A Clinical Approach to Electrohypersensitivty

Physicians For Safe Technology

A Clinical Approach to Electrohypersensitivty

We encourage practicing physicians to evaluate carefully any concerns a patient may have about whether presenting symptoms are being caused by EMF exposures (and/or other environmental issues).  In particular, a physician is in a unique position to educate and support a patient to use a blinded approach—not unlike that employed by Bruntland and Eberle—in determining if they are truly reacting to some kind of EMF.

We recommend the following articles to physicians who encounter patients who might be electrosensitive:

• EUROPAEM EMF Guideline 2016 (35):  A comprehensive review for evaluating a person with possible EHS, which includes sections on history, exam, labs, measurement of EMF exposure, prevention or reduction of EMF exposure, diagnosis, and treatment.
• Eberle’s physician recommendations (36): Another outline of how to approach the care of a person with suspected EHS, compatible with the Austrian guidelines.
• Genuis and Lipp’s review article (37):  They, too, offer both an overview of EHS and an approach to the management of the condition.
• Belpomme’s article(38): Potentially useful for directing which biomarkers might be measured.
• Eberle’s second article, “An Underworld Journey” (39):  Helpful for understanding the profound psychological sequelae that may result from this biophysical sensitivity.
  

  Summary Recommendations Derived from These Five Sources

  • Take the patient’s symptoms seriously: This alone will have a positive impact on the patient’s care.
  • Take a full history and physical:  The history should include identifying all suspected symptoms, variations of health problems depending on time and location, an assessment of EMF exposures, and an evaluation for other possible environmental sensitivities.  The Austrian guidelines note that there are no specific findings on physical exam to confirm or deny a suspected case of EHS.
  • Consider tests as indicated:  
  • • Pursue an appropriate non-EHS work-up as indicated by a patient’s symptoms.
    • The Austrian guidelines outline a comprehensive approach to a lab work-up for someone who may have EHS.
    • The Havas study suggests a possible diagnostic provocation study for those reporting sensitivity to radio-frequency EMF.
    • The Belpomme article suggests EHS biomarkers that might be worthy of measurement (e.g. checking serum histamine levels may help direct the therapeutic use of antihistamines).
    • Genuis and Lipp reference work that suggests an elevated prevalence of thyroid dysfunction and liver disease occurs in people with EHS.
  • Recommend a diagnostic “EMF vacation”.  This is most easily achieved by camping in a remote natural setting, with the support of a radio-frequency meter to confirm the environment is clear.  If symptoms improve dramatically during the “vacation”, only to return soon after coming home, then an environmental cause is possible.  Further investigation will then be needed to determine what in the environment may be a trigger for symptoms.
  • Have the patient keep a detailed symptom diary:  This is essential for helping to tease out if EMF exposures are the cause of a person’s symptoms.
  • If indicated, encourage the patient to have EMF levels evaluated at home and/or work.  Some will choose to do this themselves by ordering the necessary meters (measurements should be done for electric fields, magnetic fields, “dirty electricity” and radio-frequency radiation).  Given the complexity of the issue, however, getting EMF consultation from a reliable expert may be the preferred approach.  See the Austrian guidelines for specific recommendations about this kind of testing.
  • Use a physician’s understanding of blinded studies to help the person design exposure experiments.  As with the physician case histories described above, this will help identify triggers and then direct potentially beneficial interventions.  Meter(s) measuring the type(s) of EMF being tested will be essential to insure the quality of this self-study.
  • Encourage the person to avoid excess EMF exposure.  Here are simple, first-pass changes to consider: 1. minimize use of cellphones and cordless phones and turn them to airplane mode at night and when not in use; 2. use a wired internet connection and keep the computer in airplane mode when possible; 3. keep the internet router far from the bedroom and/or turn it off when not in use; 4. avoid the use of microwave ovens; and 5. consider calling your utility company and having nearby “smart meters” turned off or shielded.  See the Austrian guidelines and/or the Genuis and Lipp article for a more detailed review of first-pass strategies.
  • If indicated, consider a more radical approach to avoidance and shielding: For people with a severe form of EHS, the above first-pass changes may not be adequate.  Arranging EMF consultation, as mentioned above, may be critical in developing more advanced strategies.  For example, while EMF shielding can be hugely beneficial in creating a safe haven, it can also make an environment less safe if the shielding is not done properly.
  • Encourage a healthy lifestyle.  This includes a quality diet and aerobic exercise (if not contraindicated) especially after a significant exposure.  In addition, sleep is especially important to highlight (as per Belpomme’s work, melatonin production is commonly altered and insomnia is often a problem).  Interventions to consider include (1) making the bedroom into a safe EMF haven is essential, (2) using melatonin supplementation, and (3) avoiding excess blue light exposure (e.g. computer and TV screens), which can delay the circadian rhythm and disrupt sleep.
  • Support the patient’s exploration of complementary therapies.  In particular, a functional medicine evaluation may be useful.  The Austrian guidelines highlight that EMF exposure in electrosensitive people may cause a reduction of “oxidative and nitrosative regulation capacity” and thus they recommend “anti-oxidative and anti-nitrosative therapies including trace elements, vitamins and amino acids.”  The Genuis and Lipp article makes similar recommendations focused on the remediation of a person’s nutritional and biochemical status.
  • Refer for counseling and/or recommend a support group as indicated.  See Eberle’s “Underworld Journey” article (39) for a harrowing account of what a person with severe EHS may encounter psychologically, beginning with overwhelm, fear and shame.  Don’t misinterpret these difficulties as being part of a psychosomatic illness.  On the contrary, they are the sequelae of the sensitivity, not the cause.  As profound as these psychological difficulties may be, they should be addressed in parallel with the physically-oriented approaches outlined above.
  • Use existing diagnostic codes as indicated.  The EUROPAEM EMF Guideline 2016 recommends the following diagnostic codes from the International Classification of Diseases (ICD), ICD-10-WHO 2015:
    •  Electromagnetic hypersensitivity (EHS): use existing codes for the different symptoms plus code R68.8 “Other specified general symptoms and signs” plus code Z58.4 “Exposure to radiation” and/or Z57.1 “Occupational exposure to radiation”.
    • EMF-related health problems (except EHS): use existing codes for the different diseases/symptoms plus code Z58.4 “Exposure to radiation”
    • and/or Z57.1 “Occupational exposure to radiation”

  References 

  35)  Belyaev I. (2016).  EUROPAEM EMF Guideline 2016 for the prevention, diagnosis and treatment of EMF-related health problems and illness. https://www.ncbi.nlm.nih.gov/pubmed/27454111 EUROPAEM_EMF_Guideline_2016_reveh-2016-0011

  36)  Eberle S. (2014).  What’s the diagnosis, doctor?  Sonoma Medicine; Fall 2014: 27-32.  http://www.nbcms.org/about-us/sonoma-county-medical-association/magazine/fall-2014-medicine-and-politics-departments-personal-history-whats-the-diagnosis-doctor.aspx?pageid=719&tabid=747

  37)  Genuis S. (2012).  Electromagnetic hypersensitivity: Fact or fiction?  Science of The Total Environment. Volume 414, 1 January 2012, Pages 103-112.  Geniu and Lipp 2011(1)

  38)  Belpomme D. (2015).  Reliable disease biomarkers characterizing and identifying electrohypersensitivity and multiple chemical sensitivity as two etiopathogenic aspects of a unique pathological disorder.  https://www.ncbi.nlm.nih.gov/pubmed/26613326    http://www.ehs-mcs.org/fichiers/1454070991_Reliable_biomarkers.pdf

  39) Eberle S. (2017).  An underworld journey: Learning to cope with electromagnetic hypersensitivity.  Ecopsychology; June 2017; 9 (2): 106-111. http://online.liebertpub.com/doi/abs/10.1089/eco.2016.0036?journalCode=eco&