Multiple Chemical Sensitivity and Anxiety: Dispelling the MythJun 28, 2022
(a video of the original webinar that took place on May 6 for this discussion is available on the Media page)
Is Multiple Chemical Sensitivities Real?
For decades there has been a lack of recognition of multiple chemical sensitivity (MCS) as a legitimate disease deserving of accurate diagnostic tests, effective treatment and societal accommodation. There are many in society and in medicine who doubt that MCS exists at all or who believe it exists and is a psychiatric condition. Without a diagnostic test, physicians tend to be uninterested in diseases. It’s just how humans are. We believe more easily in things we can measure. Invisible conditions like MCS, ME/CFS and FM tend to be at the bottom of the disease hierarchy and receive less attention and fewer research dollars than high profile diseases such as cancer and heart disease.
Is Multiple Chemical Sensitivities Considered a Disability?
In Canada the answer is YES! In 2007 the Canadian Human Rights Commission commissioned a report by scientist Dr. Meg Sears to summarize the scientific information about environmental sensitivities. In her exhaustive review, Dr. Sears discusses the prevalence, recognition by medical authorities, triggers and symptoms and the impact on the workplace, among other topics. She notes that the health of people with environmental sensitivities, including MCS depends upon the actions of others.
The next year the Canadian Human Rights Commission commissioned a report by doctors Colin Wilkie and D. Baker to establish the status of issues related to environmental sensitivities from a legal perspective and as these relate to the protection of human rights. In their report, Wilkie and Baker examined accommodation for environmental sensitivities in Canada and similar countries. Both of these reports conclude that multiple chemical sensitivity is a bonafide medical condition justifying recognition and legal accommodation. This includes the right to workplace accommodation and disability supports when needed.
Does Skepticism Affect People with MCS?
While this scientific debate smoulders in the background, patients with MCS live with stigma, lack of care and lack of accommodation. As a result, they become isolated and discouraged. It was recently reported that a 51-year-old Ontario woman was granted and died by Medical Assistance in Dying (MAiD) in early 2022 because she could not obtain safe housing. Her inability to escape exposure from fragrance, cigarette and pot smoke resulted in constant, unbearable suffering. Dr. Riina Bray from the Environmental Health Clinic in Toronto is quoted as saying “It was an easy fix. She just needed to be helped to find a suitable place to live, where there wasn't smoke wafting and through the vents.” People creating public policy need to remember that even in the absence of a diagnostic test, real people are suffering and, in some cases, it can be matter of a life and death.
Recently, the debate about what causes MCS has heated up in Canada with the publication of a report by the National Institute of Public Health du Québec (INSPQ). The report concludes (in the short English executive summary) that the physical findings of MCS including neuroinflammation and oxidative stress are a result of recurrent emotional stress and that chronic anxiety explains all of the symptoms of MCS/SCM syndrome. They further state that these “alterations are not specific to MCS. They are also reported for chronic fatigue syndrome, posttraumatic stress disorder, electromagnetic hypersensitivity, fibromyalgia, depression, somatization disorder, phobias, and panic disorder. All of these disorders have in common is the presence of chronic anxiety.”
This view is at odds with the bulk of the scientific literature and with my clinical experience as I discuss below. Environmental physician Dr. John Molot has summarized a few of the scientific shortcomings of the INSPQ report. Other efforts are underway to document the errors in the INSPQ report. In this blog I will talk about the shortcomings from a clinical perspective.
Being a psychiatrist, I have given a lot of thought to the connections between ME/CFS, FM, ES and psychiatric conditions. I’ve struggled to come up with an understanding which represents what I see clinically. Here is my latest effort.
Is Multiple Chemical Sensitivity a Mental Illness?
From my clinical experience, I would estimate that as many as 50% of people with MCS also experience anxiety. This is higher than in some other chronic conditions. Keep in mind however that the numbers of people experiencing symptoms is always higher in clinical samples than in the general population. People with anxiety are more likely to seek care. So, the real rate is likely lower than what I see in my practice. Note that If MCS were a type of anxiety, then the rate would be 100%, and it clearly isn't. Many people manage their symptoms with remarkable calm.
What Causes Anxiety?
Anxiety is most often a response to circumstances. The mnemonic NUTS summarizes the most common anxiety triggers. Lest you think that you are immune to anxiety, research suggests that if people have daily exposure to these circumstances, almost anyone will become anxious.
N – Novelty, something new.
U – Unpredictability no way of knowing it could occur.
T - Threat to the ego feeling your competence and ability to function is questioned.
S - Sense that you don’t have control.
People with MCS face all of the NUTS anxiety provoking circumstances often with little to no validation or support.
New – New onset symptoms
Unpredictable – Don’t know when they will occur.
Threat – Can’t do the things they could before.
Sense – No control over exposures, no support
Perhaps anxiety is a rational response for them.
What Is the Cause of Anxiety in MCS?
My observation is that the anxiety experienced by people with MCS (and other disenfranchised conditions) is transactional. It's caused and worsened by the lack of understanding and support from family, friends and the medical system and of course most importantly in the case of MCS by an inability to escape exposures which trigger symptoms. If people with MCS become anxious, the solution requires societal change, not just change on the part of the patient.
The Body-Mind Chocolate Covered Almond Metaphor
I see MCS (and all other biomedical conditions) as being like a chocolate covered almond. The almond represents the disease, the biomedical reality of the symptoms that occur when, in the case of MCS, a patient is exposed to chemicals. The chocolate represents the secondary emotions which occur due to constant exposure to novelty, uncertainty, threat and lack of support. The chocolate is not the cause of the almond. It’s an addon. However, once the chocolate is added, one has to eat the chocolate and the almond together. MCS like all other health conditions are bio-psycho-social. To understand it we need to look at the big picture and to recover from it we need to look at the big picture.
Is MCS a Mental Illness?
The answer is no. In almost every case, people develop MCS after a chemical exposure irrespective of whether they were anxious start with. Chemical exposure triggers biological processes which can in some cases lead to the symptoms becoming chronic. Most people with MCS didn’t have mental health symptoms before becoming ill.
The biological triggers are well documented. There is Claudia Miller's research, showing that many people develop MCS after exposure to renovation fumes from remodeling their houses or from pesticide exposures. Many of you, outside of Calgary may not be familiar with the problems caused by mold in the Calgary courthouse. So many of the judges became ill that the government built a new, modern courthouse in Calgary. They realized the old courthouse wasn't salvageable and they needed judges. And there was the Camp Hill hospital Mold induced MCS outbreak in Nova Scotia many years ago, that led to the formation of the Nova Scotia environmental center now called the Integrated Chronic Care Service (ICCS) in fall river NS. In my experience, almost nobody gets MCS without a chemical exposure as the trigger.
How Do You Treat MCS?
1. The Toxic Load Hypothesis: The traditional environmental medicine hypothesis of MCS is that the ongoing symptoms are caused by toxic accumulation in the body exceeding the capacity of the body to detoxify and excrete the toxic molecules. In our polluted world this hypothesis makes intuitive sense. In the toxic overload model, the solution is avoidance and increasing excretion.
● Avoid toxins in air, water and food.
● Use sauna to excrete toxins in the sweat.
● Eat a nutrient rich diet and use nutritional supplements to support the liver’s detoxification capacity.
My experience is that detox protocols have some positive effects while people are “on the program”. However, it is hard and expensive to maintain over the long term. Often people relapse when they discontinue suggesting that while avoidance and detox offers short term relief - not to be sniffed at, band aids serve a purpose- I’ve been underwhelmed by this approach over the long term.
2. Mast Cell Activation Syndrome: A more recent finding is that many people with MCS have mast cell activation syndrome (MCAS), a recently described condition, in which mast cells are fragile and likely to burst open in response to triggers including chemicals, drugs, heat, stress and others. Mast cells are also implicated in asthma and various allergies. When the burst, they release a flood of diverse immune molecules causing innumerable and sometimes life-threatening symptoms. Although definitive research isn’t yet published, MCAS is quickly gaining acceptance even among mainstream immunologists. See the website of the American Academy of Allergy, Asthma and Immunology for a description of MCAS.
Though it probably doesn't explain all cases of MCS, I would recommend that you read about MCAS and discuss it with your doctor if you feel it may be an issue for you. Though difficult to diagnose, there are some tests available. Treatments such as mast cell stabilizers, antihistamines and other allergy medications are relatively safe, inexpensive and often very helpful.
3. Neuroplastic Hypothesis: It has been suggested that after being exposed to a chemical trigger, the alarm system of the brain can be activated leading to sensitization. When this occurs, the brain senses danger even when exposed to tiny concentrations of toxins. It is as if the fight/flight accelerator gets stuck. If this neuroplastic theory is correct, then avoidance and detoxification, while helpful, will be insufficient for full recovery. The limbic system will need to be gotten unstuck and the fight/flight response retrained so that the brain responds accurately to small, daily exposures. There are an increasing number of online programs (Dynamic Neural Retraining System, The Gupta Program and ANS rewire to name a few) teaching people how to calm and retrain the brain. In my practice these approaches have been very helpful for people even with severe and long standing MCS and I routinely recommend them.
The take home message is that MCS is a debilitating biomedical condition that causes isolation and sometimes unbearable suffering. There are a variety of tools available to help. Do your research. Consider my Pathways to Improvement online course to learn more about optimizing your self management to improve your health and function.