Genetically Modified Foods
According to the World Health Organization, Genetically Modified Organisms(GMOs) are “organisms in which the genetic material (DNA) has been altered in such a way that does not occur naturally.”1 This technology is also referred to as “genetic engineering”, “biotechnology” or “recombinant DNA technology” and consists of randomly inserting genetic fragments of DNA from one organism to another, usually from a different species. For example, an artificial combination of genes that includes a gene to produce the pesticide Cry1Ab protein (commonly known as Bt toxin), originally found in Bacillus thuringiensis, is inserted in to the DNA of corn randomly. Both the location of the transferred gene sequence in the corn DNA and the consequences of the insertion differ with each insertion. The plant cells that have taken up the inserted gene are then grown in a lab using tissue culture and/or nutrient medium that allows them to develop into plants that are used to grow GM food crops.2
Natural breeding processes have been safely utilized for the past several thousand years. In contrast, “GE crop technology abrogates natural reproductive processes, selection occurs at the single cell level, the procedure is highly mutagenic and routinely breeches genera barriers, and the technique has only been used commercially for 10 years.”3
Despite these differences, safety assessment of GM foods has been based on the idea of “substantial equivalence” such that “if a new food is found to be substantially equivalent in composition and nutritional characteristics to an existing food, it can be regarded as safe as the conventional food.”4 However, several animal studies indicate serious health risks associated with GM food consumption including infertility, immune dysregulation, accelerated aging, dysregulation of genes associated with cholesterol synthesis, insulin regulation, cell signaling, and protein formation, and changes in the liver, kidney, spleen and gastrointestinal system.
There is more than a casual association between GM foods and adverse health effects. There is causation as defined by Hill’s Criteria in the areas of strength of association, consistency, specificity, biological gradient, and biological plausibility.5 The strength of association and consistency between GM foods and disease is confirmed in several animal studies.2,6,7,8,9,10,11
Specificity of the association of GM foods and specific disease processes is also supported. Multiple animal studies show significant immune dysregulation, including upregulation of cytokines associated with asthma, allergy, and inflammation. 6,11 Animal studies also show altered structure and function of the liver, including altered lipid and carbohydrate metabolism as well as cellular changes that could lead to accelerated aging and possibly lead to the accumulation of reactive oxygen species (ROS). 7,8,10 Changes in the kidney, pancreas and spleen have also been documented. 6,8,10 A recent 2008 study links GM corn with infertility, showing a significant decrease in offspring over time and significantly lower litter weight in mice fed GM corn.8 This study also found that over 400 genes were found to be expressed differently in the mice fed GM corn. These are genes known to control protein synthesis and modification, cell signaling, cholesterol synthesis, and insulin regulation. Studies also show intestinal damage in animals fed GM foods, including proliferative cell growth9 and disruption of the intestinal immune system.6
Regarding biological gradient, one study, done by Kroghsbo, et al., has shown that rats fed transgenic Bt rice trended to a dose related response for Bt specific IgA. 11
Also, because of the mounting data, it is biologically plausible for Genetically Modified Foods to cause adverse health effects in humans.
In spite of this risk, the biotechnology industry claims that GM foods can feed the world through production of higher crop yields. However, a recent report by the Union of Concerned Scientists reviewed 12 academic studies and indicates otherwise: “The several thousand field trials over the last 20 years for genes aimed at increasing operational or intrinsic yield (of crops) indicate a significant undertaking. Yet none of these field trials have resulted in increased yield in commercialized major food/feed crops, with the exception of Bt corn.”12However, it was further stated that this increase is largely due to traditional breeding improvements.
Therefore, because GM foods pose a serious health risk in the areas of toxicology, allergy and immune function, reproductive health, and metabolic, physiologic and genetic health and are without benefit, the AAEM believes that it is imperative to adopt the precautionary principle, which is one of the main regulatory tools of the European Union environmental and health policy and serves as a foundation for several international agreements.13 The most commonly used definition is from the 1992 Rio Declaration that states: “In order to protect the environment, the precautionary approach shall be widely applied by States according to their capabilities. Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation.”13
Another often used definition originated from an environmental meeting in the United States in 1998 stating: “When an activity raises threats to the environment or human health, precautionary measures should be taken, even if some cause and effect relationships are not fully established scientifically. In this context, the proponent of an activity, rather than the public, should bear the burden of proof (of the safety of the activity).”13
With the precautionary principle in mind, because GM foods have not been properly tested for human consumption, and because there is ample evidence of probable harm, the AAEM asks:
- Physicians to educate their patients, the medical community, and the public to avoid GM foods when possible and provide educational materials concerning GM foods and health risks.
- Physicians to consider the possible role of GM foods in the disease processes of the patients they treat and to document any changes in patient health when changing from GM food to non-GM food.
- Our members, the medical community, and the independent scientific community to gather case studies potentially related to GM food consumption and health effects, begin epidemiological research to investigate the role of GM foods on human health, and conduct safe methods of determining the effect of GM foods on human health.
- For a moratorium on GM food, implementation of immediate long term independent safety testing, and labeling of GM foods, which is necessary for the health and safety of consumers.
(This statement was reviewed and approved by the Executive Committee of the American Academy of Environmental Medicine on May 8, 2009.)
Submitted by Amy Dean, D.O. and Jennifer Armstrong, M.D.
What is environmental medicine?
Simply stated, Environmental Medicine is concerned with the interaction between mankind and the environment. More specifically, Environmental Medicine involves the adverse reactions experienced by an individual on exposure to an environmental excitant. Excitants to which individual susceptibility exists are found in air, food, water, and drugs, and are frequently found in the home, work, school, and play environments. Exposures to these agents may adversely affect one or more organ system and this effect is commonly not recognized by individuals and their physicians.
Environmental Medicine offers a sweeping reinterpretation of medical thinking, especially in its approach to many previously unexplained and ineffectively treated chronic diseases. The basis of this view is the simple concept that there are causes for all illnesses, and the obvious but not well accepted fact, that what we eat or are exposed to in our environment, has a direct effect upon our health.
The basic theories of Environmental Medicine include the “total load” concept, individual susceptibility, and adaptation. The “total load” concept postulates that multiple and chronic environmental exposures in a susceptible individual contribute to a breakdown of that person’s homeostatic mechanisms. Rarely is there only one offending agent responsible for causing a diseased condition. Multiple factors co-exist, usually over a prolonged period of time in bringing about the disease process. Individual susceptibility to environmental agents occurs for a variety of reasons including gentic predisposition, gender, nutritional status, level of exposures to offending substances, infectious processes, and emotional and physical stress. Adaptation is defined as the ability of an organism to adjust to gradually changing sustained circumstances of its existence. Maladaptation would be a breakdown of the adaptive mechanism.
An Overview of Environmental Medicine
Gary R. Oberg, M.D., FAAEM
“The time has come to give the study of the responses that the living organism makes to its [diet and] environment
the same dignity and support which is being given at present to the study of the component parts of the organism….
Overemphasis on a reductionist approach will otherwise lead biology and medicine into blind alleys…” [Rene Dubos]
The current medical care model has an impressive track record of performance for helping generally well patients
who get acute and self-limiting illnesses such as infectious diseases and trauma. This model has assumed for many years
that good health is the natural homeostatic state of the human body. The environment is seen as an essentially benign place
that generally has little effect on health, and the diet is simply a passive source of metabolic fuels for the body’s inherently
stable metabolic functions. Therefore, when physicians are looking for the cause of a chronic disease, this same assumption
is applied, and the potential roles of the environment and diet are superficially acknowledged, but their true importance in
chronic disease is neither appreciated nor effectively accommodated in actual practice.
Yet, during the past several decades, there has been a burgeoning growth in the incidence of more complex and
chronic diseases in our population. Unfortunately, application of the current medical model to these diseases seems to be
resulting in a rapidly increasing cost for their care, accompanied by a rapidly decreasing satisfaction with the quality of life
that results from this care. In an effort to find the explanation for this unacceptable and puzzling situation, a group of clinicians
from various specialties banded together in the 1960’s and formed a medical society that has evolved into the American
Academy of Environmental Medicine (AAEM). These physicians noted, as many have, that increased chronicity of illness and
multiple organ system involvement consistently and significantly decrease response rates to treatment. They determined that
such treatment failures seemed to result when too much emphasis was placed on the nature of the disease and its
symptomatic treatment, and not enough attention on the causes and why the disease developed in the first place. To correct
this situation, these physicians formed a new, more comprehensive, cause-oriented model for the diagnosis, treatment, and
prevention of chronic disease, called the Model of Environmental Medicine.
The new model has its roots in the ancient traditions of both western and eastern medicine. In more recent times it
has been influenced by research on the physiologic effects of prolonged exposure to cumulative stresses (Selye, 1946)
(Randolph, 1962), by systems analysis (Bertalanffy, 1950), and chaos theory(Capra, 1996). The knowledge base used in this
model is a standard composite of modern basic sciences and clinical disciplines.
The model of Environmental Medicine is based on the growing appreciation that the human body is constantly coping
with its dynamic environment by means of a number of inherited, built-in, complexly interacting, and usually reversible
biologic mechanisms and systems.
These systems are designed to maintain overall homeodynamic (not homeostatic) functioning among all biological
mechanisms. Their ongoing adjustments are unique to the individual and change continually over time.
According to this model, substances in the diet or environment are appreciated as being potential stressors, capable
of contributing to de-stabilization of homeodynamic functions, therefore causing disease. The term “homeodynamic
functioning” is preferred because it reflects the fact that maintenance of health and function is an active process rather than
a passive one. Categories of potential external stressors would include organic inhalants such as dusts, molds, pollens, and
danders; the myriad of man made and naturally occurring chemicals; the diet and the many substances in it; infectious
organisms; and physical phenomena such as radiation, heat, cold, humidity, vibrations, noise, electro-magnetic fields, etc.
Categories of potential internal stressors would include psychological stresses, genetic limitations, malnutrition,
dysfunctioning biological mechanisms, etc. Treatment strategies must be individualized and customized for each patient.
THE MODEL OF ENVIRONMENTAL MEDICINE
OPTIMAL HEALTH is a sustained state of optimal physical, neuro/cognitive, psychological, and social well being. It
is achieved and sustained by an active, ongoing expenditure of metabolic energy to insure a homeodynamic stability of
interacting biologic functions despite the dynamically changing potential for disruption from all environmental and internal
ENVIRONMENTALLY TRIGGERED ILLNESSES (ETI) are the adverse consequences that result when the homeodynamic
interactions among biological functions are compromised by external or internal stressors. These stressors may range from
severe acute exposure to a single stressor, to cumulative relatively low-grade exposures to many stressors over time. The
resultant dysfunction is dependent on the patient’s genetic makeup, his nutrition and health in general, the stressors, the
degree of exposure to them, and the effects of seven fundamental biological governing principles: biochemical individuality,
individual susceptibility, the total load, the level of adaptation, the bipolarity of responses, the spreading phenomenon, and the
ENVIRONMENTAL MEDICINE is the comprehensive, cost-effective, proactive cause-oriented, patient-centered and
preventive strategic approach to medical care dedicated to the evaluation, management, and prevention of the adverse
consequences resulting from ETI.
EVALUATION of ETI is accomplished by use of a chronological, sufficiently detailed, environmentally and diet
focused history designed to accurately detect the various clinical patterns generated by the involvement of specific stressors
and by the dynamic interactions resulting from the above governing principles. A positive history is then supplemented as
indicated by an appropriate physical examination, laboratory testing to assess the functional status of the patient’s biologic
mechanisms, medical imaging techniques, diagnostic surgical techniques, and endorsed diagnostic testing techniques.
MANAGEMENT of appropriately identified ETI is by use of the endorsed treatment techniques of comprehensive
patient education about the nature of the illness, correction of abnormal nutritional, metabolic, and psychological
dysfunctions, immunotherapy, reasonable elimination of identified stressors, and symptomatic drugs and surgery where
PREVENTION of ETI is achieved by the skillful proactive application of the concepts and principles of Environmental
Medicine. This would include the adoption of appropriate lifestyles that specifically minimize exposures to identified
stressors as much as practical, that provide less contaminated air, food, and water, and that insure ongoing optimal nutrition
and metabolic functioning, and optimal physical, neuro/cognitive, psychological, and social well being.
THE ULTIMATE LONG-TERM GOAL of appropriate diagnosis and treatment is the cost-effective attainment and
sustaining of optimal physical, neuro/cognitive, psychological, and social well being. This includes the return to a pre-illness
level of functioning and improved tolerance to stressors that previously caused adverse reactions. Through education,
patients should develop and adopt appropriate lifestyles to prevent the recurrence and development of new illnesses.
Successful Application of the Model of Environmental Medicine
The proactive and preventive strategies of Environmental Medicine are applied through a conventional sequence.
This begins with a comprehensive environment and diet focused medical history, a physical examination, and diagnostic
testing. It proceeds to a hypothesis of the condition’s origins and concludes with an effective match between suggested
treatments and a beneficial response by the patient.
There are several major requirements that must be met in order for all patients to benefit most effectively and
consistently from the concepts and modalities of Environmental Medicine:
1. The physician must know how and when to supplement the current model with the Environmental Medicine
model, as dictated by the needs of each patient. This involves determining when symptomatic drugs alone
may be appropriate, and when it is necessary to also actively seek the actual nature of the disease with the
goal of identifying and correcting its actual causes.
2. When treating acute and self-limited diseases, it is appropriate to look for fixed name disease diagnoses to
guide the choosing of appropriate symptomatic drugs. The drugs may be used to buy time until the body’s
own homeodynamic functions recover from the acute illness, and restore health again.
3. When treating more chronic and complex illnesses, it is more useful to think in terms of identifying
dysfunctions in specific biological mechanisms; for example, defects in insulin, glucose, and glycosalation
control; activation of chronic pro-inflammatory pathways, etc. The goal is to repair discovered dysfunctions,
in order to return the mechanisms to their homeodynamic state, restoring health.
4. The physician must be able to identify and test for the complex range of possible external and internal
stressors that can contribute to ETI.
5. The physician must understand the functioning of the body’s many biological mechanisms and appreciate
how they all interact inextricably in the “web of life”. The physician must be able to assess the functional
status of these mechanisms and their interactions with appropriate tests.
6. The physician must appreciate the true complexity of the relationships between biological mechanisms and
the environment and diet as they interact in health and disease. As one astute old physician put it, “Mother
Nature ain’t playing Checkers! She’s playing Chess!”
7. In order to ascertain the causes of disease and to understand the dynamic ongoing clinical manifestations
of an evolving illness, the physician must effectively apply the six fundamental biological principles of
Environmental Medicine while obtaining the patient’s chronological history.
8. A reasonable effective treatment plan must accommodate the patient’s individual list of stressors, the
functional status of biological mechanisms, the level of understanding, and the patient’s resources.
Treatment modalities should be those that will be the most cost effective, convenient, and efficacious for
restoring the patient to good health and preventing further disease.
9. The physician must try to discover the dynamic nature of each patient’s illnesses, and the must be able to
teach this to the patient in a clear and useful manner. After all, the word “doctor” comes from the Latin verb
“docere”, which means “to teach”. There is no more powerful way for the patient to control his/her chronic
disease than to understand its very nature and to be able to manipulate its causes to reverse and prevent
it. This will be best \achieved by an ongoing and dynamic partnership between a well motivated, effectively
educated patient and a physician and staff who are well trained and experienced in the discipline of
Forms of Therapy
The most effective and cost efficient therapies will be proactive and will stress early assessments and interventions
to maintain optimal physical, emotional/cognitive, and psychological health, and spiritual well being. The short term and long
term forms of therapy must be customized for each and every patient, and may consist of any combination of the following
categories of treatment modalities:
1. Patient Education: On the nature of the illness, its treatment, and on future prevention.
2. Therapeutic Customized Diets: Whole food diets and nutriceuticals designed to reverse specific nutritional
deficiencies; to provide optimal nutrition, and to accommodate specific diet related problems such as
food-born toxins, food allergies, and food intolerances, etc.
3. Nutritional Supplements: Vitamins, minerals, amino acids, fatty acids, and other specific nutrients provided
to help correct or optimize specific biological mechanism functions such as detoxification, anti-oxidation, and
anti-inflammatory pathways, etc.
4. Immunotherapies: Customized vaccines made up of specific inhalants, foods, chemicals, etc. May be
taken by subcutaneous injection or sublingually.
5. Psychotherapies: Specific modalities to attain and sustain optimal neuro/cognitive, psychological, social,
and spiritual well being.
6. Detoxification Therapies: Specific oral and parenteral nutritional protocols, heat depuration/massage/
exercise, etc. designed to detoxify indicated patients contaminated with various types of xenobiotics such
as esticides, volatile organic hydrocarbons, heavy metals, etc.
7. Environmental Controls: Protocols to achieve clean air, water, and food by the elimination or minimization
as practical of specific environmental stressors such as organic inhalants and chemicals, and physical
8. Pharmaceuticals: All symptomatic drugs are routinely used as needed to provide symptomatic relief from
symptoms while the underlying causes of an illness are being found and corrected. However, the potential for
adverse reactions when using drugs must always be remembered.
9. Surgeries: Surgeries as indicated
There are hundreds of physicians (M.D.’s and D.O.’s) who have been trained in Environmental Medicine to varying
degrees by attending the continuing medical education courses of the American Academy of Environmental Medicine
(AAEM). They may be found in almost any medical specialty, scattered throughout all parts of North America and Europe.
AAEM has a directory of these physicians on its website at http://www.aaem.com. See “AAEM” in the section listing associations
(below). There are also many clinicians in any specialty who have independently appreciated various aspects of
Environmental Medicine and have incorporated various insights or modalities into their practices.
Patients seeking out an Environmental Medicine approach to their chronic and complex medical problems come
from all walks of life, all ages, both sexes, and many different cultural groups.
Indications and Reasons For Referral (Target Ailments)
Referral to a physician well trained and experienced in Environmental Medicine should be considered anytime a
patient or his/her physician wishes to try to find the actual causes behind a chronic and/or complex illness rather than just
continue to treat it with symptomatic drugs. All organ systems are commonly involved with illnesses that may respond well
to the Environmental Medicine approach. See the “Office Applications” section below.
A referral might be particularly helpful if a patient’s illness is chronic; consists of multiple symptoms in multiple organ
systems; exhibits patterns that fluctuate over time (especially if the patterns are known to result from biological mechanisms
dysfunctioning due to involvement with exposures to environmental inhalants, chemicals, or the diet); or has not responded
satisfactorily to a symptomatic multiple drug approach.
This list illustrates only some of the potentially extensive range of adverse health effects that have been associated
with Environmentally Triggered Illnesses (ETI) as defined in this chapter. By listing a disease name here, it is not implied
that it is always the result of ETI. However, the physician should be alert to the possibility and should consider evaluating
the patient for an ETI connection if indicated by an appropriate history.
Where an illness does involve an ETI component, therapy to correct the contributing causes of the illness should
always rank as the number one choice, ahead of any other therapy that is just symptomatic, though symptomatic therapies
are appropriate adjuncts. All of the diseases and symptoms listed here are documented in the published peer reviewed
medical literature to be potentially due to the mechanisms of ETI:
• Systemic illnesses: alcoholism, obesity, and tobacco use
• Cardiovascular Disorders: Migraine headaches, arrhythmias, vasculitis, thrombophlebitis, hypertension,
angina, myocardial infarctions, edema and fluid retention syndromes
• Eye/Ear/Nose/Throat Disorders: conjunctivitis, eczema of the eyelids, blurring of vision, photophobia,
laryngeal edema, Meniere’s disease, recurrent otitis media, rhinitis, frequent colds, sinusitis, vertigo, hearing
loss, tinnitus, and pressure in the ear.
• Pulmonary Disorders: Asthma, certain pneumonias, and chronic bronchitis.
• Endocrine Dysfunction: Thyroid dysfunction, premenstrual syndrome, fibrocystic breast disease
• Gastrointestinal Disorders: aphthous stomatitis, gastric and duodenal ulcers, chronic gastritis, irritable
bowel syndrome, infantile enterocolitis, eosinophilic gastroenteritis, regional ileitis, ulcerative colitis, certain
malabsorption syndromes, and gut flora dysbiosis
• Hematologic Disorders: certain anemias, thrombocytopenia
• Genitourinary Disorders: glomerulonephritis, nephrotic syndrome, chronic cystitis, recurrent vaginitis,
enuresis, dysmenorrhea, infertility, and vulvodynia
• Neurological Disorders: Fatigue, certain seizure disorders, sleep disorders, Parkinson’s disease,
Alzheimer’s disease, multiple sclerosis, and various cognitive and memory disorders
• Neurobehavioral and Psychiatric Disorders: attention deficit disorder, manic-depressive illness,
somatoform disorders, sexual dysfunction, eating disorders, schizophrenia, panic disorders, irritability,
anxiety, spaciness, and chronic fatigue
• Rheumatologic Disorders: lupus erythematosus, scleroderma, myalgia and arthralgia, fibromyalgia,
rheumatoid arthritis, and other arthritides
• Musculoskeletal Disorders: muscle spasm headaches
• Skin Disorders: eczema, urticaria, angioedema, scleraderma, and dermatitis herpetiformis
Appropriate indications and applications for both the current and the Environmental Medicine models are routinely
and simultaneously found in every medical practice. A physician must know how to identify those patients who will benefit
from each model, and should be able to provide all indicated care, or refer the patient out, as determined by the physician’s
expertise and experience. This involves determining when simply identifying and treating a disease after the fact with
symptomatic drugs may be appropriate, and when it is necessary to actively and deliberately seek the actual nature of the
disease with the goal of identifying and correcting its actual causes.
A simple ranking of conditions responsive to this form of therapy is as follows. As with all alternative therapies, use
of Environmental Medicine does not preclude the use of mainstream medical therapies in addition.
Top level: A therapy ideally suited for these conditions.
Asthma, cancer (adjunctive therapy), gut flora dysbiosis, irritable bowel syndrome, Meniere’s disease, rhinitis, and
Second level: One of the better therapies for these conditions.
Attention deficit disorder, chronic bronchitis, chronic fatigue, dermatitis herpetiformis, dysmenorrhea, eczema, enuresis,
fatigue, fibrocystic breast disease, fibromyalgia, infantile enterocolitis, laryngeal edema, migraine headaches, muscle spasm
headaches, myalgia and arthralgia, premenstrual syndrome, recurrent otitis media, regional ileitis, rheumatoid arthritis,
sinusitis, ulcerative colitis, and urticaria.
Third level: A valuable adjunctive therapy for these conditions.
Alcoholism, Alzheimer’s disease, angina, angioedema, anxiety, aphthous stomatitis, arrhythmias, certain anemias, certain
malabsorption syndromes, certain pneumonias, chronic cystitis, chronic gastritis, conjunctivitis, eating disorders, eczema of
the eyelids, edema and fluid retention syndromes, eosinophilic gastroenteritis, frequent colds, gastric and duodenal ulcers,
glomerulonephritis, hearing loss, hypertension, infertility, irritability, lupus erythematosus, manic-depressive illness, multiple
sclerosis, myocardial infarctions, nephrotic syndrome, obesity, other arthritides, panic disorders, parkinson’s disease,
pressure in the ear., recurrent vaginitis, schizophrenia, scleraderma, scleroderma, sexual dysfunction, spaciness,
thrombocytopenia, thrombophlebitis, thyroid dysfunction, tinnitus, various cognitive and memory disorders, vasculitis, vertigo,
There are literally dozens of books and thousands of articles in the world peer reviewed scientific literature that
provide the data base about the nature of the interactions between humans and their environment in health and disease, or
that provide support for the concepts and modalities as promulgated by the discipline of Environmental Medicine. The reader
is referred to the Suggested Reading Section and References at the end of this chapter.
The information that delineates the molecular and physiological basis behind the nature of the “web of life” as used
in Environmental Medicine is discussed in depth by Rea (Rea, 1992-96) and by Pischinger (Pischinger, 1991). Capra (Capra,
1996) discusses how these concepts actually apply at all levels of life on the earth.
Risk and Safety
The practice of Environmental Medicine is a strategic comprehensive approach to medical care. It is not a limited
modality of therapy for one or more specific purposes. The safety and risks of its application to ill patients is directly related
to the medical skills of the practitioner to proceed wisely and effectively in the evaluation and treatment, and to the severity
and complexity of the patient’s illness. This is true for all medical care models.
All illnesses whose causes include those involved with ETI will improve to some degree, within the patient’s capacity
to correct dysfunctioning mechanisms, if the specific causes can be properly identified and corrected as much as possible.
As the physician’s depth of medical knowledge and level of clinical skills in Environmental Medicine modalities increases, the
treatment outcome for a wider and wider scope of applicable illnesses will improve concomitantly.
Future Research Opportunities and Priorities
Much more research is needed in this area. Such topics relate to cost-effectiveness, nutritional needs in health and
disease, responses to natural and synthetic environmental chemicals, epidemiology of ETI’s, and systems interactions.
The comprehensive treatment modalities of Environmental Medicine make use of all pharmaceuticals,
nutraceuticals, dietary supplements, dietary manipulations, etc. as indicated for each case. The appropriate way to use all
of these substances is beyond the scope of this overview discussion.
Self-help vs. Professional
The therapies involved with Environmental Medicine range in complexity from entirely safe and simple to potentially
very dangerous and quite complicated. Whether any particular therapy may be self administered or utilized only under the
care of a trained health professional will be best determined by an ongoing and dynamic partnership between a well
motivated, effectively educated, and responsible patient and a physician and staff who are well trained and experienced in
the discipline of Environmental Medicine.
Visiting a Professional
It is very helpful to tell the patient that the Environmental Medicine physician will want to know everything the patient
can remember about when, where, and under what circumstances his/her different symptoms have occurred, the order in
which they have evolved, and the results of how they have been evaluated and treated up to that point, because a
chronological, sufficiently detailed, environmentally and diet focused history is the most important and revealing part of an
evaluation. This history may be taken by having the patient fill out a comprehensive history form before the visit, or by an
interview with the physician or staff member at the first visit. The final history is then supplemented as indicated by an
appropriate physical examination. A typical first visit takes from ½ to 1-½ hours. Appropriate laboratory testing to assess
the functional status of the patient’s biologic mechanisms (some combination of blood, saliva, urine, hair, or stool
specimens), medical imaging techniques, and endorsed diagnostic testing techniques (skin tests, etc.) may be performed
also at the first visit or scheduled for another time. After the physician has a complete picture about the full nature of the
patient’s problems, a comprehensive treatment plan will then be devised.
Subsequent management usually includes comprehensive patient education about the nature of the illness, and
correction of dysfunctions by a variety of medical, nutritional, and psychological modalities. Once prescribed, the program is
generally carried out by the physician’s staff, with ongoing monitoring by the physician, as needed. Communication with the
patient’s other physicians (if any) is required in order to coordinate all care being given.
Through education, patients should develop and adopt appropriate lifestyles to prevent the recurrence and
development of new illnesses. This goal will be best achieved by an ongoing and dynamic partnership between a well
motivated, effectively educated patient and a physician and staff who are well trained and experienced in the discipline of
The American Academy of Environmental Medicine (AAEM) feels that the most effective form of medical care based
on this model can be provided by an M.D. or D.O., because these practitioners have the medical licensure to carry out all
aspects of a potentially comprehensive evaluation and treatment plan. Patients should be careful to determine the
credentials and professional experience of anyone from whom they seek medical advice.
The American Academy of Environmental Medicine (AAEM) provides a comprehensive, ACCME-accredited Continuing
Medical Education Program dedicated to train physicians in all aspects of Environmental Medicine. Its CME activities are
based upon the Core Curriculum of Environmental Medicine, which is determined by the AAEM CME Committee. AAEM has
different levels of membership, based upon the member’s level of training in the field. There are also several non-physician
categories of membership. All questions concerning AAEM and its physician education program or other functions should
be addressed to the academy at its central office.
Other medical or health care provider organizations, with varying levels of accreditation, may provide educational activities
about different aspects of the discipline, according to their educational goals and objectives. But only AAEM is currently
providing a full and comprehensive program in this discipline, endorsed by this discipline’s accrediting board, the
The American and International Boards of Environmental Medicine (ABEM and IBEM) are independent
organizations with two missions:  To grant board certification in the field of Environmental Medicine, and  To establish
educational and training criteria for those individuals wishing to prepare themselves as Experts in the field of Environmental
Medicine. Applications and other information may be obtained from the Executive Secretary of the Boards at the address
below. The ABEM and IBEM are not members of the American Board of Medical Specialties.
What to Look For In a Provider
The reader may determine if any particular physician has credentials or training in Environmental Medicine from the
AAEM and ABEM/IBEM by contacting these organizations. Also, AAEM has published Practice Guidelines for the Field of
Environmental Medicine. Readers can call physicians and ask them about their practices and whether these guidelines are
followed in their practices.
Barriers and Key Issues
There is already sufficient scientific support to warrant all physicians to at least become familiar with the concepts
of Environmental Medicine and how they enhance the cost efficiency and quality of life response in the treatment of chronic
However, it is difficult for physicians to embrace a comprehensive medical model that is different from what they are
used to. But all physicians have the same goal for their patients: they want them to get better. Therefore, when they are
aware of the credible scientific evidence to support the superior efficacy of a different way of treating the patient, they should
take the time to at least become familiar with it, if not become trained to apply it in their practices. At the very least, physicians
must become trained to recognize where the application of Environmental Medicine is appropriate, to deal with it, or be willing
to refer appropriate patients to other physicians who have this training.
Suggested Reading and References
Each of the following selections and References below has been chosen because it provides a comprehensive review of its
topic(s) and a significant compilation of literature sources supporting different aspects of the discipline of Environmental
Ashford, Nicholas A., Ph.D., J.D. and Miller, Claudia S., M.D., M.S. Chemical Exposures: Low Levels and High Stakes.
2nd Edition. Van Nostrand Reinhold, New York, New York. 1998.
An up to date, balanced, and superbly referenced review of the controversial topic of Multiple Chemical Sensitivities
Beasley, Joseph D., M.D., and Swift, Jerry, M.A. The Kellogg Report: The Impact of Nutrition, Environment, and Lifestyle
on the Health of Americans. 1989. The Institute of Health Policy and Practice, The Bard College Center. Annandale-on-
Hudson, New York 12504.
A comprehensive and eloquent treatise on the value of Preventive Medicine concepts
Bertalanffy, Ludwig Von. “The Theory of Open Systems in Physics and Biology”, Science, vol. 111, pp 23-29, 1950.
Brostoff, J., Challacombe, S.J. Food Allergy and Intolerance. Bailliere Tindall, Philadelphia, 1987.
Excellent chapters on treatment strategies for food-related illnesses
Capra, Fritjof. The Web of Life. Anchor Books/Doubleday, New York, 1996.
An erudite dissertation setting forth a new scientific language to describe the interrelationships and
interdependencies of biological, psychological, social, and cultural phenomena – the “web of life”. A grand overview of
the Big Picture of Life.
Dickie, Lawrence D., Editor. Clinical Ecology. Charles C. Thomas Publishers, Springfield, Illinois. 1976.
The original physician textbook containing AAEM’s initial concepts on Environmental Medicine. Still an invaluable
source of clinical experience although the name “Clinical Ecology” was dropped many years ago.
Effective Medicine In Clinical Practice. The British Society For Allergy and Environmental Medicine and The British Society
For Nutritional Medicine Subcommittee on Allergy Practice. 1997. Obtain from the BSAENM, P.O. Box 28, Totton,
Southampton SO40 2ZA, England. Fax number from the USA: 011-44-1703-813912. Cost: £ 60.00
This text of twenty superbly referenced chapters presents a current comprehensive overview of the practices of
Environmental medicine as endorsed by the AAEM and BSAENM.
Pischinger, Alfred Matrix and Matrix Regulation: Basis For A Holistic Theory In Medicine. (Edited by Prof. Hartmut Heine,
Ph.D.) Haug International, Brussels, Belgium. 1991 (English Edition).
A superb discussion on the ground substance regulation system as the molecular level basis for the biological
phenomena of the “web of life”. Discusses additional valuable medical strategies that arise when adding th concepts
of ground substance matrix regulation to our understanding of health and illness.
Randolph, Theron G. Human Ecology and Susceptibility to the Chemical Environment, Charles C. Thomas, Springfield,
The seminal book bringing together for the first time the concepts of the potential role of chemical sensitivity in
many chronic illnesses, written by the Father of Environmental Medicine.
Rea, William J. Chemical Sensitivity: Vols I-IV. CRC Press, Inc., 2000 Corporate Blvd., Boca Raton, Florida 33431.
1992, 1994, 1995, 1996.
Though focusing on the topic of chemical sensitivities, these four volumes are the Magnum Opus for the entire
field of Environmental Medicine as endorsed by the Academy of Environmental Medicine and are must reading for
all serious students and practitioners of this approach to medical care. Contains several thousand medical
Selye, Hans. “The General Adaptation Syndrome and the Diseases of Adaptation”, Journal of Allergy (1946) 17:231-247,
Bibliography: Genetically Modified Foods Position Paper AAEM
- World Health Organization. (Internet).(2002). Foods derived from modern technology: 20 questions on genetically modified foods. Available from: http://www.who.int/foodsafety/publications/biotech/20questions/en/index.php
- Smith, JM. Genetic Roulette. Fairfield: Yes Books.2007. p.10
- Freese W, Schubert D. Safety testing and regulation of genetically engineered foods. Biotechnology and Genetic Engineering Reviews. Nov 2004. 21.
- Society of Toxicology. The safety of genetically modified foods produced through biotechnology. Toxicol. Sci. 2003; 71:2-8.
- Hill, AB. The environment and disease: association or causation? Proceeding of the Royal Society of Medicine 1965; 58:295-300.
- Finamore A, Roselli M, Britti S, et al. Intestinal and peripheral immune response to MON 810 maize ingestion in weaning and old mice. J Agric. Food Chem. 2008; 56(23):11533-11539.
- Malatesta M, Boraldi F, Annovi G, et al. A long-term study on female mice fed on a genetically modified soybean:effects on liver ageing. Histochem Cell Biol. 2008; 130:967-977.
- Velimirov A, Binter C, Zentek J. Biological effects of transgenic maize NK603xMON810 fed in long term reproduction studies in mice. Report-Federal Ministry of Health, Family and Youth. 2008.
- Ewen S, Pustzai A. Effects of diets containing genetically modified potatoes expressing Galanthus nivalis lectin on rat small intestine.Lancet. 354:1353-1354.
- Kilic A, Aday M. A three generational study with genetically modified Bt corn in rats: biochemical and histopathological investigation. Food Chem. Toxicol. 2008; 46(3):1164-1170.
- Kroghsbo S, Madsen C, Poulsen M, et al. Immunotoxicological studies of genetically modified rice expression PHA-E lectin or Bt toxin in Wistar rats. Toxicology. 2008; 245:24-34.
- Gurain-Sherman,D. 2009. Failure to yield: evaluating the performance of genetically engineered crops. Cambridge (MA): Union of Concerned Scientists.
- Lofstedt R. The precautionary principle: risk, regulation and politics. Merton College, Oxford. 2002.