On behalf of Dr. Claudia Miller:

Treating patients who present with a confusing array of symptoms, who don’t respond to usual therapies and who have no unifying diagnosis is challenging, particularly since chemically induced illnesses were not emphasized in medical school.

We are at the “Germ Theory” stage in terms of our understanding of Toxicant Induced Loss of Tolerance (TILT). TILT emerged from the collective observations of researchers, physicians and patients in more than a dozen countries and introduces a new paradigm for understanding and treating illness. In contrast to current practice, the principal approach to the treatment of TILTed patients is removing exposures to chemicals, foods and drugs that may be causing harm. We call this “Take‐away Medicine.”

The Quick Environmental Exposure and Sensitivity Inventory (QEESI) can be useful for predicting whether a patient might benefit from reducing exposure triggers. A majority of patients with TILT also experience adverse reactions to foods, including non‐IgE mediated reactions. Because patients respond adversely to so many triggers, all contributory exposures must be removed entirely before symptoms will improve.

Patients should be treated in a specially designed and constructed hospital facility called an Environmental Medical Unit (EMU), a chemically “clean” hospital environment. When an EMU is not available, identifying the triggering exposures is an arduous process. Lacking an EMU, physicians can do their best to help TILTed patients by scaling back on non‐essential medications, suggesting a supervised rotary elimination diet, and guiding them to reduce unnecessary chemical exposures.

Once the medical community understands how challenging the diagnosis and treatment of TILT is, it becomes clear that the most important message is prevention. Physicians have the power to recommend a Personal Precautionary Principle approach to all of their patients.

Claudia Miller, M.D. M.S.