ESSAYS BY MICHEL ODENT, M.D.
8. How Effective is the Accordion Method? Evaluating our Preconceptional Programme
The development of our preconceptional programme (‘accordion method’) is now entering its sixth phase. Our new objectives cannot be understood without a reminder of the previous phases.
PHASE ONE: KEEPING IN MIND OLD PREOCCUPATIONS
In the early 1990s the preconceptional programmes were often limited to the prescription of supplements of folic acid (400 microgrammes a day via enriched breakfast cereals or tablets), in order to reduce the risks of abnormalities of the neural tube such as spina bifida, anencephaly and encephalocele. These prescriptions were based on the results of studies published in prestigious medical journals 1,2 and encouraged by huge public health campaigns. In the mind of many people folic acid was almost synonymous of preconceptional preparation. It was usual to associate these prescriptions with recommendations regarding smoking and alcohol consumption. More sophisticated programmes were taking into account around the dangers of mineral imbalances and deficiencies (zinc, magnesium, manganese, selenium, etc.) and the dangers of heavy metals (lead, aluminium, cadmium, mercury). Zinc, vitamins C and B, garlic were among the most common prescriptions, associated with dietary recommendations (eating organic, etc.).
PHASE TWO: NEW PREOCCUPATIONS
In the late 1990s we could gather a sufficient amount of data to realise that one of the main threats for the health of the unborn generations is intrauterine pollution by fat-soluble man-made molecules. It would be difficult to give a comprehensive list of intrauterine pollutants. Let us just recall the name of some well-known families: dioxins (a family of 219 different toxic chlorinated chemicals), PCBs (more than 200 related compounds), APES (non ionic detergents), furans, PCDDs, trans fatty acids (introduced in the human diet via the processing of oils). Today we all have in our body hundreds of such molecules. They accumulate over the years in the adipose tissues and they have a long life. The prerequisite to realise the importance of the phenomenon is to establish links between a great diversity of recent data that are scattered in the scientific literature.
Data regarding neurological and intellectual development were originally provided by researchers who wanted to evaluate the long-term effects of human milk pollution. Milk pollution is easily detected and therefore well documented. For example, according to a WHO survey, the daily estimated intake of dioxins and PCBs by breastfed infants in 1993-1994 was 170pg per kg body weight at 2 months, and 39pg at 10 months. The tolerable daily intake according to WHO is 10pg (the tolerable levels are based on lifetime exposure). Since in formula milk lipids are replaced by lipids of vegetable origin with a negligible content of PCBs and dioxins, the first question was: Do the well-known benefits of breastfeeding outweigh the theoretical risks associated with PCBs and dioxin exposure? A series of Dutch studies compared breastfed infants (at least 6 months) and formula fed infants. Results of 7 months, 18 months and 42 months follow-up assessments were published 3, 4, 5. No negative effects of exposure to PCBs and dioxin through breastmilk could be detected. After taking into account many associated factors, it appeared that the focus should be on intrauterine pollution. The negative effects of intrauterine pollution were detectable in all studies.
Similar conclusions can be drawn from an American study of the intellectual functions of 11-year-old children. The authors recruited originally 212 babies born to mothers who had eaten Lake Michigan fish contaminated with PCBs6. Concentrations of PCBs in maternal serum and milk at delivery were slightly higher than in the general population. Prenatal exposure was evaluated by measuring concentrations in umbilical-cord serum and by taking into account maternal serum and milk concentrations. When the children were 11 years of age, a battery of IQ and achievement tests was administered. Prenatal exposure to PCBs was associated with lower IQ scores after controlling for potential confounding variables such as socio-economic status. The strongest effects were related to memory and attention. The most highly exposed children were three times as likely to have low average scores and twice as likely to be at least two years behind in reading comprehension. Although larger quantities of PCBs are transferred by breastfeeding than in utero, there were only deficits in association with transplacental exposure.
Dentists from Finland studying how polychlorinated chemicals interfere with tooth development also came to the conclusion that it is intrauterine pollution that really matters. They noticed that many children had poorly developed molars, discoloured and soft. The normal hard enamel coating was missing, making the teeth subject to decay. They took into account the effects of an accidental exposure to dioxins in Taiwan7. Children whose mothers were exposed while pregnant showed tooth problems similar to those of Finnish children. Taking this as a clue, they combined animal experiments8 and clinical studies9 to reach the conclusion that mineralization defects of the permanent first molars were the best available indicator of dioxin exposure during fetal life.
Reports in different countries indicate that the increasing rates of disorders of the male genital tract are related to intrauterine pollution. More and more boys have undescended testicles 10, 11. Hypospadias (the most common abnormality of the penis) is also more frequent. A recent analysis in the United States showed that the rate of hypospadias had nearly doubled in all 4 regions of the United States from 1970 to 199312. During the same period, testicular cancer rates have also increased13. Today it is commonly accepted that most cancers of the testicles are the long-term effects of developmental defects during fetal life. The spectacular fall of the average sperm counts since the middle of this century represents the most intriguing sign of the increased vulnerability of the male genital tract14, 15. The only plausible interpretation is that all the synthetic polychlorinated chemicals that we accumulate over the years in our adipose tissues are hormonal disruptors. More precisely they mimic oestrogens Therefore they interfere with the development of the testis at the very beginning of intrauterine life.
Not only is the male genital tract in danger, furthermore the rate of survival of male fetuses is dramatically decreasing. This is demonstrated by a study of the vital statistics in Japan that evaluated the dramatic increase of the male/female ratio of miscarriages16. The numbers of fetal deaths in Japan were counted after 12 weeks of gestation, when it is possible to identify the sex of most fetuses. The male/female ratio of miscarriages between 12-15 weeks gestation increased from 2.52 in1966, to 3.10 in 1976, to 6.19 in1986, to 10.01 in 1996! The vulnerability of male fetuses to new environmental factors was already suspected after the publication of reports indicating that the proportion of males at birth has declined significantly in the past 3 decades17. The male proportion among newborns in Denmark18 and the Netherlands19 have both declined in a parallel manner from the 1950s to the 1990s. There were similar trends in Canada20 and the USA21 for the period 1970 to 1990. For Canada, during this period, there was a loss of 2.2 male births per 1000 live births. In the USA, there was a decrease of 1.0 male birth per 1000 live births. It has been observed that in some Latin American countries22 the male proportion has also declined since the 1970s. Similar trends have been reported in Finland23 and in Italy24.
The current increasing death rate of male fetuses is obviously related to prenatal pollution. This interpretation is supported by the reports following the 1976 industrial accident at Seveso (Italy) which produced the highest documented community exposures to TCDD (one of the most toxic dioxins). Between 1977 and 1984, 48 girls but only 26 boys were born to parents exposed to TCDD25.
Trans fatty acids represent a particular group of fat-soluble pollutants. Today they are abundant in such foods as cakes, biscuits, French fries, fast foods, etc. A German team demonstrated that they cross the placenta and have adverse effects on fetal growth26. An American team found a correlation between the maternal intake of trans fatty acids and the risk of pre-eclampsia, a maternal disease that can have long term consequences for the child.
PHASE THREE: THE EMERGING CONCEPT OF MALE MEDIATED DEVELOPMENTAL TOXICITY
In 1999 this concept appeared for the first time in a main stream medical journal. According to a study from Montreal published in the Lancet, when a man is more exposed than most men to polychlorinated chemicals, his children are at increased risk of acute lymphoblastic leukaemia, which is the most common form of cancer in childhood27. Soon after we learned from another study in the Lancet the results of an enquiry regarding the population accidentally exposed to high concentrations of dioxins in Seveso, Italy, in 1976. It was revealed that fathers exposed when they were younger than 19 sired significantly more girls than boys (sex ratio 0.38).
We are probably at the dawn of a new era of research inspired by this emerging concept. A study looked at the reproductive effects of paternal exposure to chlorophenate wood preservatives in the sawmill industry28. The authors identified 19,675 children (born between 1952 and 1988) of 9,512 fathers who had worked at least one year in British Columbia sawmills where dioxin contaminated chlorophenates had been used. The controls were matched for year of birth and gender. The children of male sawmill workers were at increased risk for developing congenital anomalies of the eyes, particularly congenital cataracts; elevated risks for developing anencephaly or spina bifida and congenital anomalies of genital organs were shown according to specific windows of exposure.
Animal experiments had been instrumental in introducing and developing the concept. There have been countless studies of alterations in offspring of experimental animals following paternal exposures to miscellaneous chemicals. The effects include decreased litter size and weight, increased stillbirth and neonatal death, birth defects, tumours, and behavioural abnormalities - some of these effects being transmitted to the second and third generations. A review article of such experimental studies came to the conclusion that paternal exposures may contribute to the incidence of a great variety of disorders in humans29.
PHASE FOUR: TOWARDS NEW STRATEGIES
This list of preliminary warnings will probably lengthen in the near future. Meanwhile preconceptional programmes must adapt to these new preoccupations. Any new strategy must take into account that most new synthetic industrial chemicals accumulate and persist in the adipose tissues (of women and men), even after their environmental levels have fallen. There may be a very long time lag between exposure and effect. The only rational approach one can offer is based on lipid mobilisation: the primary objective should be to renew the stored fats. Fasting30, 31, 32 and physical activity33 are two mechanisms that tend to mobilise stored lipids and fat soluble chemicals. When there are more free fatty acids in the blood and therefore more fat soluble chemicals, the human body must rely on extra hepatic and extra renal means of excretion: human livers are incapable of detoxifying chemicals to which they have not been exposed during millions of years of evolution, and the kidneys cannot eliminate fat soluble substances. The human body must rely on sweat and intestinal excretion. Fat soluble contaminants such as dioxins diffuse across the intestinal wall and are attracted by the fat contained in the intestinal lumen. Our preconceptional programme (‘accordion method’) takes all these facts into account. It is based on a series of short repeated semi-fasting sessions. The principle is to lose weight and to mobilize fatty acids during each session and to recover immediately one’s previous weight between two sessions (‘accordion’). The duration of each session is about 2 or 3 days. During such a session there is no other food available than a specially designed cocktail made from a mixture of maple syrup, palm tree syrup and lemon juice. Cayenne pepper is added after dilution (a way to slightly increase the body temperature). The cocktail can be consumed at any time without any restriction. Its mineral content is exceptionally rich. The ratio of zinc to manganese to iron is ideal (in the region of 5:2:1). The ratio of calcium to magnesium is around 2.5 to 1 and the ratio of potassium to sodium around 10 to 1. The lemon juice represents the main source of natural vitamin C.
During a session steam baths, saunas and exercise are combined. Physical activity is adapted to individual lifestyles. Women must make sure that they cannot become pregnant before, during or immediately after a session, when they have more pollutants in their blood. For obvious reasons the point is not to reach a complete renewal of the stored fat. It is to minimise the possible effects of pollution on the offspring, should a conception occur.
PHASE FIVE: EVALUATING THE FEASIBILITY OF THE PROGRAMME
After establishing such a strategy, we had first to evaluate the feasibility of the programme. We first tested group sessions. We had friendly and interesting weekends. The participants were gathered on Saturday and Sunday. The conversations about all topics that are interesting for parents-to-be were interrupted by steam baths, saunas and fast walks on the local hill. On Friday the participants had already reduced their calories intakes by relying on vegetable soups and fruits. On Monday the return to the usual food intake was gradual. The participants were educated as to how to repeat the sessions at home at a rhythm of about once a month.
During such sessions we collected interesting preliminary observations. At the beginning of the second day everyone was invited to talk about himself or herself. Many participants mentioned headache and lack of concentration. Most of them also mentioned that they had a good night sleep after the first day and that they did not feel hungry at all. The tongues appeared whiter than at the beginning of the first day. At the end of the session it was euphoria that was reported. Several participants thought that more pepper had been introduced in the cocktail, compared with the previous day: this was a sign of a more acute sense of taste-smell. There were obvious signs of weight loss. For example, a woman noticed that she could easily take off her ring. We had at our disposal a Japanese measuring device that evaluates the proportion of body fat. Before the session the extreme numbers were 22% and 35%. At the end of the session the fat loss was between 1 and 3 units. Furthermore we tested the acceptability of laxative tea bags containing Senna.
Although these group sessions were useful in evaluating the feasibility of the programme, we had to replace them by personalized consultations. The group sessions were difficult to organize because very few couples could participate together and in general only women were coming. We must add that many couples seem to need to talk about their particular case. Furthermore when the man is involved from the very beginning, there is a reinforced shared motivation.
PHASE SIX: EVALUATING THE EFFICACY OF THE PROGRAMME
The time has come to evaluate the efficacy of the programme. This will be possible thanks to the co-operation of Dr Vyvyan Howard, a well-known expert in fetal and infant toxico-pathology. The first step of the project will be to recruit twenty women aged 20 to 30. We assume that the results will be more easily interpreted if all the participants belong to the same age group and the same sex. Such recruitment should be possible on the net, via specialised agencies that have at their disposal mail lists classified according to such criteria as age.
For each participant the programme will include five sessions over a period of five months. The programme will be preceded and followed by a lipid biopsy. A lipid biopsy is about as invasive as taking a blood sample. In the fatty cells it will be possible to compare the amount of fat soluble chemicals, particularly polychlorinated chemicals, before and after the series of sessions.
REFERENCES
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