Article published online December 2006.

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Background
On September 11, 2001, the attack and collapse of the gigantic World Trade Center towers caused an enormous release of toxic substances into a densely populated urban environment. These included asbestos, radionuclides, benzene, dioxins, polychlorinated biphenyls (PCBs), fiberglass, mercury, lead, silicon, sulfuric acid²⁹ – agents associated with cancer as well as severe lung pathology, neurological and cardiovascular disease, and a myriad of immune dysfunctions.

Emergency workers were exposed to unprecedented levels of these chemicals and breakdown products during the ensuing eight and one-half month rescue and cleanup effort. Daily exposures continued as firefighters, paramedics, police, clean-up crews, and other personnel continued their efforts, working long hours for over eight months after the attack. Personal Protective Equipment (PPE) was not always available or was generally ineffective in preventing the rescue workers from absorbing contaminants by inhalation, ingestion, or dermal exposure.⁸

There is no doubt that the tens of thousands of men and women who participated in the rescue and recovery operations were exposed to a wide range of toxins, many of which are known to accumulate in body tissues, with half-lives measured in years or decades.^12,28 Exposure symptoms have not abated with time; instead, a substantial number of those exposed are experiencing worsening health status involving multiple organ systems. Studies demonstrate a definite link between exposures to WTC-derived airborne pollutants and respiratory disease.²

The acute complaints of emergency responders were often pulmonary.^14,19,38 However, other debilitating health consequences exist. The depression, anger, and low motivation commonly reported among this population and assigned to Post-Traumatic Stress Disorder are more likely indicative of toxic encephalopathy.¹⁶ Other major concerns include persistent pulmonary and digestive tract inflammatory syndromes, such as reactive airways dysfunction syndrome (RADS), reactive upper airways dysfunction syndrome (RUDS), gastroesophageal reflux disease (GERD), and inflammatory pulmonary parenchymal syndromes, as well as respiratory tract and nonrespiratory malignancies.^5,10,47

Sauna Detoxification
The method of detoxification developed by Mr. Hubbard is a precise protocol, documented for mobilizing fat-stored toxins and enhancing their elimination while restoring metabolic balance. The protocol has long been established as safe.⁴⁵ Previous case reports,^39,51 as well as a number of non-randomized, controlled studies of exposed workers (including firefighters),²¹ demonstrate that detoxification reduces body burdens of PCBs, PBBs, dioxins, various drugs, and pesticides^44,46 with concurrent symptomatic improvement.^44,20,22

Publications over the past two decades also show that this regimen can improve memory, cognitive functions, immune parameters, and general physical condition in different study populations.^44,46

The detoxification protocol is standardized¹⁷ and includes the following:

• A daily regimen of physical exercise, immediately followed by forced sweating in a sauna at 140-180°F for two-and-a-half to five hours with short breaks for hydration to offset the loss of body fluids and cooling.
• Nutritional supplementation centered on gradually increasing doses of crystalline niacin (nicotinic acid) to promote lipid mobilization of stored toxicants and stimulate circulation.
• Administration of additional vitamins, minerals, electrolytes, and oils includes vitamins A, D, C, E, B complex, B1; multi-minerals including calcium, magnesium, iron, zinc, manganese, copper, and iodine; sodium and potassium; and a blend of polyunsaturated oils including soy, walnut, peanut, and safflower.

Each of these program components have biologic roles that support healing. The integrity of physiological systems – including those associated with detoxification, cellular repair, immune processes, and neural and endocrine function – depends upon nutritional and vitamin status. Of note are niacin and the use of oils as a source of essential fatty acids. The inclusion of a balanced complement of additional nutrients is aimed at maintaining supplies adequate for increased demand.

Niacin can shift the adipose-blood equilibrium of toxin concentrations by stimulating release of fatty acids from tissues into the blood.^31,43,52 Mobilizing free fatty acids has been shown to mobilize fat stored pesticides¹¹ and PCBs.⁷ Niacin raises high density cholesterol (HDL-C) more effectively than either of the common pharmacologic interventions, statin or fibrate therapy, and has been proven to reduce cardiovascular events in monotherapy studies.⁴

Niacin coenzymes are necessary for more than 500 enzymatic reactions, particularly in the form of nicotinamide adenine dinucleotide (NAD).³⁶ Niacin coenzymes are required for biotransformation of foreign compounds as a step in eliminating those compounds from the body.²⁴ They also regulate liver detoxification pathways so that the activated radicals of phase I detoxification are rapidly conjugated with glutathione or other compounds during phase II.⁴⁸ Further, marginal deficiencies in folate, vitamin B12, niacin, and zinc increase the rate of spontaneous chromosome damage.⁹ Niacin coenzymes regulate DNA strand break repair.^30,54

Inclusion of polyunsaturated oils enhances detoxification and also replaces the essential fatty acids mobilized from stores. The walnut and soy oils used in this regimen contain high levels of omega-3 fatty acids; the safflower, soy and peanut oils are rich in omega-6 fatty acids. Polyunsaturated oils can line the intestine and prevent re-uptake of toxins that have been eliminated through large intestine pathways.⁴⁰ Oils may also have a direct effect on toxin elimination.^33,41,42

This rehabilitative therapy is provided on a daily basis, seven days a week, and averages 33 days for completion. (The range was 23-106 days.) Body weight, pulse, and blood pressure are monitored before and after each daily session with body weight kept constant throughout. Physicians monitor individual client programs.

Rehabilitating Rescue Workers
Recognizing that they had had an unprecedented exposure, a group of firefighters and union officials felt that a program should be available to rescue workers that specifically addressed body accumulations of toxins. They contacted the Foundation for Advancements in Science and Education (FASE) for assistance in making the detoxification regimen available to exposed personnel.

An independent facility funded by private donations was set up in September 2002 in lower Manhattan, providing this therapy without charge. To date, more than 500 have completed the program in Manhattan and at a second facility established on Long Island. The great majority have been uniformed rescue workers—firefighters, paramedics, sanitation workers, and police. A small number of individuals who lived or worked in the WTC or near the site have also completed the program.

The primary goal of this project is to restore quality of life and job fitness to those exposed to toxic materials at the WTC site. The focus to date has been to identify individuals who are not responding, or not recovering fully, after receiving medical treatments being offered to WTC exposure victims.

Outcome Measures
Individuals are referred to the project because of persistent symptoms following exposure to WTC toxins. The project's rehabilitative goal emphasizes restored quality of life ("wellness"). Additionally, the project includes ongoing tests to identify the full range of health effects associated with the WTC exposures and evaluating the efficacy of detoxification in resolving specific effects. A complete set of tests are given before and after detoxification.

To evaluate the effectiveness of this rehabilitative therapy, participants are given a structured medical examination. Participants also complete a comprehensive Health History and Symptom Survey developed specifically for this project. This survey gathers basic demographic information; employment history and relevant work exposure questions; recent symptomatology focusing on the cluster of symptoms common to environmental exposures; and the number of lost workdays. Clients also undergo intelligence quotient (IQ) testing, as well as a panel of standard laboratory tests including CBC, comprehensive metabolic panel, thyroid panel, lipid panel, ECG, and urinalysis.

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