12,000 Canaries Can’t Be Wrong (book review)

Dr. John Molot is a Canadian physician, specializing in Environmental Medicine. As a result he has seen over 12,000 patients suffering from Multiple Chemical Sensitivities (MCS), Fibromyalgia, ME/CFS and other issues that seem to leave patients with more questions than answers. The premise of the book is that those of us with MCS, Fibromyalgia, and ME/CFS are basically the canaries in the coalmine of life. We are the early-warning sirens that the environment is toxic.

A few weeks back a representative for Dr. John Molot contacted me and asked if I’d be interested in reviewing a copy of his book, 12,000 Canaries Can’t Be Wrong. After looking at the premise of the book, I decided that I certainly would be.

If you aren’t familiar with the ideas of canaries in a coalmine, prior to technology, miners carried canaries down into the coalmines. When/if the canaries began getting sick and/or dying the miners knew it was time to head back to fresh air. The analogy here is that our environment is a coalmine, filled with toxins, and that we are the canaries signaling a warning that those toxins are rising and getting too high.

But, why are some of us more sensitive than others?

It’s an interesting thing and something that has bugged me since I first understood it after taking statistics, the “normal distribution” and its use in medical diagnosis. The idea is that the average person responds within a certain range. The problem is that that’s the AVERAGE person. There are going to be those who respond faster, and those who respond slower. We canaries fall on one extreme of the normal distribution rather than in the middle (with the average people). We are typically more sensitive to chemicals, smells, noises, and medications.

Often it seems that doctors forget that we are all individuals and that just because a certain set of responses is normal for the “average” person doesn’t mean that we are all average people. They ignore those of us don’t fit the curve, leaving us to fend for ourselves, and find our own answers. In this book, Dr. Molot notes a pattern he’s seen in his patients. He shares some of the science that has been often overlooked by other doctors, and he shares his 9-step process for helping the canaries recover their health.

In the first section of the book, Dr. Molot explains what Environmental Medicine is and how he became interested in this very young field of medicine (when it was even much younger). This section was a quick read and very interesting as it tells his story, as well as shares the stories of a few of his patients.

A topic that he hit on in this section (and returns to again and again) is the overlap between the physical and the mental. He talks repeatedly about how often the patients he sees have been dismissed as having “mental” issues rather than physical issues. However, he takes the time to explain how the various physical ailments we are dealing with affect our mental states, and vice versa. His answer is that yes, it’s both.

He takes the time to point out that patients are individuals, that because no two are the same, a one-size-fits-all model is not appropriate. Rather,  the practice of medicine should be treated as an art, and each patient as an individual.

Next, Dr. Molot talks about What is Making Us Sick. He reminds us that it’s not just one thing, but that it’s the accumulation of all the things, people, situations, and environments that we’ve encountered over our lives. The air we breathe, both indoors and outdoors, makes a difference. As we breathe air with higher levels of pollution (whether from emissions outdoors, or paint fumes, carpets, and cleaning agents indoors) we are more likely to get sick.

He points out the issues with many of the studies that try to suggest that small doses of chemicals are not harmful. A single small dose of a single chemical may not be, but when we are getting small doses repeatedly and mixing it with small doses of hundreds of other chemicals it can be. (Studies typically only look at a single small dose of one chemical at a time to determine if it’s harmful). He also points out that thresholds vary based on many endpoints, population studied, and the time of the measurement.

Indoors we not only have to deal with the chemicals in our various building supplies, but also cleaning agents, fragrances, and hundreds of other sources of chemicals that are not only inhaled but absorbed into our skin and through our eyes and other mucous membranes. He also points out the large amount of time that we all spend indoors, rather than in fresh air (assuming we even live somewhere that we can get fresh air outside).

Dr. Molot addresses the fact that it’s not like one day we suddenly go from 100% healthy to chronically ill. “The process of developing a chronic illness begins long before it can be detected clinically.” He takes the time to explain some basic biology. This is where the book starts getting pretty deep and if you are like me and didn’t do to well at High School Biology you might struggle a little. I had to reread some of these sections repeatedly to let them soak in. He explains the important role of oxygen, and the role of the mitochrondria in properly processing oxygen. He explains free radicals and how “they are the waste product of the cell’s metabolism.” When a cell is required to work harder it produces too many free radicals and this can cause damage to the cells.

He explains the two stages of detoxification and how they work together to rid the body of free radicals and other waste materials. This leads into a discussion of oxidative stress (something we’ve all been hearing more and more about). His simple explanation is that oxidative stress is the “imbalance between the production of oxidants or other free radicals and our ability to neutralize or detoxify them.” Basically, oxidative stress is when your body is creating more waste material than it can dispose of, so it builds up and clogs up your system. He explains how environmental chemicals add to the burden of oxidative stress.

In Part 3, Dr. Molot begins to address some of the environmental illnesses that he sees regularly. The first is MCS, which he explains is a brain disorder. This relates back to sensitization (a common component of MCS, Fibromyalgia, ME/CFS and several others). This is when your body reacts over-strongly to a stimuli. Instead of learning to habituate (get used to) a stimuli that it is experiencing repeatedly the brain freaks out turning up the volume on that stimuli so that even the slightest touch causes pain, the slightest fragrance gives you a headache, or the slightest noise seems like someone is screaming in your ear.

He explains that the limbic system is the part of the brain where the stress response takes place and how it is responsible for recognition of and reaction to new stimuli. The limbic system is responsible for maintaining balance within the body. It’s involved in thinking, mood and emotion, attention processing, autonomic nervous system function, the sleep/wake cycle, pain, and immune function (among others). Really, it’s involved in pretty much every process to some degree.

Our stress response is also impacted by other factors, including obesity and lifestyle factors like (smoking, alcohol use, and exercise). “The more stressed we are by something, the more easily we can be stressed by other factors.” Stress causes stress causes stress. When stress from one source is elevated it increases the likelihood that we will become sensitized to other stressors. He explains the role of receptors and specifically the TRPV1 receptors and how they have become sensitized in those with MCS (as well as other disorders).

The TRPV1 receptors are something that he returns to repeatedly and that appear to be a common link between many of these disorders. This is actually one area of the book that I wish I’d been able to understand better. TRPV1 receptors are also known as the Capsaicin receptors, they are found on the membranes of pain and heat-sensing neurons on the skin and in the mucous membranes. He points out that MCS patients while they often “fail” other studies are hypersensitive to the inhalation of capsaicin, when compared to controls. He returns to this discussion throughout the book.

As I said at the beginning he addresses a “pattern” that he’s seen in his patients over the years, a pattern that pretty much everyone with MCS, Fibromyalgia, or ME/CFS seem to fit. The pattern includes complaints of chronic pain, reduced memory function, lack of concentration, sleep issues, mood changes, fatigue, respiratory issues, allergy symptoms, GI issues, and sensitivities to food, temperature, lights, noise, and weather. They are also more likely to be diagnosed with migraine, IBS, and autoimmune diseases.

He points out that it’s difficult for a doctor to understand a patient’s pain. First off, they are relying on subjective reports from the patient. He points out that it is more valuable to ask how a patient’s pain is impacting their daily life than it is to ask them where they pain falls on a scale of 1-10. Most physicians, he points out, have never had to deal with the types and level of symptoms that their patients describe. This often leads to a psychiatric diagnosis rather than a physical diagnosis, especially when the doctor doesn’t believe in certain diagnoses like MCS, ME/CFS, or Fibromyalgia.

Returning tot he limbic system he begins to connect the dots, pointing out how stress feeds on stress from the time we are children, often leaving us hitting a wall. He explains learned hyper-vigilance, which is  a state of hyper-awareness. We learn to be constantly on guard for the next “attack”, to be careful to avoid situations that would cause us pain or stress (physical or emotional). He connects other dots between ME/CFS and mitochondrial function and how that relates to slower than normal recovery times following exercise.

He also discusses the increased prevalence of depression among ME/CFS patients, before discussing a number of other chronic pain disorders. Then he connects the dots with a discussion of cytokines, the role that they play in these disorders, and the role that air pollution plays in triggering the release of cytokines. Basically, it all boils down to this: chemical exposures increase the burden on our detox systems, causing or increasing oxidative stress. Chemical exposures AND oxidative stress activate the TRPV1 receptors, igniting the pattern of symptoms involved in the various disorders.

In Part 4, Dr. Molot goes more deeply into the various environmental influences that can play a role in our long-term health, everything from being delivered via C-section (which reduces your immunity), our intestinal flora and how it varies depending on what we eat (and even what our mother ate when we were being in uturo), how both of those play a role in obesity, and even how pollution plays a role in obesity. He also addresses the endocrine disruptors in the environment, how those play a role in obesity and illness, and how obesity leads to systemic inflammation. He discusses obesity quite a bit in this chapter but what I came away with was not “you need to lose weight” but rather than much of the cause for our rise in obesity rates are not within our control. The causes literally start before we are born and have much to do with our environment.

Rather than looking for one single cause, or at one single system, Dr. Molot’s position is that we  need to look at health (w)holistically. We need to look at the whole system, rather than at a single complaint. Too often the medical community takes a “reductionist” approach to medicine, looking at one symptom or looking for one single cause. They look at a single tree, rather than the forest and realizing that it’s not just the one tree that is suffering.

In Part 5, Dr. Molot spends some time on what we can do. With so much of the cause out of our control, is there anything we can do? He says that there is. He focuses on these areas:

• The environment – Whether it’s the chemicals in your home, how close you live to major roadways, the community you live in, hobbies, or occupation – there are many sources of potential issues in our environment. A key element is simply identifying them and removing as many risks as possible.
• Diet – He is obviously a proponent of eating an organic vegan diet. However, he does give some other options for those who quite go that far. Unfortunately, the way that he provides them makes it clear that those options aren’t quite good enough. He does address elimination diets and how they can be used to help you determine if food sensitivities are causing symptoms.
• Detoxification – Aside from using food to detox he also suggests sauna therapy to help you sweat out toxins.
• Exercise – This is an area of the book I was a bit disappointed in, only because aside from making the point that those with ME/CFS have to approach exercise differently (and have to base their limits on perceived exertion), he doesn’t really spend enough time on how exercise helps, or how to approach exercise when you are dealing with the pain and fatigue that comes with Fibromyalgia. In the end, I felt like many patients would come away from this chapter feeling as disheartened as they often do when leaving their doctor’s office after being told “exercise more.”
• Supplements – He does give a basic list of the supplements he suggests, which is helpful, but overall this is another section I felt could have benefited from more.

Overall, this entire section paled in comparison to the rest of the book. He spends a good bit of time describing potential hazards, but how to remove them is still left largely up to you. This is very much a what is causing your problem and what to do about it book, but very much not a “how to do it” book. Perhaps, he’s planning that for a sequel. That said, I think for some patients, especially those still in the thick of their illness situation they could come away from reading this book more disheartened than they were before they started. Few of us are lucky enough to have an Environmental Medicine specialist in our area, and even fewer lucky enough to have one that is covered by insurance. Sadly, this leaves us back where we started, with a lot of symptoms, and many suggestions, but really unsure how to go about doing anything about it.

Overall, I thought this was an interesting book and very informative. At times the material was a bit complicated and hard to absorb, but I felt that he did a really good job of breaking things down so that those of us without scientific minds could understand what he was talking about. While he did include a “more reading” section at the end of the book that did provide some of the citations, I was disappointed that to get all of the citations you have to buy a separate book that costs more than this book.

If you are interested in understanding the science behind sensitization, MCS, ME/CFS, & Fibromyalgia, I think this book can go a long way to helping you do that. However, if you are looking for answers on what to do about it, this book won’t help you much.

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