To Reach Optimal Wellness, Indoor Air Quality is Just as Important as Modern Medicine
Becoming ill from environmental allergens, pathogens, and toxins creates an almost impossible path for sick individuals. People inherently believe in poisons being harmful to human health. In addition, there are clear scientific conclusions that poor indoor air quality is bad for our health. At a scientific level, it is the particulates. Particulates are separate and distinct particles. Solid, gas, or liquid particles from organic and chemical sources circulate in the air we breathe. Unfortunately, the same people who believe in poisons do not necessarily want to understand or believe that what appears to be clean air can be dangerous. Outdoor pollution in densely populated areas is widely known to be harmful to our health. However, indoor air pollutants on average can be 2-5 times higher than outdoor pollutants in the same geography.
“The scientific evidence is unequivocal: air pollution can harm health across the entire lifespan. It causes disease, disability and death, and impairs everyone’s quality of life. It damages lungs, hearts, brains, skin and other organs; it increases the risk of disease and disability, affecting virtually all systems in the human body.” 
“About twice as many people die in total as die just from the [disease]pathways we understand. We’ve been underestimating all along.”
Emergence of “Upstream Medicine”
I wrote an article long ago about the work of Dr. Rishi Manchada that uses clean air as an example of upstream issues that are essential to wellness. “Upstream medicine” is addressing signs and symptoms earlier in the treatment hierarchy. Dr. Manchanda is the Founder and President of HealthBegins, a social enterprise that provides training, clinic redesign, and technology to transform health care and the social determinants of health. Dr. Manchada suggests that our healthcare systems are broken. He focuses on the social elements that contribute to public health. Communities need to look upstream to find contributory elements to illness. This is not just a technical challenge — it’s transformational work. It requires continuous improvement and learning, new ways of working and communicating together, and sustained engagement and commitment from everyone involved in bridging clinical and community approaches to health. As a result, it emphasizes that today, it is incumbent upon patients to ensure their physicians are looking upstream to the environmental causes of their illness.
Watch Dr. Manchanda's Closing Keynote at the 2016 Los Angeles Global Health Conference
“Moving healthcare upstream: Tackling social determinants of health to transform care and communities”
Dr. Manchada’s primary focus is built upon looking upstream to identify the root cause of illness. It is illustrated in the “River Story,” often referred to as the “Public Health Parable.” It has been written and re-written numerous times to apply to many social injustices. The primary messages for all physicians are:
- Look downstream in preparation to address crises
- Look upstream for the root cause of disease and mitigate risks
- Look midstream to identify emerging risk factors
The River Story – A Public Health Parable
“Imagine a large river with a high waterfall. At the bottom of this waterfall hundreds of people are working frantically trying to save those who have fallen into the river and have fallen down the waterfall, many of them drowning. As the people along the shore are trying to rescue as many as possible one individual looks up and sees a seemingly never-ending stream of people falling down the waterfall and begins to run upstream. One of other rescuers hollers, “Where are you going? There are so many people that need help here.” To which the man replied, “I’m going upstream to find out why so many people are falling into the river.”
“As you look further upstream, you notice bridges in various states of repair along the river. Some are strong, made of sturdy components. Others are weak and debilitated, with missing boards or flimsy railings. It doesn’t surprise you that most of the people falling in the river are crossing the poorly made bridges and those individuals that live near or travel across the strong bridges are protected. Of course, all of the bridges could use more reinforcement, but it’s easy to see which bridges need the most attention… In the stream parable, we know that certain groups of people are more likely to fall in the river than others. They do not fall in because of individual weakness or intrinsic flaws. Rather, we know that some people are privileged to live in communities with strong bridges, usually made of high-quality materials that protect them from falling in the river and promote their safe passage across.”
While Dr. Manchada’s focus is on the social elements of public health, the parable has been recognized to place a significant emphasis on the air we breathe as a critical element to our health.
Physicians rarely diagnose and treat for environmental illness. The advent of an increasing number of Natural Disasters during recent times have made environmental illness a recognized ailment. Unfortunately, it can often take medicine decades to understand the new disease pathways, study and publish, develop medicines or protocols, and treat patients with unknown clusters of symptoms without a clear diagnostic. The following disasters resulted in floods of patients exhibiting similar symptoms with one clear, common element, they lived through natural disasters and had become ill by significant exposure to environmental allergens, pathogens, chemical and natural toxins.
- Gulf war syndrome was observed in soldiers who spent time in Iraq and Kuwait in the Gulf War where oil wells were set ablaze causing widespread oil pollutants from an endless source of fuel from the ground.
- The BP oil spill in the gulf overwhelmed the entire Gulf Coast with polluted waters and had an enormous impact on aquatic life.
- Hurricane Katrina and related flooding leveled New Orleans and surrounding communities. It was followed by years of massive demolition, restoration, and reconstruction.
- Hurricane Sandy did the same to the NE coast where an older infrastructure of well-built dwellings was able to withstand much of the storm damage; however, they couldn’t withstand the extended moisture water damage and the microbial infestation that resulted.
In more recent years, there have been ~15-20 environmental natural disasters per year (costing billions). The US has endured record breaking droughts, hurricanes, deep freezes, flooding, tornadoes, and forest fires, including the smoke particulates that have travelled across the entire west coast to the Rocky Mountains and further. FEMA (Federal Emergency Management Assistance) is currently a well-known entity.
A destroyed beach house in the aftermath of Hurricane Sandy in Far Rockaway, NY.
Most information surrounding natural disasters has been observed prior to recent years and only studied a limited number of examples that occurred over decades. However, natural disasters of all types have increased exponentially. We used to discuss natural disasters that were recognized by the year. Today, the US alone accounts for 15-20 Natural Disasters per year, each costing over $1B in resources to manage. It is believed that this significant increase is attributed to global warming. Some scientists and politicians still deny that global warming is the issue.
The evidence from numerous catastrophic natural disasters did not allow physicians to “overlook the obvious” when it came to the root cause of illness in these areas at that time. Following these natural disasters, large numbers of ill patients required medical assistance. Physicians have now had the experience of seeing an adequate number of patients with environmental illnesses directly tied to the disasters. Prior to that, water damaged home exposures were limited to one-off leaks and flooding and random episodes. While this is good news regarding awareness, only a small representation of integrative medicine specialists conduct standard research and publish their findings. Relatively few publications have made it to mainstream peer review journals and R&D institutions. The emergence of environmental illness is currently undeniable given the Covid 19 Pandemic, yet very little has been done to train practicing physicians to treat environmental illness.
The NIH Budget for medical research search is over 41 billion dollars. 80% is allocated to external research. Only a tiny and negligible fraction (~2%) of this funding is allocated toward environmental health. The majority of that focuses on prevention and not treatment. However, DARPA (Defense Advanced Research Projects Agency) supplements medical research in infectious diseases in anticipation of bioterrorism. DARPA has been responsible for major world-changing technologies and innovations such as the computer mouse, GPS, the internet, and drones. DARPA also contributes to Covid 19 research vaccine technologies, detection, and aerosol monitoring. Proactive solicitation of grant funding to study environmental illness is required for significant changes in the treatment and treatment options to occur. Following adoption, reimbursement by insurance companies will require further research into the healthcare economics of new treatments to reimburse physicians for treatments.
Breathing clean air is essential for prevention and treatment of chronic illnesses. It is as important as diet, exercise, and medical treatment!
- Healing from illness and injuries is pretty taxing on the body. Since every cell requires oxygen, the body’s effort to replace damaged cells increases your body’s demand for air. Oxygen therapy has been demonstrated to improve recovery time for patients.
- Sleep has recently been recognized to be critical for the body to heal and for wellness and longevity.
- The human body breathes in approximately 17,000 liters a day of air.
- The air indoors can be 2-10 times more polluted than outdoors.
- We spend approximately 90% of our time indoors.
- When environmentally ill patients return to sleep in their homes with poor air quality, the immune system is continuously taxed to address these particulates. Because of this phenomenon, many patients simply will not heal.
- Energy efficiency for cost savings has led to the installation of HVAC systems that recycle air rather than replacing polluted air with fresh air. HVAC filters are insufficient for whole house air filtration. Smaller particulates require a more comprehensive HEPA filtration system that does not overtax existing HVAC systems.
- The emergence of COVID has placed indoor air quality (“IAQ”) front and center to avoid COVID exposure and to mitigate the risk of contamination with improved HEPA air filtration, HEPA vacuums, and sanitation practices which have become mainstream for homes and buildings across public spaces.
Clean air is essential for healing. Another way of stating this is that the air we breathe should be clear of allergens, pathogens, chemical poisons, toxins, and gases. Indoor Air Quality (“IAQ”) is the new buzzword used by HVAC professionals, contractors, mold remediators, and building scientists. Often, when a severely ill patient does not get better over time with medicine, it is likely that their home or work environment is causing, or prolonging, their illness. When environmental illness is suspected, patients are often asked to spend time away from their homes. In these cases, improved health may indicate that the home itself is sick.
Inhaling poor air quality has a severe impact on the body and healing. First, it introduces more harmful air particles into the sinuses and lungs. Second, it prevents patients from healing because their immune system is constantly geared up to address the new foreign particles. Finally, the body’s glymphatic system does not function properly if the patient continues to breathe in particulates while sleeping. In these cases, the glymphatic system cannot remove toxins from the brain. These neurological symptoms are often the “scariest” for patients. Read: How Mold and Mycotoxins Poison Your Brain.
“Air pollution affects people from the beginning until the end of life, causing a wide range of acute and chronic diseases from the earliest stages of child development to extreme old age. Particularly sensitive populations include infants in the womb, children, the elderly, and people with pre-existing chronic diseases. Almost all organs, systems and processes in the human body may be impacted: the lungs, the heart, the brain, the vascular system, the metabolism, and reproduction. Air pollution is a major cause of pneumonia, bronchitis and asthma in infants and children. It slows the growth of the developing lungs of children and adolescents. It contributes to heart disease including cardiac arrhythmias and acute myocardial infarction, stroke, cancer, asthma, chronic obstructive pulmonary disease, diabetes, allergies, eczema, and skin aging. There is emerging and growing evidence that air pollution contributes to dementia in adults and impacts brain development in children.” 
MD Blind Spots
In the context of the importance of clean air required for healing, patients who suspect environmental illness must research on their own to navigate the health care system, insurance, and find physicians. Most physicians in the developed world have been trained in modern western medicine. Alternative medicines and homeopathic remedies are available, but empirical logic and problem-solving approaches are what mainstream medicine practice to diagnose disease. This dates all the way back to ancient Greece with the Hippocratic Corpus. Empiricism relies on vital information about the patient. Treatment is individualized to the patient. It is oriented towards treating the patient’s symptoms and treats illnesses based on deductive logic. The doctor only treats individuals, not disease classes. Alternative medicine, in contrast, is mechanistic and systems oriented rather than symptom oriented.
All MDs are trained in using empirical practices. “Proponents of evidence-based medicine have clearly acknowledged one aspect of this gap: the part that requires the consideration of values, both patient and professional, prior to arriving at medical decisions, written by M.R. Tonelli. “Not as clearly recognized, however, is the gap that exists due to the fact that empirical evidence is not directly applicable to individual patients, as the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand.”
Because of this, empirical practices omit diseases caused by external elements such as pathogens, allergens, and toxins which constitute major blind spots for physicians. Infections are the exception. Bacterial, and in some cases fungal, infections can be cultured and tested easily with modern diagnostics and treated with antibiotics of antifungals. All that is needed is a petri dish and a microscope. Treatment of other foreign pathogens has not benefited from medical advances. We are all exposed to these foreign elements. Environmental pollutants in our homes are seldomly monitored with scrutiny.
In recent decades, we have learned from the epidemics and pandemics of Covid 19, SARS, HIV, and Ebola that viruses can be deadly and result in epidemics and pandemics where science has to play catch up to treat patients. Heavy metals and chemical exposure also cause a series of serious chronic symptoms that resemble many chronic illnesses. Mold, bacteria, and mold mycotoxins are common in highly humid climates and wherever water damage occurs in a home.
Government Involvement Via Environmental Regulations
It wasn’t until 1969 when the Nixon Administration formed the EPA due to increasing concerns of pollution’s impact on society. At that time lead was still being used for indoor plumbing. Lead and arsenic were ingredients of paint. Asbestos was used in construction. Toxic chemicals were regularly used as pesticides.
History of Clean Air Act of 1970
Lead-Based Paint Restrictions January 13, 1971
EPA Takes National Action on Air Quality April 30, 1971
EPA Bans DDT (pesticide) June 14, 1972
Clean Water Act October 18, 1972
Leaded Gasoline Phase-Out December 28, 1973
Toxic Substances Control Act (TSCA) October 11, 1976
Phase out of Cholorofluorocarbons (CFCs) October 15, 1978
Nuclear Waste Policy Act January 1, 1982
Mold Illness, which dates back to biblical times, has emerged as a cause of sickness and disease. Toxic mold stories now appear in the news. Unfortunately, western allopathic or allopathic doctors seldom make an accurate diagnosis immediately without trials of medicine or diagnostics. This subjects individuals to countless referrals and rounds of pharmaceuticals prescribed.
Public Health Acknowledgement
On August 14–18, 2017, the CDC announced its First Fungal (Mold) Awareness week. This was a significant announcement that recognized fungus as an actual cause of chronic disease. In addition, it suggested that patients who are not getting well question their physicians about fungus as the cause.
Fungal Disease Awareness Week, observed in early October, focuses on fungal diseases. These are generally caused by inhaling fungi spores. Symptoms include an infection in the lungs or on the skin. Often undiagnosed, more than 300 million people worldwide suffer from fungal diseases. Events and activities during the week focus on identifying and diagnosing them early enough to provide life-saving treatment. Fungal Awareness demonstrates the progress made in the Public Health Sector. Patients are educated to question their doctors. Unfortunately, fungal awareness is in its infancy with physician awareness and practices.
The Importance of HVAC Systems
The HVAC system is, in my opinion, the most important mechanical system/appliance in any home. This opinion is not standard across homeowners. Unfortunately, price is almost always a major consideration for HVAC installations, ductwork, and replacements. HVAC systems are commonly installed improperly due to rule-of-thumb guestimates vs properly calculations that consider building physics and the recognition that people, sun facing windows, and other factors generate heat.
It is critical that HVAC systems be properly calculated and installed.
Housing developers and builders rely on large purchases, price, and uniformity to drive HVAC decisions. It is best to not cut corners when selecting an HVAC system to replace an existing unit. That unit may be improperly installed.
- Make sure the installer does the proper calculations.
- Consider variable speed unit and air handler. These units cycle on and off more often using less power. Air is “conditioned” continuously and allows you to use higher rated air filters in the unit.
- Make it clear that the system needs a fresh air source.
- Consider an ERV (Energy Recovery Ventilator) for a fresh air exchange
- Purchase an air purifier unit for your most occupied rooms, especially the bedroom.
You can learn more about how to inspect, test your air conditioning and heating unit in last year’s article: HVAC Systems and Mold: Air Handler and Ductwork Cleaning and Maintenance.
I hope these past several articles have provided some useful background to understand environmental illness from various perspectives. If you have a question, comment, or topic you would like to suggest, please feel free to email me at firstname.lastname@example.org.
- Roberts, David. “Air Pollutions Is Much Worse Than We Thought.” Vox. Aug 12, 2020.
- Roberts, David. “Air Pollutions Is Much Worse Than We Thought.” Vox. Aug 12, 2020.
- Story by Saul Alinski, Sheldon, et.al, “Juvenile Justice in America: Problems and Prospects. Waveland Press. January 18, 2008.
- NIH Budget. ”What We Do?/Budget”. nih.gov/about
- Tonelli MR. The limits of evidence-based medicine. Respir Care. 2001 Dec;46(12):1435-40; discussion 1440-1. PMID: 11728302.
EXCELLENT series! Reading this in one series reminded me of much of the research and strategies that I have been using for the past decade or more since my major mold exposure. One very important factor that triggered me is: I must move out during the upcoming repair process for our condo as my toxic load limit may be overflowed again during the construction process. Thank you for this timely reminder. These are all lifesaving pieces.