate, the body has a number of ways of deactivating and eliminating them. Toxins may be excreted directly through the kidneys, liver, lungs or skin, or changed chemically so that they are no longer toxic, or combined with other molecules and then excreted. Unfortunately these detoxifying mechanisms can be overwhelmed or even themselves be poisoned, if the load is too great. When this occurs, health suffers and disease sometimes appears.

The picture becomes even more complicated when nutritional deficiencies and toxic exposures come together. A classic example is(was) lead poisoning in undernourished children living in slum neighbourhoods near industrial sites. Not only are there toxins to eliminate, but certain nutritional requirements actually increase.

Some biochemical processes that support detoxification upregulate (or speed up) and need more "fuel" to continue. An example is the liver's production of glutathione, the major carrier of heavy metals out of the body. Glutathione requires methionine and cysteine, amino acids derived from dietary protein. Vegetarians and others on low protein diets are particularly vulnerable to toxins because they are unable to create enough glutathione is their livers.

Another example is the relationship between selenium and mercury. Inuit (Eskimos) seem to tolerate high levels of mercury in their diets because their diets also provide high levels of selenium. Selenium has a protective effect from mercury poisoning.

In environmental medicine, patients are evaluated for the possibility of toxins affecting their health. They are also assessed nutritionally. The patient's story, the physical examination and laboratory tests are all important in this process. If significant toxins are found, strategies are developed to both eliminate toxins and to optimize nutritional status. The goal is to optimize health and if possible, to eliminate disease.