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EUROPAEM EMF Guideline 2016 for the prevention, diagnosis and treatment of EMF-related health problems and illnesses

Authors:
  • Biomedical Research Center Slovak Academy of Sciences

Abstract and Figures

Chronic diseases and illnesses associated with non-specific symptoms are on the rise. In addition to chronic stress in social and work environments, physical and chemical exposures at home, at work, and during leisure activities are causal or contributing environmental stressors that deserve attention by the general practitioner as well as by all other members of the health care community. It seems necessary now to take "new exposures" like electromagnetic fields (EMF) into account. Physicians are increasingly confronted with health problems from unidentified causes. Studies, empirical observations, and patient reports clearly indicate interactions between EMF exposure and health problems. Individual susceptibility and environmental factors are frequently neglected. New wireless technologies and applications have been introduced without any certainty about their health effects, raising new challenges for medicine and society. For instance, the issue of so-called non-thermal effects and potential long-term effects of low-dose exposure were scarcely investigated prior to the introduction of these technologies. Common electromagnetic field or EMF sources: Radio-frequency radiation (RF) (3 MHz to 300 GHz) is emitted from radio and TV broadcast antennas, Wi-Fi access points, routers, and clients (e.g. smartphones, tablets), cordless and mobile phones including their base stations, and Bluetooth devices. Extremely low frequency electric (ELF EF) and magnetic fields (ELF MF) (3 Hz to 3 kHz) are emitted from electrical wiring, lamps, and appliances. Very low frequency electric (VLF EF) and magnetic fields (VLF MF) (3 kHz to 3 MHz) are emitted, due to harmonic voltage and current distortions, from electrical wiring, lamps (e.g. compact fluorescent lamps), and electronic devices. On the one hand, there is strong evidence that long-term exposure to certain EMFs is a risk factor for diseases such as certain cancers, Alzheimer's disease, and male infertility. On the other hand, the emerging electromagnetic hypersensitivity (EHS) is more and more recognized by health authorities, disability administrators and case workers, politicians, as well as courts of law. We recommend treating EHS clinically as part of the group of chronic multisystem illnesses (CMI), but still recognizing that the underlying cause remains the environment. In the beginning, EHS symptoms occur only occasionally, but over time they may increase in frequency and severity. Common EHS symptoms include headaches, concentration difficulties, sleep problems, depression, a lack of energy, fatigue, and flu-like symptoms. A comprehensive medical history, which should include all symptoms and their occurrences in spatial and temporal terms and in the context of EMF exposures, is the key to making the diagnosis. The EMF exposure is usually assessed by EMF measurements at home and at work. Certain types of EMF exposure can be assessed by asking about common EMF sources. It is very important to take the individual susceptibility into account. The primary method of treatment should mainly focus on the prevention or reduction of EMF exposure, that is, reducing or eliminating all sources of high EMF exposure at home and at the workplace. The reduction of EMF exposure should also be extended to public spaces such as schools, hospitals, public transport, and libraries to enable persons with EHS an unhindered use (accessibility measure). If a detrimental EMF exposure is reduced sufficiently, the body has a chance to recover and EHS symptoms will be reduced or even disappear. Many examples have shown that such measures can prove effective. To increase the effectiveness of the treatment, the broad range of other environmental factors that contribute to the total body burden should also be addressed. Anything that supports homeostasis will increase a person's resilience against disease and thus against the adverse effects of EMF exposure. There is increasing evidence that EMF exposure has a major impact on the oxidative and nitrosative regulation capacity in affected individuals. This concept also may explain why the level of susceptibility to EMF can change and why the range of symptoms reported in the context of EMF exposures is so large. Based on our current understanding, a treatment approach that minimizes the adverse effects of peroxynitrite - as has been increasingly used in the treatment of multisystem illnesses - works best. This EMF Guideline gives an overview of the current knowledge regarding EMF-related health risks and provides recommendations for the diagnosis, treatment and accessibility measures of EHS to improve and restore individual health outcomes as well as for the development of strategies for prevention.
Content may be subject to copyright.
Rev Environ Health 2016; aop
European Academy for Environmental Medicine (EUROPAEM) – EMF
working group:
*Corresponding author: Gerd Oberfeld, Department of Public
Health, Government of Land Salzburg, Austria,
E-mail: gerd.oberfeld@salzburg.gv.at
Igor Belyaev: Cancer Research Institute BMC, Slovak Academy of
Science, Bratislava, Slovak Republic; and Prokhorov General Physics
Institute, Russian Academy of Science, Moscow, Russia
Amy Dean: American Academy of Environmental Medicine, Wichita,
KS, USA
Horst Eger: Association of Statutory Health Insurance Physicians of
Bavaria, Medical Quality Circle “Electromagnetic Fields in Medicine –
Diagnostic, Therapy, Environment”, no. 65143, Naila, Germany
Gerhard Hubmann: Center for Holistic Medicine “MEDICUS”, Vienna,
Austria; and Wiener Internationale Akademie für Ganzheitsmedizin
(GAMED), Vienna, Austria
Reinhold Jandrisovits: Medical Association Burgenland,
Environmental Medicine Department, Eisenstadt, Austria
Markus Kern: Medical Quality Circle “Electromagnetic Fields in
Medicine – Diagnosis, Treatment and Environment”, Kempten,
Germany; and Kompetenzinitiative zum Schutz von Mensch, Umwelt
u. Demokratie e.V., Kempten, Germany
Michael Kundi and Hanns Moshammer: Institute of Environmental
Health, Medical University Vienna, Vienna, Austria
Piero Lercher: Medical Association Vienna, Environmental Medicine
Department, Vienna, Austria
Kurt Müller: European Academy for Environmental Medicine,
Kempten, Germany
Peter Ohnsorge: European Academy for Environmental Medicine,
Wurzburg, Germany
Peter Pelzmann: Department of electronics and computer science
engineering, HTL Danube City, Vienna, Austria
Claus Scheingraber: Working Group Electro-Biology (AEB), Munich,
Germany and Association for Environmental- and Human-Toxicology
(DGUHT), Wurzburg, Germany
Roby Thill: Association for Environmental Medicine (ALMEN),
Beaufort, Luxembourg
Igor Belyaev, Amy Dean, Horst Eger, Gerhard Hubmann, Reinhold Jandrisovits, Markus
Kern, Michael Kundi, Hanns Moshammer, Piero Lercher, Kurt Müller, Gerd Oberfeld*,
PeterOhnsorge, Peter Pelzmann, Claus Scheingraber and Roby Thill
EUROPAEM EMF Guideline 2016 for the prevention,
diagnosis and treatment of EMF-related health
problems and illnesses
DOI 10.1515/reveh-2016-0011
Received March 16, 2016; accepted May 29, 2016
Abstract: Chronic diseases and illnesses associated with
non- specific symptoms are on the rise. In addition to
chronic stress in social and work environments, physi-
cal and chemical exposures at home, at work, and during
leisure activities are causal or contributing environmen-
tal stressors that deserve attention by the general practi-
tioner as well as by all other members of the health care
community. It seems necessary now to take “new expo-
sures” like electromagnetic fields (EMF) into account.
Physicians are increasingly confronted with health prob-
lems from unidentified causes. Studies, empirical obser-
vations, and patient reports clearly indicate interactions
between EMF exposure and health problems. Individual
susceptibility and environmental factors are frequently
neglected. New wireless technologies and applications
have been introduced without any certainty about their
health effects, raising new challenges for medicine and
society. For instance, the issue of so-called non- thermal
effects and potential long-term effects of low-dose
exposure were scarcely investigated prior to the introduc-
tion of these technologies. Common electromagnetic field
or EMF sources: Radio-frequency radiation (RF) (3MHz to
300 GHz) is emitted from radio and TV broadcast anten-
nas, Wi-Fi access points, routers, and clients (e.g. smart-
phones, tablets), cordless and mobile phones including
their base stations, and Bluetooth devices. Extremely low
frequency electric (ELF EF) and magnetic fields (ELF MF)
(3Hz to 3 kHz) are emitted from electrical wiring, lamps,
and appliances. Very low frequency electric (VLF EF) and
magnetic fields (VLF MF) (3 kHz to 3MHz) are emitted,
due to harmonic voltage and current distortions, from
electrical wiring, lamps (e.g. compact fluorescent lamps),
and electronic devices. On the one hand, there is strong
evidence that long-term exposure to certain EMFs is a
risk factor for diseases such as certain cancers, Alzhei-
mer’s disease, and male infertility. On the other hand,
the emerging electromagnetic hypersensitivity (EHS) is
more and more recognized by health authorities, disabil-
ity administrators and case workers, politicians, as well
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via Slovak Academy of Science
2Belyaev etal.: EUROPAEM EMF Guideline 2016
as courts of law. We recommend treating EHS clinically as
part of the group of chronic multisystem illnesses (CMI),
but still recognizing that the underlying cause remains
the environment. In the beginning, EHS symptoms occur
only occasionally, but over time they may increase in fre-
quency and severity. Common EHS symptoms include
headaches, concentration difficulties, sleep problems,
depression, a lack of energy, fatigue, and flu-like symp-
toms. A comprehensive medical history, which should
include all symptoms and their occurrences in spatial and
temporal terms and in the context of EMF exposures, is
the key to making the diagnosis. The EMF exposure is usu-
ally assessed by EMF measurements at home and at work.
Certain types of EMF exposure can be assessed by asking
about common EMF sources. It is very important to take
the individual susceptibility into account. The primary
method of treatment should mainly focus on the preven-
tion or reduction of EMF exposure, that is, reducing or
eliminating all sources of high EMF exposure at home and
at the workplace. The reduction of EMF exposure should
also be extended to public spaces such as schools, hos-
pitals, public transport, and libraries to enable persons
with EHS an unhindered use (accessibility measure). If
a detrimental EMF exposure is reduced sufficiently, the
body has a chance to recover and EHS symptoms will be
reduced or even disappear. Many examples have shown
that such measures can prove effective. To increase the
effectiveness of the treatment, the broad range of other
environmental factors that contribute to the total body
burden should also be addressed. Anything that supports
homeostasis will increase a person’s resilience against
disease and thus against the adverse effects of EMF expo-
sure. There is increasing evidence that EMF exposure has
a major impact on the oxidative and nitrosative regula-
tion capacity in affected individuals. This concept also
may explain why the level of susceptibility to EMF can
change and why the range of symptoms reported in the
context of EMF exposures is so large. Based on our current
understanding, a treatment approach that minimizes the
adverse effects of peroxynitrite – as has been increasingly
used in the treatment of multisystem illnesses – works
best. This EMF Guideline gives an overview of the current
knowledge regarding EMF-related health risks and pro-
vides recommendations for the diagnosis, treatment and
accessibility measures of EHS to improve and restore indi-
vidual health outcomes as well as for the development of
strategies for prevention.
Keywords: accessibility measures; Alzheimer’s disease;
cancer; chronic multisystem illnesses (CMI); diagnosis;
electric; electromagnetic field (EMF); electromagnetic
hypersensitivity (EHS); infertility; leukemia; magnetic;
medical guideline; nitrosative stress; non-ionizing;
oxidative stress; peroxynitrite; prevention; radiation;
static; therapy; treatment.
Current state of the scientific and
political debate about EMF-related
health problems from a medical
perspective
Introduction
The Environmental Burden of Disease Project assessed
the influence of nine environmental stressors (benzene,
dioxins including furans and dioxin-like PCBs, second-
hand smoke, formaldehyde, lead, noise, ozone, particu-
late matter and radon) on the health of the population of
six countries (Belgium, Finland, France, Germany, Italy,
and the Netherlands). Those nine environmental stressors
caused 3%–7% of the annual burden of disease in the six
European countries (1).
The Bundespsychotherapeutenkammer (BPtK) study
in Germany showed that mental disorders had increased
further and especially burnout as a reason of inability
to work increased seven-fold from 2004 to 2011 (2). In
Germany, 42% of early retirements in 2012 were caused by
mental disorders, depression being the leading diagnosis
(3). In Germany, psychotropic drugs are in third place for
the prescriptions of all drugs (4).
The consumption of methylphenidate (Ritalin,
Medikinet, Concerta), a psychotropic drug prescribed as
a treatment for attention deficit hyperactivity disorder
(ADHD) especially for young children and adolescents,
has increased alarmingly since the early 1990s. Accord-
ing to statistics of the German Federal Institute for Drugs
and Medical Devices (Bundesinstitut für Arzneimittel
und Medizinprodukte), prescriptions have increased
even more dramatically since 2000 and reached a climax
in 2012. In 2013, only a slight decline in the number of
prescriptions was observed (5). Interestingly, the rapid
increase in the use of methylphenidate coincides with
the enormous expansion of mobile telecommunication
and other related technologies, posing an open research
question.
In Germany, work disability cases and absence days
due to mental health disorders more than doubled from
1994 to 2011 (6). In the Organization for Economic Co-
operation and Development (OECD) countries, a huge
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variability in the prescription of antidepressants has
occurred and generally an increasing trend has been
observed. Socioeconomic status and therapeutic stand-
ards cannot fully explain these observations (7). Func-
tional disturbances like chronic inflammation and
changes of neurotransmitter functions caused by environ-
mental influences have hardly been investigated.
A steady increase in the prevalence of allergic/
asthmatic diseases globally has occurred, with about
30%–40% of the world population now being affected by
one or more allergic/asthmatic conditions (8).
It is suspected that environmental conditions such as
the increasing exposure of the population to electromag-
netic fields (EMFs) play a causal role for EMF-related health
effects (9–12), including exposure to radio- frequency radi-
ation (RF), which emanates from, e.g. cordless phones
(DECT), mobile phone base stations, and mobile phones
(GSM, GPRS, UMTS, LTE), especially smartphones, data
cards for laptop and notebook computers, wireless LAN
(Wi-Fi), wireless and powerline communication-based
smart meters, but also exposure to extremely low fre-
quency (ELF) electric fields (EF) and magnetic fields (MF)
including “dirty electricity”, which emanate from distur-
bances on electric wiring, power lines, electric devices,
and other equipment. For the society and the medical
community, all of this raises new challenges.
While biophysical and biochemical mechanisms of
biological effects of EMF at low-intensity levels are not
exactly known, significant progress has been achieved in
the last decades, and there are numerous data indicating
that these mechanisms may overlap for ELF and RF effects
(13–18). In the following sections, we provide some back-
ground information on important aspects of EMF biologi-
cal effects. However, this must not be misunderstood as a
full review of the evidence. We do not always strictly dif-
ferentiate between RF and ELF fields because of the above
mentioned overlap in biological mechanisms. It should
also be mentioned here that very specific exposure condi-
tions may trigger biological responses in one individual,
but not in others. Anecdotal reports, however, indicate
that such individual responsiveness or susceptibility does
expand over time and the intolerance then extends over a
broad range of exposure conditions.
Chronic diseases and illnesses associated with unspe-
cific symptoms are on the rise. In addition to chronic stress
in social and work environments, physical and chemical
exposures at home, at work, and during leisure activities
are causal or contributing environmental stressors that
deserve attention by the general practitioner as well as by
all other members of the health care community. It seems
certainly necessary now to take “new exposures” like EMF
into account, or as stated by Hedendahl etal. (19): “It is
time to consider ELF EMF and RF EMF as environmental
pollutants that need to be controlled”.
Worldwide statements of organizations
regarding EMF
The recommendations of the World Health Organization
(WHO) regarding ELF electric and magnetic fields and RF
radiation, compiled by the International Commission on
Non- Ionizing Radiation Protection (ICNIRP) (20, 21), are
based on currents induced in the body (ELF) and thermal
effects (RF).
Thermal effects are defined as effects that originate in
elevated temperatures from the absorption of electromag-
netic energy. The specific absorption rate (SAR) is defined
as the rate of absorption of electromagnetic energy in a unit
mass of biological tissue. It is proportional to the incre-
mental temperature increase in that tissue. Indeed while
a significant temperature increase must be avoided as it
can be of immediate adverse health consequences (tissue
necrosis, cardiac stress, etc.) exposures can be without
(measureable) temperature increase either because of heat
dissipation or because the exposure is too low to be associ-
ated with relevant heating. The latter type of exposure is
termed non-thermal. Biological and health-relevant effects
at non-thermal levels have been shown and discussed by
many research groups all over the world (9, 10, 22–24).
The ICNIRP recommendations were adopted by
the EU in its Council Recommendation of 1999, without
considering long-term non-thermal effects. However, it
should be stressed that at an international EMF confer-
ence in London (2008), Professor Paolo Vecchia, ICNIRP
Chairman from 2004 to 2012, said about the exposure
guidelines “What they are not”: “They are not mandatory
prescriptions for safety”, “They are not the’ ‘last word’ on
the issue”, and “They are not defensive walls for industry
or others” (25).
For all RF-based non-thermal EMF effects, SAR esti-
mates are not an appropriate exposure metric, but instead
either the field intensity or power density (PD) in combi-
nation with exposure duration should be used in safety
standards (26, 14, 27). In contrast to the ICNIRP guidelines,
the Russian safety standards, are based on non-thermal
RF effects, which were obtained by several research insti-
tutes in the former Soviet Union during decades of studies
on chronic exposures to RF (28, 29).
In contrast to the WHO headquarter in Geneva, the
International Agency for Research on Cancer (IARC), a
WHO-affiliated specialized agency in Lyon, classified
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extremely low frequency magnetic fields (ELF MF) as pos-
sibly carcinogenic to humans (Group 2B) in 2002 (30) and
radio-frequency radiation in 2011 (24).
It should be noted that, during the last 20 years, more
than 20 position papers and resolutions regarding EMF
and health have been adopted by EMF researchers and
physicians. These include the Vienna EMF Resolution,
Austria, 1998; Stewart Report, UK, 2000; Salzburg Reso-
lution, Austria, 2000; Freiburg Appeal, Germany, 2002;
Catania Resolution, Italy, 2002; Irish Doctors’ Environ-
mental Association Statement, Ireland, 2005; Helsinki
Appeal, Finland, 2005; Benevento Resolution, Italy, 2006;
Venice Resolution, Italy, 2008; Porto Alegre Resolution,
Brazil, 2009; Russian National Committee on Non-Ioniz-
ing Radiation Protection Resolution, Russia, 2001; Inter-
national Doctors’ Appeal, Europe, 2012; and the Report of
the Standing Committee on Health, Canada, 2015 (3134).
In August 2007 and December 2012, the BioInitiative
Working Group, an international group of 29 experts with
different competences, published two groundbreaking
reports “BioInitiative 2007/resp. 2012 – A Rationale for a
Biologically-based Public Exposure Standard for Electro-
magnetic Fields (ELF and RF)” edited by Cindy Sage and
David O. Carpenter, calling for preventive measures against
EMF exposure based on the available scientific evidence
(9, 10). The BioInitiative reports are global milestones with
respect to a comprehensive review of biological effects and
health effects of low-intensity electromagnetic radiation
as well as the conclusions and recommendations given for
the public. The BioInitiative report 2012 includes sections
on the evidence for effects on: gene and protein expres-
sion, DNA, immune function, neurology and behavior,
blood-brain barrier, brain tumors and acoustic neuromas,
childhood leukemia, melatonin, Alzheimer’s disease,
breast cancer, fertility and reproduction, fetal and neo-
natal disorders, autism, disruption by the modulating
signal, EMF medical therapeutics, as well as sections on:
statement of the problem, the existing public exposure
standards, evidence for inadequacy of the standards, the
precautionary principle, global public health examples,
key scientific evidence and public health recommenda-
tions, and summary for the public and conclusions.
As it is mostly neglected as a health hazard, the Euro-
pean Environment Agency compared the risks of non-ioniz-
ing radiation (EMF) to other environmental hazards such as
asbestos, benzene, and tobacco, urgently recommending to
implement a precautionary approach regarding EMF (35).
This position was confirmed and elaborated more compre-
hensibly in further publications in 2011 and 2013 (36, 37).
In September 2008, a statement of the European Par-
liament called for a review of the EMF limits set out in the
EU Council Recommendation of 1999, which was based on
the ICNIRP guidelines, with reference to the BioInitiative
Report (38). This was further strengthened in the Euro-
pean Parliament resolution of April 2009 (39).
At the meeting in November 2009 in Seletun, Norway,
a scientific panel adopted a Consensus Agreement that rec-
ommends preventative and precautionary actions that are
warranted now, given the existing evidence for potential
global health risks from EMF exposure (40). Besides general
and specific recommendations, e.g. for mobile and cordless
phone use, the panel recommended exposure limits for
ELF magnetic fields and radio-frequency radiation. It was
stated by the panel: “Numeric limits recommended here
do not yet take into account sensitive populations (EHS,
immune-compromised, the fetus, developing children, the
elderly, people on medications, etc.). Another safety margin
is, thus, likely justified further below the numeric limits for
EMF exposure recommended here”.
Since 2007 the Highest Health Council of the Ministry
of Health in Austria has recommended to take preventive
action by reducing exposure levels from RF devices which
may lead to long-term human exposure of at least a factor
of 100 below the guideline levels of the European Com-
mission and by issuing rules on how to reduce one’s indi-
vidual exposure to RF radiation from mobile phones (41).
In May 2011, the Parliamentary Assembly of the
Council of Europe adopted the report “The Potential
Dangers of Electromagnetic Fields and their Effects on the
Environment” (42). The Assembly recommended many
preventive measures for the member states of the Council
of Europe with the aim to protect humans and the envi-
ronment, especially from high-frequency electromagnetic
fields such as: “Take all reasonable measures to reduce
exposure to electromagnetic fields, especially to radiofre-
quencies from mobile phones, and particularly the exposure
of children and young people who seem to be most at risk
from head tumors”, or “Pay particular attention to ‘electro-
sensitive’ people who suffer from a syndrome of intolerance
to electromagnetic fields and introduce special measures to
protect them, including the creation of wave-free areas not
covered by the wireless network”.
Recognizing that patients are being adversely affected
by EMF exposure, the American Academy of Environ-
mental Medicine (AAEM) published recommendations
regarding EMF exposure in July 2012. The AAEM called
for physicians to consider electromagnetic exposure in
diagnosis and treatment and to recognize that EMF expo-
sure “may be an underlying cause of the patient’s disease
process” (43).
Since 2014, the Belgian government has prohibited the
advertising of mobile phones for children under the age of
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7 and has required the specific absorption rate (SAR) of
mobile phones be listed. Furthermore, at the point of sale,
well-marked warnings must be posted that instruct users
to use headsets and to minimize their exposure (44).
In January 2015, the French parliament adopted a
comprehensive law that protects the general public from
excessive exposure to electromagnetic waves. Among
other things, it was passed to ban Wi-Fi in nurseries for
children under the age of 3 and to enable Wi-Fi at primary
schools with children under the age of 11 only when used
specifically for lessons. Public places offering Wi-Fi must
clearly advertise this fact on a sign. At the point of sale of
mobile phones, the SAR value must be clearly shown. In
the future, any mobile phone advertisement must include
recommendations on how users can reduce RF radiation
exposure to the head such as the use of headsets. Data on
local EMF exposure levels shall be made more easily acces-
sible to the general public, among others, through country-
wide transmitter maps. Also, the French government will
have to submit a report on electromagnetic hypersensitiv-
ity to the parliament within a year (45).
As of February 2016, 220 scientists from 42 coun-
tries have signed an international Appeal, directed to
the United Nations (UN) and WHO, calling for protec-
tion from non-ionizing electromagnetic field exposure.
The appeal addresses the scientifically proven effects
on health and the inadequate international guidelines
(ICNIRP) to date and their use by the WHO. In addition,
nine requests were made, including that: “the public be
fully informed about the potential health risks from elec-
tromagnetic energy and taught harm reduction strategies
and that “medical professionals be educated about the
biological effects of electromagnetic energy and be pro-
vided training on treatment of patients with electromag-
netic sensitivity” (46).
In September 2015 an International Scientific Decla-
ration on Electromagnetic Hypersensitivity and Multiple
Chemical Sensitivity was published by the Scientific Com-
mittee following the 5th Paris Appeal Congress, which
took place on 18 May 2015 at the Royal Academy of Medi-
cine, Brussels, Belgium. It calls upon national and inter-
national agencies and organizations to recognize EHS and
multiple chemical sensitivity as a disease and urges par-
ticularly the WHO to include EHS and MCS in the Interna-
tional Classification of Diseases. It also asks national and
international agencies and organizations to adopt simple
precautionary measures of prevention, to inform the
public, and to appoint truly independent expert groups to
evaluate these health risks based on scientific objectivity,
which is not the case today (47).
EMF and cancer
Except for a few investigations in occupational settings,
epidemiological research of EMF started in 1979 when
Wertheimer and Leeper published their study about the
relationship between the proximity to so-called power
line poles (ELF MF) with “service drop” wires and the
occurrence of childhood cancer (specifically leukemia
and brain tumors) (48). At the same time Robinette etal.
studied mortality in a cohort of Korean War veterans
having been trained on military radars (RF) in the early
1950s (49). Both studies found indications of increased
risks and initiated a new era of studying health-relevant
effects from exposure to EMFs.
ELF MF
In the following years, a large number of investigations
about the relationship between childhood leukemia and
extremely low frequency magnetic fields (ELF MF) have
been published. However, the results seemed inconsist-
ent until in 2000 two pooled analyses (50, 51) were con-
ducted, providing little indication of inconsistency and
demonstrating an increase of leukemia risk with increas-
ing average exposure levels that was significant for levels
above 0.3 or 0.4 μT relative to averages below 0.1 μT but
without indication of a threshold. Based on these find-
ings, the International Agency for Research on Cancer
(IARC) classified ELF MF in 2002 as a Group 2B (possible)
carcinogen (30). To this category belong, e.g. lead, DDT,
welding fumes, and carbon tetrachloride.
Since then additional epidemiological studies have
been conducted that gave essentially the same results
(52, 53). The only study to date on the gene-environment
interaction in relation to power-frequency MF reported a
significant effect enhancement in children with a poly-
morphism in a DNA-repair gene (54). In a review on child-
hood leukemia and ELF MF, Kundi concluded that there
is sufficient evidence from epidemiological studies of an
increased risk for childhood leukemia from exposure to
power-frequency MF that cannot be attributed to chance,
bias, or confounding. Therefore, according to the rules of
IARC, such exposures ought to be classified as a Group 1
(definitive) carcinogen (55).
The BioInitiative Report 2012 (56) stated: “Children
who have leukemia and are in recovery have poorer sur-
vival rates if their ELF exposure at home (or where they are
recovering) is between 1mG [0.1 μT] and 2 mG [0.2 μT] in
one study; over 3mG [0.3 μT] in another study” (56).
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RF
There were several mechanisms identified which might be
responsible for carcinogenic effects of RF (23). Epidemio-
logical studies of RF before the general rise in exposure
to mobile telecommunication devices was very restricted
and only a few studies had been conducted in the vicin-
ity of radio transmitters, radar stations, for occupational
exposures, and in radio amateurs. After the introduction
of digital mobile telephony, the number of users of mobile
phones increased dramatically and it was recommended
in the 1990s to perform epidemiological studies with a
focus on intracranial tumors. Since the first publication
in 1999 by the Swedish group of Prof. Lennart Hardell
(57), about 40 studies have been published. The majority
of these studies investigated brain tumors, but salivary
gland tumors, uveal melanoma, malignant melanoma
of the skin, nerve sheath tumors, testicular cancer, and
lymphoma were also studied. Many of these studies are
inconclusive because exposure durations are too short;
however, two series of investigations, the international
Interphone Study conducted in 13 countries and the
Swedish studies of the Hardell group, had a significant
proportion of long-term mobile phone users and could
in principle be used for risk assessment. In 2011, IARC
classified radio-frequency electromagnetic fields (RF) as
a Group 2B carcinogen based on evidence from epide-
miological studies and animal experiments (24). Since
then, additional studies have corroborated the assump-
tion of a causal relationship between mobile phone use
and cancer (58–60). Hardell and Carlberg (61) concluded
that RF EMF ought to be classified as a definitive human
carcinogen (IARC Group 1). The evidence for a causal rela-
tionship between long-term mobile and cordless phone
use and the risk of glioma has increased further: in 2014,
a study by Carlberg and Hardell (62) showed significantly
decreased survival rates in patients with glioblastoma
multiforme (astrocytoma grade IV) and the use of wireless
phones and, in 2015, another pooled case-control study
by Hardell and Carlberg (63) including latency periods
of  > 25 years.
That also other tumors might be related to EMF expo-
sure is exemplified by the observation in women who have
worn their mobile phone in their bra for prolonged periods
of time and later developed breast cancer at that site (64).
The Italian Supreme Court confirmed a previous deci-
sion by the Civil Court of Appeals of Brescia (no. 614 of
10 December 2009) that ruled that the National Institute
for Workmen’s Compensation (INAIL) must compensate
a worker who had developed a tumor in the head due to
long-term, heavy use of mobile phones while on the job.
The case was an ipsilateral neuroma of the trigeminal
nerve in a subject who had occupational exposure for
> 10 years, with  > 15,000 h on mobile and cordless phones.
The court recognized that “it is likely (qualified probabil-
ity) that RF have a role which is at least contributory in
the development of the origin of the tumor suffered by the
subject” (65).
Many modern devices emit EMF of different frequency
ranges simultaneously. For example, mobile phones
create EMF in RF, VLF, and ELF frequency ranges and also
a static magnetic field; for a review see (23). Therefore, it is
important to consider combined exposures for the assess-
ment of health effects.
Genotoxic effects
Genotoxic effects of EMF dealing with DNA damage,
mutations, chromatin structure, and DNA repair have
recently been reviewed by Henry Lai in the Bioinititive
Report (66) and by the IARC Working Group in the assess-
ment of RF carcinogenicity (24). In general, about half of
the available studies found genotoxicity (positive reports),
although other studies did not (negative reports) (23). Of
note, a similar ratio of positive and negative RF studies
was reported for other biological endpoints (67–69). The
evident reason for this eventual inconsistency is strong
dependence of the EMF effects on a number of physical
and biological parameters, which significantly varied
between studies. These dependencies were established
for both ELF (70–72) and RF effects (24, 27).
Among other parameters, in human lymphocytes, an
individual variability in chromatin response to ELF has
been reported, which might suggest a stronger response in
cells from EHS individuals (72). The same research group
performed comparative studies on genotoxicity with cells
from EHS and carefully matched control subjects (73–75).
The response of lymphocytes to RF from GSM mobile
phones (915 MHz) and power-frequency magnetic fields
(50 Hz) was investigated (73). The 53BP1 protein, which
participates in the formation of DNA repair foci at the loca-
tion of DNA double-strand breaks (DSB), was analyzed by
immunostaining in situ. Exposure to either 915 MHz or
50Hz significantly condensed chromatin and inhibited the
formation of DNA repair foci. The EMF-induced responses
in lymphocytes from healthy and hypersensitive donors
were similar but not identical to the stress response
induced by heat shock. The effects of GSM on chroma-
tin and DNA repair foci in lymphocytes from EHS were
further confirmed (74, 75). Although individual variability
was observed, effects of RF from mobile phones strongly
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depended on the carrier frequency/frequency channel
(7477). Regardless of the cell type (human lymphocytes,
fibroblasts, or stem cells), the effects at the 905 MHz/
GSM channel 74 on DNA repair foci and chromatin were
consistently lower as compared to the effects at the 915
MHz/GSM channel 124. The data also indicated stronger
effects of exposure to RF from UMTS mobile phone radia-
tion at the frequency of 1947.4 MHz. These data provided
evidence that different frequency channels of different
types of mobile communications technologies should be
tested separately in provocation studies with EHS. While
some minor differences were detected, very similar ELF/
RF effects were observed in cells from EHS and matched
control subjects. It is likely that compensatory reactions
at a more complex level of biological organization such
as reactions of tissues, organs, and organ systems are less
efficient in persons with EHS, thereby providing a stronger
connection of the EMF cellular response with symptoms
of hypersensitivity.
Neurological effects of EMF
Neurological and behavioral effects were among the ear-
liest topics of research on potential adverse effects of ELF
as well as RF EMFs (78, 79). Concerning epidemiological
evidence, more than a decade before the seminal publi-
cation of Wertheimer and Leeper (48), Haynal and Regli
reported in 1965 an approximately four-fold higher preva-
lence of a history of electrical engineering jobs in patients
with amyotrophic lateral sclerosis (ALS) than in control
subjects (80).
Functional, morphological, and biochemical changes
at the cellular, tissue, and organism level, as well as
behavioral changes have been studied under experimen-
tal conditions, and epidemiology has assessed the asso-
ciation between occupational and residential exposure to
EMFs and neurodegenerative diseases as well as neuro-
logical symptoms.
Research has shown that EMFs (RF and ELF) have
deleterious effects on brain neurons and brain function-
ing (81). Epidemiological research has also shown an
increased risk for Alzheimer’s and dementia from occupa-
tional and residential exposure to ELF.
Neurological effects of radio-frequency radiation
Early studies of RF are difficult to assess because the
descriptions of exposure conditions are often insufficient
to derive the relevant dosimetric quantities. As early as
1932, Schliephake (82) reported effects that he considered
to be non-thermal: „Es treten Erscheinungen auf, wie wir sie
bei Neurasthenikern zu sehen gewohnt sind: starke Mattig-
keit am Tag, dafür in der Nacht unruhiger Schlaf, zunächst
ein eigenartig ziehendes Gefühl in der Stirn und Kopfhaut,
dann Kopfschmerzen, die sich immer mehr steigern, bis
zur Unerträglichkeit. Dazu Neigung zu depressiver Stim-
mung und Aufgeregtheit.“ [“Phenomena occur that we are
accustomed to seeing in neurasthenics: pronounced fatigue
during the day, however, restless sleep at night, in the
beginning, a peculiar pulling sensation on the forehead and
scalp, and then headaches that increase beyond the limit of
tolerance. In addition, a tendency to depressive moods and
agitation”.] Such symptoms, not unlike those later sum-
marized as microwave or radio wave sickness syndrome,
have been found in a substantial percentage of exposed
workers in the Soviet Union (83) and also in individuals
presenting as electrohypersensitive (see below).
Experimental research in humans was scarce before
the advent of digital mobile telephony. Since the earliest
studies (84, 85) on brain electrical activity, a large evidence
base has been compiled that indicates subtle changes
in CNS function after and during short-term exposure to
different types of RF. Experimental investigations were
predominantly about effects on EEG power spectra (e.g.
86–96), event related potentials (e.g. 97104), sleep (e.g.
105–119) and cognitive function (e.g. 120–131). A few inves-
tigations were about effects on glucose metabolism (132,
133) and regional cerebral blood flow (134, 135), applying
PET scan imaging. Animal studies covered a wide variety
of behavioral aspects, ranging from learning and memory
(e.g. 136–141) to anxiety-related behavior (142).
The reaction of the CNS to RF is not restricted to the
presence of the exposure but persists for some time after
the exposure, making short-term cross-over studies unin-
formative. The location of exposure could be of relevance
under certain circumstances, but often effects are bilat-
eral after unilateral exposure, suggesting involvement of
subcortical structures. Effects on sleep may depend on
individual characteristics, which led to the conclusion
that conflicting results are not strong evidence against an
effect (113). Pulsed RF is more effective than continuous
waves, but there is some evidence of the importance of
exposure characteristics including the site of coupling of
the RF field and its modulation.
In the 2012 update of the BioInitiative Report, Henry
Lai summarized the experimental evidence as follows
(143):Almost all the animal studies reported effects,
whereas more human studies reported no effects than
effects. This may be caused by several possible factors:
(a) Humans are less susceptible to the effects of RFR than
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are rodents. (b) It may be more difficult to do human than
animal experiments, since it is, in general, easier to control
the variables and confounding factors in an animal experi-
ment. (c) In the animal studies, the cumulative exposure
duration was generally longer and studies were carried out
after exposure, whereas in the human studies, the exposure
was generally one time and testing was done during expo-
sure. This raises the question of whether the effects of RFR
are cumulative”.
Neurological effects of extremely low frequency
electromagnetic fields (ELF EMF)
Neurophysiological investigations of ELF EMFs were
already conducted in the 1970s. Studies of chick and
cat brain tissue (e.g. 144–146) revealed effects of weak
ELF EMFs and ELF modulated RF fields that depended
on intensity and frequency (so-called window effects).
Adey proposed in 1981 (147) that effects are due to
a primary interaction of EMFs at the cell membrane
surface inducing a cascade of intracellular processes.
This early insight has been corroborated by recent
studies on various transmitter receptors in the brain
such as N-methyl-D-aspartate receptors, dopamine and
serotonin receptors (e.g. 148–151). Some of these more
recent studies also reported frequency window effects
as well as intensity window effects on the neurodevelop-
ment in the rat (152).
Behavioral effects of ELF EMF have been studied at
rather high levels in the 1970s and 1980s (e.g. 153, 154),
while recent studies include low-level exposures and
support effects on behavior at different levels of complex-
ity. These include: changes in locomotor activity (e.g. 148,
149, 155, 156), anxiety (e.g. 157–159) and depression-like
behavior (160, 161). “Since different behavioral effects have
been observed in different exposure conditions, species of
animals, and testing paradigms, they provide the strongest
evidence that exposure to ELF EMF can affect the nervous
system”. (Lai, 2012, BioInitiative Report, section 9, Evidence
for effects on neurology and behavior effects, 143). Also in
humans, effects were reported at low levels (e.g. 162–164).
Neurodegenerative diseases
The most prevalent of neurodegenerative diseases is
Alzheimer’s disease with an estimated 45 million patients
worldwide for 2015, followed by Parkinson’s disease,
Huntington’s disease, amyothrophic lateral sclerosis
(ALS), and other motoneuron diseases (MND). To date,
the pathophysiology of these diseases is incompletely
understood. In many of these diseases, atypical protein
assemblies, mitochondrial dysfunction, and programmed
cell death play a role and some genetic changes have been
detected. As some such changes could be a consequence
of oxidative stress (see below), disruption of calcium
homoeostasis, and disturbance of intracellular signal-
ing pathways, there is a theoretical possibility that EMFs
could contribute to the risk of these diseases. Since the
1980s, more than 30 epidemiological studies assessing
the potential relationship between exposure to ELF EMFs
and neurodegenerative diseases have been conducted. In
the last years, several meta-analyses have been published.
Concerning Parkinson’s disease, there is little evidence of
an association (165). Concerning ALS, Zhou et al. (166)
summarize their results as follows: Although there are
potential limitations from study selection bias, exposure
misclassification, and the confounding effect of individual
studies in this meta-analysis, our data suggest a slight but
significant ALS risk increase among those with job titles
related to relatively high levels of ELF EMF exposure”. A
review by Vergara et al. came to another conclusion (167):
“Our results do not support MF [magnetic fields] as the
explanation for observed associations between occupa-
tional titles and MND”. This discrepancy can be resolved
by discriminating between different methods of endpoint
assessment (incidence, prevalence or mortality data) and
the potential for misclassification due to various sources
of exposure data used. If these factors are considered,
there is a consistent relationship between ELF EMF from
occupational exposure and ALS/MND, and also the few
studies about residential exposure are in line with an
increased risk from exposure to MF(168).
Blood-brain barrier
All exchanges between blood and brain are strictly regu-
lated by the blood-brain barrier (BBB). The BBB prevents
the passage of various molecules from the blood into the
brain and vice versa. An increase in a normally low BBB
permeability for hydrophilic and charged molecules could
potentially be detrimental. While the data on ELF effects
are very sparse, several research groups investigated
whether RF affects the BBB. These data have recently been
reviewed (169–171). Although some BBB studies reported
negative data, other studies, including replicated studies
with rats from the Swedish group of Leif Salford and Bertil
Persson, suggested that RF from mobile phones may affect
the BBB under specific exposure conditions (171). More
recent studies showing EMF effects at specific conditions of
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exposure (150, 172, 173) and not showing effects on the BBB
under other conditions (174) are in line with this suggestion.
EMF and infertility and reproduction
Infertility and reproduction disorders are on the rise.
Based on the BioInitiative Report (175), it should be con-
cluded that men who use – and particularly those who
wear a mobile phone, personal digital assistant (PDA) or
pager on their belt or in a pocket – show adverse effects
on sperm quality, motility, and pathology. The usage of
mobile phones, the exposure to mobile phone radiation,
or the storage of a mobile phone close to the testes of
human males affects sperm count, motility, viability, and
structure (176–184). Animal studies have demonstrated
oxidative and DNA damage, pathological changes in the
testes of animals, decreased sperm mobility and viability,
and other measures of deleterious damage to the male
germ line (182, 185–188).
There are also some studies of adverse birth outcomes
in EMF-exposed women. A case-control study (189) and
a population-based prospective cohort study (190) from
California showed an association between miscarriage
and the maximum value measured by a 24-h body-worn
magnetic field dosimeter.
Electromagnetic hypersensitivity (EHS)
An increasing number of humans are continuously
exposed in their daily life to increasing levels of a com-
bination of static, ELF and VLF (very low frequencies,
in general terms from 3 kHz to 3 MHz, in detailed terms
from 3 kHz to 30 kHz) electric and magnetic fields and RF
electromagnetic fields. These exposures are of different
signal patterns, intensities, and technical applications for
varying periods of time. All these fields are summarized as
EMF, colloquially referred to as “electrosmog”.
Some historical examples of EHS from as early as 1932
(82, 83) are given in the chapter “Neurological effects of
radio-frequency radiation”.
In a questionnaire survey in Switzerland in 2001, which
was addressed to persons attributing specific health prob-
lems to EMF exposure, of the 394 respondents 58% suffered
from sleep problems or disorders, 41% from headaches,
19% from nervousness, 18% from fatigue, and 16% from
difficulties with concentration. The respondents attributed
their symptoms to, e.g. mobile phone base stations (74%),
mobile phones (36%), cordless phones (29%), and high-
voltage power lines (27%). Two thirds of the respondents
had taken measures to reduce their symptoms, the most
frequent one being to avoid exposure (191).
In 2001, 63 persons who attributed health problems
to environmental exposure were counseled in an interdis-
ciplinary environmental medicine pilot project in Basel.
An interdisciplinary expert team assessed the individual
symptoms by a medical psychological-psychiatric and
environmental examination, including visits and envi-
ronmental measurements at home. With respect to the 25
persons with EHS, the expert team attested to the fact that
in one third of them at least one symptom was plausibly
related to electrosmog, although the EMF exposure was
within the Swiss limits. They concluded that patients with
EHS should be advised medically, psychologically, and
environmentally (192, 193).
A questionnaire study of Finns (n = 206), who describe
themselves as suffering from electromagnetic hypersensi-
tivity (EHS), revealed that the most common symptoms
were related to the nervous system: stress (60%), sleep-
ing disorders (59%) and fatigue (57%). The sources that
were most often reported to have triggered EHS were:
personal computers (51%) and mobile phones (47%).
For 76% of the participants the reduction or avoidance of
electromagnetic fields (EMF) helped in their full or partial
recovery (194).
A representative telephone survey (n = 2048; age > 14
years) carried out in Switzerland in 2004 yielded a fre-
quency of 5% (95% CI 4% to 6%) for having symptoms
attributed to electrosmog, so-called EHS. In n = 107 EHS
persons, the most common symptoms being sleep prob-
lems (43%), headache (34%), and concentration difficul-
ties (10%). Remarkably, only 13% consulted their family
doctor. Individuals with a past history of symptoms attrib-
utable to EMF gave “turned off the source” as the answer
to measures taken three times as often as the ones who
still had symptoms (195).
In a Swiss questionnaire study of GPs in 2005, two-
thirds of the doctors were consulted at least once a year
because of symptoms attributed to EMF. Fifty-four percent
of the doctors assessed a relation as possible. The doctors
in this questionnaire asked for more general information
about EMF and health and instructions on how to deal
with patients with EHS (196).
In another questionnaire study, also mandated by the
Swiss Federal Government and performed by the Univer-
sity of Bern in 2004, Swiss doctors working with comple-
mentary diagnostic and therapeutic tools reported that
71% of their consultations related to EMF. Remarkably, not
only the patients but even more so the doctors suspected a
possible relation between illness and EMF. The reduction
or elimination of environmental sources was the main
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therapeutic instrument in treating symptoms related to
EMF (197).
A questionnaire study of Austrian doctors yielded
similar results. In this study, the discrepancy between the
physicians’ opinions and established national and inter-
national health risk assessments was remarkable, consid-
ering that 96% of the physicians believed to some degree
in or were totally convinced of a health-relevant role of
environmental electromagnetic fields (198).
In a survey conducted 2009 in a Japanese EHS and
multiple chemical sensitivity (MCS) self-help group (n  =
75), 45% of the respondents had EHS as a medical diag-
nosis and 49% considered themselves EHS. Every second
respondent had medically diagnosed MCS (49%) and 27%
had self-diagnosed MCS. The main EHS-related symptoms
were fatigue, headache, concentration problems, sleep dis-
orders, and dizziness. The most frequent causes included
base stations, other persons’ mobile phones, PC, power
lines, television, own mobile phone, public transporta-
tion, cordless phones, air conditioner, and car. Suspected
EMF source of EHS onset were: mobile phone base sta-
tions, PC, electric home appliances, medical equipment,
mobile phones, power lines, and induction cookers (199).
In 2010, Khurana etal. reported that eight out of ten
epidemiological studies that assessed health effects of
mobile phone base stations reported an increased preva-
lence of adverse neurobehavioral symptoms or cancer in
populations living at distances within 500 m from base
stations. None of the studies reported exposure levels
above accepted international guidelines, suggesting that
current guidelines may be inadequate in protecting the
health of human populations (200).
Carpenter reported in 2015 (201) a series of healthy
people that developed EHS after a brief, high- intensity
microwave radiation exposure. Typical symptoms
included, for example, chronic headaches, irritability,
and emotional lability, decreased libido, and memory
problems, which in some patients, lasted for years.
Hedendahl et al. (19) reported two 15-year-old male
students and one 47-year-old female teacher who experi-
enced health effects like headaches, difficulties concen-
trating, tachycardia, poor memory, or dizziness when
exposed to Wi-Fi in school. This example is mentioned
to point specifically to the potential health impacts from
increasing RF exposure of students and teachers by Wi-Fi.
The question, whether EHS is causally associated with
EMF exposure is controversially discussed. On the one
hand, physicians judge a causal association between EMF
exposures as plausible based on case reports, on the other
hand, national and international health risk assessments
mostly claim that there is no such causal association,
because provocation studies under controlled blinded
conditions mostly failed to show effects. However, these
studies have severe shortcomings that must be addressed:
sequences of exposure conditions were often contiguous
neglecting aftereffects of exposure; the exposure duration
and the examined effects were short-term; the sham expo-
sure was frequently under conditions that could provoke
arousal in sensitive individuals; the time frame neglected
the temporal conditions of symptom occurrence and dis-
appearance, and/or the recruitment of persons with EHS
was not medically assessed.
The WHO does not consider EHS as a diagnosis and rec-
ommends to medical doctors that the treatment of affected
individuals should focus on the health symptoms and the
clinical picture, and not on a person’s perceived need for
reducing or eliminating EMF in the workplace or at home
(202). Based on the existing evidence and practical knowl-
edge this view ignores a causal approach; see also (203).
The paper “Electromagnetic hypersensitivity: fact or
fiction” by Genuis and Lipp (204) offers an instructive
review of studies of the last decades concerning EHS,
including historical milestones, reviews, pathogenesis,
biochemical markers, therapeutic management, as well
as the debate about the legitimacy of EHS.
In facial skin samples of electrohypersensitive
persons, a profound increase of mast cells has been found
(205). From this and other earlier studies when EHS mani-
fested itself often during exposure to EMFs from cathode
ray tubes (CRT), it became clear that the number of mast
cells in the upper dermis is increased in the EHS group.
A different pattern of mast cell distribution also occurred
in the EHS group. Finally, in the EHS group, the cytoplas-
mic granules were more densely distributed and more
strongly stained than in the control group, and the size of
the infiltrating mast cells was generally found to be larger
in the EHS group as well. It should be noted that increases
of a similar nature were later demonstrated in an experi-
mental situation, employing normal healthy volunteers in
front of CRT monitors, including ordinary household tel-
evision sets (206).
A French research group headed by Belpomme (207)
investigated prospectively, since 2009, self-reported
cases of EHS and/or MCS clinically and biologically in
an attempt to establish objective diagnostic criteria and
to elucidate the pathophysiological aspects of these two
disorders. Based on 727 evaluable cases, the investigation
showed a number of new and important insights such as:
(a) None of the biomarkers so far identified in the study
are specific for EHS and/or MCS.
(b) Several biomarkers like histamine, nitrotyrosine,
and circulating antibodies against O-myelin were
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increased. The 24-h urine melatonin/creatinine ratio
was decreased.
(c) EHS and MCS are genuine somatic pathological
entities.
(d) Under the influence of EMFs and/or chemicals a cer-
ebral hypoperfusion/hypoxia-related neuroinflam-
mation may occur.
(e) EHS and/or MCS patients might be potentially at risk
of chronic neurodegenerative diseases and cancer.
While a 2006 study by Regel etal. (208) described no expo-
sure effects, two provocation studies on exposure of “elec-
trosensitive” individuals and control subjects to mobile
phone base station signals (GSM, UMTS, or both) found
a significant decline in well-being after UMTS exposure
in the individuals reporting sensitivity (209, 210). Most
so-called provocation studies with EHS show no effects.
However, all these studies used a very limited number of
exposure conditions and most have methodological weak-
nesses. Taking in account the strong dependence of EMF
effects on a variety of physical and biological variables
(27), available provocation studies are scientifically diffi-
cult to interpret and, in fact, are not suitable to disprove
causality.
There is increasing evidence in the scientific literature
of various subjective and objective physiological altera-
tions, e.g. heart-rate variability (HRV) as apparent in some
persons with EHS claiming to suffer after exposure to certain
frequencies of RF like DECT or Wi-Fi (211–215). Analysis of
the data available on the exposure of people living near
mobile phone base stations has yielded clear indications of
adverse health effects like fatigue, depression, difficulty in
concentrating, headaches, dizziness, etc. (216–220). A syn-
opsis of 30 studies on mobile phone base stations is given
in the document “Leitfaden Senderbau” (221).
Residential EMF exposures in the VLF frequency range
are often due to “dirty power”/“dirty electricity” origi-
nating from voltage and/or current perturbations from
diverse sources like electronic power supplies for TVs,
monitors, PCs, motor drives, inverters, dimmers, compact
fluorescent lamps (CFLs), phase-angle control devices,
as well as sparking and arcing from switching operations
and from electric motors with brushes. The kHz waves/
transients travel along the electric wiring and grounding
systems (conducted emissions) and radiate electric and/
or magnetic fields into free space (radiated emissions),
leading to human exposures in the vicinity.
First epidemiological evidence links dirty electricity
to most of the diseases of civilization including cancer,
cardiovascular disease, diabetes, suicide, and attention
deficit hyperactivity disorder in humans (222).
While the dependence of ELF effects on the local mag-
netic field has been reported by many research groups
(13, 223), there are also a few studies which suggest that
the RF effects are also dependent on slight changes in the
local static magnetic field. In the review by Belyaev (224),
a physical mechanism has been suggested to account for
such effects (225). Slight changes in the local static mag-
netic field within 10 μT, which are usually observed within
offices and homes due to ferromagnetic objects, were
reported to induce biological effects that corresponded
well to the predictions following from the mechanism of
ion interference developed by Binhi (226).
On July 8, 2015, a court in Toulouse, France, ruled in
favor of a woman with the diagnosis “syndrome of hyper-
sensitivity to electromagnetic radiation” and determined
her disability to be 85% with substantial and lasting
restrictions on access to employment (227).
In France, the first low-EMF zone has been established
at Drôme in July 2009 (228). In Austria, the construction
of a multi-family house has been planned for 2015, which
was designed by a team of architects, building biology
professionals, and environmental medicine health care
professionals to provide a sustainable healthy living envi-
ronment. Both the outdoor and indoor environments were
explicitly chosen and designed to meet low-EMF require-
ments (229). The implementation of low-EMF zones for
electrosensitive individuals is pursued in numerous coun-
tries. The realization of such projects greatly depends
on the understanding, knowledge, and tolerance of the
members of the chosen community.
Possible mechanism of EHS
Based on the scientific literature on interactions of EMF
with biological systems, several mechanisms of interac-
tion are possible (14, 13, 22, 26). A plausible mechanism
at the intracellular and intercellular level, for instance,
is an interaction via the formation of free radicals or
oxidative and nitrosative stress (230–238). It has been
shown in many reports reviewed by Georgiu (15) that
reactive oxygen species (ROS) may be involved in radical
pair reactions; thus, radical pairs may be considered as
one of the mechanisms of transduction able to initiate
EMF-induced oxidative stress. Furthermore, many of the
changes observed in RF-exposed cells were prevented
by (pre)treatment with antioxidants and radical scaven-
gers (24). While the data from different studies should
be interpreted with care in view of variations in physical
and biological parameters, a majority of the studies have
shown effects of ELF and RF on the oxidative stress (239).
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The IARC monograph states: even small effects on radical
concentration could potentially affect multiple biological
functions”, page 103 (24).
Yakymenko etal. (238) have summarized the current
evidence: Analysis of the currently available peer-
reviewed scientific literature reveals molecular effects
induced by low-intensity RFR in living cells; this includes
significant activation of key pathways generating reactive
oxygen species (ROS), activation of peroxidation, oxidative
damage of DNA and changes in the activity of antioxidant
enzymes. It indicates that among 100 currently available
peer-reviewed studies dealing with oxidative effects of low-
intensity RFR, in general, 93 confirmed that RFR induces
oxidative effects in biological systems. A wide pathogenic
potential of the induced ROS and their involvement in cell
signaling pathways explains a range of biological/health
effects of low-intensity RFR, which include both cancer and
non-cancer pathologies”.
Reviews by Pall (12, 16, 240) provide evidence for a
direct interaction between static and time-varying electric
fields, static and time-varying magnetic fields and elec-
tromagnetic radiation with voltage-gated calcium chan-
nels (VGCCs). The increased intracellular Ca2+ produced
by such VGCC activation may lead to multiple regulatory
responses, including increased nitric oxide levels pro-
duced through the action of the two Ca2+/calmodulin-
dependent nitric oxide synthases, nNOS and eNOS. In
most pathophysiological contexts, nitric oxide reacts with
superoxide to form peroxynitrite, a potent non-radical
oxidant, which can produce radical products, including
hydroxyl and NO2 radicals.
Peroxynitrite is by far the most damaging molecule that
occurs during metabolism in our body. Although not a free
radical, peroxynitrite is much more reactive than its parent
molecules NO and
2
.O
The half-life of peroxynitrite is com-
paratively long (10–20 ms), sufficient to cross biological
membranes, diffuse one to two cell diameters, and allow
significant interactions with most critical biomolecules and
structures (cell membranes, nucleus DNA, mitochondrial
DNA, cell organelles), and a large number of essential met-
abolic processes (225). Elevated nitrogen monoxide, forma-
tion of peroxynitrite, and induction of oxidative stress can
be associated with chronic inflammation, damage of mito-
chondrial function and structure, as well as loss of energy,
e.g. via the reduction of adenosine triphosphate (ATP).
A significant increase of 3-nitrotyrosine was observed
in the liver of Wistar rats exposed to ELF, suggesting a
deteriorative effect on cellular proteins due to possible
formation of peroxynitrite (241). Nitrotyrosin was found to
be increased ( > 0.9 μg/mL) in 30% of the 259 tested EHS
individuals (207).
A study by De Luca etal., in 2014 on 153 EHS and 132
controls showed metabolic pro-oxidant/pro-inflammatory
alterations in EHS like decreased erythrocyte glutathione
S-transferase (GST) activity, decreased reduced glu-
tathione (GSH) levels, increased erythrocyte glutathione
peroxidase (GPX) activity, an increased ratio of oxidized-
CoQ10/total-CoQ10 in plasma, and a 10-fold increased
risk associated with EHS for the detoxifying enzymes
glutathione S transferase haplotype (null) GSTT1+(null)
GSTM1 variants (242).
The importance of ATP has been shown for chronic
fatigue syndrome (CFS) (243) and for stress control (244).
Those patients describe the same symptoms as those suf-
fering from CMI. This could indicate similarities in their
pathomechanisms. Similar disturbances in neurotrans-
mitter expression has been described both with chronic
exposure to EMF (245) and in CMI patients (232, 246).
A study (247) proposed to investigate a possible asso-
ciation between RF exposure and myelin integrity via
classical immunohistochemical markers for healthy and
degenerated myelin, respectively, and for Schwann cells
in general.
Complaints in chronic fatigue syndrome (CFS), fibro-
myalgia (FM), multiple chemical sensitivity (MCS), post-
traumatic stress disorder (PTSD), and Gulf War syndrome
(GWS) are almost the same. Meanwhile, they are summa-
rized as chronic multisystem illnesses (CMI) (246). In all of
them, various disturbances of functional cycles have been
shown: activation of nitrogen oxide and peroxynitrite,
chronic inflammation by activation of NF-kB, IFN-y, IL-1,
IL-6, and interaction with neurotransmitter expression
(232, 246, 248). We recommend classifying EHS as part of
CMI (232, 249), but still recognizing that the underlying
cause remains the environment (see Figure1).
Other diseases that require attention with
respect to EMF
Based on interactions between EMF exposure and biologi-
cal responses that, e.g. lead to a disturbance of the oxi-
dative/nitrosative homeostasis, a variety of diseases are
possible and even expected to occur. Some examples are
given here.
Havas reported in 2008 (250): “Transient electromag-
netic fields (dirty electricity), in the kilohertz range on elec-
trical wiring, may be contributing to elevated blood sugar
levels among diabetics and prediabetics. By closely follow-
ing plasma glucose levels in four Type 1 and Type 2 diabetics,
we find that they responded directly to the amount of dirty
electricity in their environment. In an electromagnetically
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clean environment, Type 1 diabetics require less insulin
and Type 2 diabetics have lower levels of plasma glucose.
Dirty electricity, generated by electronic equipment and
wireless devices, is ubiquitous in the environment. Exercise
on a treadmill, which produces dirty electricity, increases
plasma glucose. These findings may explain why brittle
diabetics have difficulty regulating blood sugar. Based on
estimates of people who suffer from symptoms of electrical
hypersensitivity (3%–35%), as many as 5–60 million dia-
betics worldwide may be affected”.
With respect to fetal and early childhood exposures
to EMF, Sage in the BioInitiative Report 2012 (56) pointed
out: “Fetal (in-utero) and early childhood exposures to cell
phone radiation and wireless technologies in general may
be a risk factor for hyperactivity, learning disorders and
behavioral problems in school.” [&] “Common sense meas-
ures to limit both ELF EMF and RF EMF in these populations
is needed, especially with respect to avoidable exposures
like incubators that can be modified; and where education
of the pregnant mother with respect to laptop computers,
mobile phones and other sources of ELF EMF and RF EMF
are easily instituted”.
In a 2013 review, Herbert and Sage (251, 252) reported
remarkable similarities between pathophysiological phe-
nomena found in autism spectrum conditions (ASCs) and
the physiological impacts of ELF MF/RF, such as oxida-
tive stress, free radical damage, malfunctioning mem-
branes, mitochondrial dysfunction, inflammatory issues,
neuropathological disruption and electrophysiological
dysregulation, cellular stress proteins and deficiencies of
antioxidants such as glutathione.
In a 6-year study, certain blood hormone levels were
monitored in volunteers. Mobile phone use as well as close
distances to mobile phone base stations were associated
Metals
Pesticides
Fungi
Traumata
Bacteria
Viruses
Nitrosative stress
Nitric oxide
Peroxynitrite Superoxid iNOS
iopathy
ATP
Solvents
EMF
Plastizisers
Food
Inflammation
Impaired
Immune
To lerance
Oxidative
stress
TNF-α
Interferon-γ
HYistamine
Severe psycho-social stress
TH2
dominanc
Loss of
Treg cells
Figure 1:Pathogenesis of inflammation, mitochondriopathy, and
nitrosative stress as a result of the exposure to trigger factors (248).
with decreased testosterone levels in males, as well as
decreased ACTH, cortisol, T3 and T4 levels in males and
females (253).
Recommendations for action
EUROPAEM has developed guidelines for differential diag-
nosis and potential treatment of EMF-related health prob-
lems with the aim to improve/restore individual health
outcomes and to propose strategies for prevention. These
recommendations are further outlined below.
These recommendations are preliminary and in large
parts, although related to the whole body of evidence
rooted in the experience of the team, cannot in every
detail be strictly considered evidence-based.
Evidence of treatment strategies for
EMF-related illness including EHS
There are only a few studies assessing therapeutic
approaches to EHS. The interdisciplinary based assessing
and counseling of EHS in the Swiss Environmental Pilot
Project performed in 2001 showed, in an evaluation inter-
view half a year after counseling, that 45% of the persons
with EHS had benefitted from realizing certain advice, e.g.
changing the bedroom (192, 193).
In the 2005 Swiss questionnaire study of physi-
cians working with complementary therapeutic tools,
two-thirds chose exposure reduction as a principal tool,
whereas complementary therapeutics were only chosen
as a supplement (197).
Since 2008, the Swiss Society of Doctors for the Envi-
ronment has run a small interdisciplinary environmen-
tal medicine counseling structure for patients with EHS,
which is embedded in everyday practice with a central
coordination and consultation office as well as a network
of general practitioners interested in environmental medi-
cine who perform environmental medical assessments
and consultations based on a standard protocol. If nec-
essary, environmental experts are consulted and home
inspections are conducted. The aim of the assessments is
to detect or rule out common diseases and to analyze the
impact of suspected environmental burdens on the com-
plaints in order to find individual therapeutic approaches.
The main instrument of the assessment is an extensive
medical and psycho-social history with an additional
environmental history, including a systematic question-
naire and environmental key questions.
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In the first years, the project was scientifically
assessed. In a questionnaire 1 year after counseling, 70%
of the persons recommended the interdisciplinary based
counseling structure and 32% of them considered the
counseling as being helpful. Therefore, a model based
on such an interdisciplinary concept, embedded in the
family doctor’s holistic and lasting concept of treatment,
seems to be promising for a better therapeutic approach to
EHS, also including accessibility measures targeted at the
actual environment (254).
In Finland, psychotherapy is the officially recom-
mended therapy for EHS. In a questionnaire study of
EHS people in Finland, symptoms, perceived sources
and treatments, the perceived efficacy of medical and
complementary alternative treatments (CAM) in regards
to EHS were evaluated by multiple choice questions.
According to 76% of the 157 respondents, the reduc-
tion or avoidance of EMF helped in their full or partial
recovery. The best treatments for EHS were given as
weighted effects: dietary change (69.4%), nutritional
supplements (67.8%), and increased physical exercise
(61.6%). The official treatment recommendations of
psychotherapy (2.6%) were not significantly helpful,
or for medication (–4.2%) even detrimental. The avoid-
ance of electromagnetic radiation and fields effectively
removed or lessened the symptoms in persons with EHS
(194, 255).
Response of physicians to this development
In cases of unspecific health problems (see Questionnaire)
for which no clearly identifiable cause can be found –
besides other factors like chemicals, non-physiological
metals, molds – EMF exposure should, in principle, be
taken into consideration as a potential cause or cofactor,
especially if the person presumes it.
A central approach for a causal attribution of symp-
toms is the assessment of variation in health problems
depending on time and location and individual suscep-
tibility, which is particularly relevant for environmental
causes such as EMF exposure.
Regarding such disorders as male infertility, mis-
carriage, Alzheimer’s, ALS, blood sugar fluctuations,
diabetes, cancer, hyperactivity, learning disorders and
behavioral problems in school, it would be important to
consider a possible link with EMF exposure. Some people
with EHS might be misdiagnosed with multiple sclerosis
(MS) since many of the symptoms are similar. This offers
an opportunity to causally influence the course of the
disease.
Differential diagnosis including
diagnostic tests
Assessment of EMF exposure
Take special medical history, including the assessment of symptoms, diseases,
and circumstances regarding the times and places of appearance of symptoms
(see Annex Patient Questionnaire)
Reduction and prevention
of EMF exposure
EMF exposure presented by the patient/person
or
EMF exposure suspected by the physician
Relevance and conclusion
Possible association
with EMF
Association with other
environmental factors
Reduction and
prevention of other
environmental factors
No relevant association
with environmental
factors
Consultation of other
disciplines
Medical treatment
Figure 2:Flowchart for the handling of EMF-related health problems.
How to proceed if EMF-related health
problems are suspected
The recommended approach to diagnosis and treatment
is intended as an aid and should, of course, be modified
to meet the needs of each individual case (see Figure2).
1. History of health problems and EMF exposure
2. Medical examinations and findings
3. Measurement of EMF exposure
4. Reduction and prevention of EMF exposure
5. Diagnosis
6. Treatment of the patient including the environment
History of health problems and EMF exposure
In order to put later findings into a larger context, a
general medical history is necessary. Part of this history
should include:
Electrical trauma: multiple shocks, electrocution,
struck by lightning.
Chemical trauma: exposure to pesticides, metals,
chlorinated hydrocarbons (PCBs, DDT, etc.)
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Biological trauma in the form of a large load of
parasites, fungal infections, viral infections, etc.
Physical trauma to the central nervous system in the
form of whiplash, other accidents, spinal problems
Autoimmune disorders
In the next steps, we focus only on EMF-related health
effects.
A questionnaire to take a systematic history of health
problems and EMF exposure, compiled by the EUROPAEM
EMF Working Group, is available in the Annex of this EMF
Guideline.
The questionnaire consists of three sections:
(a) List of symptoms
(b) Variation of health problems depending on time,
location, and circumstances
(c) Assessment of certain EMF exposures that can be
evaluated by questionnaire
The list of symptoms in the questionnaire serves to sys-
tematically quantify health problems regardless of their
causes. It also includes questions as to when the health
problems first occurred. Most EMF-related symptoms are
nonspecific and fall within the scope of health problems
due to inadequate regulation (decompensation), e.g. sleep
problems, fatigue, exhaustion, lack of energy, restless-
ness, heart palpitations, blood pressure problems, muscle
and joint pain, headaches, increased risk for infections,
depression, difficulty concentrating, disturbances of coor-
dination, forgetfulness, anxiety, urinary urgency, anomia
(difficulty finding words), dizziness, tinnitus, and sensa-
tions of pressure in the head and ears.
The health problems may range in severity from
benign, temporary symptoms, such as slight headaches
or paresthesia around the ear, e.g. when using a mobile
phone, or flu-like symptoms after maybe some hours of
whole-body EMF exposure, to severe, debilitating symp-
toms that drastically impair physical and mental health. It
has to be stressed that, depending on the individual state
of susceptibility, EHS symptoms often occur only occa-
sionally, but over time they may increase in frequency and
severity. On the other hand, if a detrimental EMF exposure
is sufficiently reduced, the body has a chance to recover
and EHS symptoms will be reduced or will vanish.
Variation of health problems depending on time,
location, and circumstances
The answers to questions of when and where the health
problems occur or recede, and when and where the symp-
toms increase or are particularly evident, provide only
indications. They must be interpreted by the investigator
(e.g. regarding the correct attribution between location/
EMF sources and health problems). Special attention
should be drawn to sleeping areas, because of the duration
of influence and the vital role of sleep for regeneration.
Assessment of certain EMF exposures that can be
evaluated by questionnaire
The assessment of EMF exposure usually starts with
certain questions of usual EMF sources. Regardless of
whether or not the patient suspects EMF exposure as
a cause, these questions should be used to assess the
existing exposure level, at least as a rough estimate. It is
important to note that only certain types of EMF exposure
can be assessed by means of questions, such as the use
of compact fluorescent lamps, mobile phones, and cord-
less phones. Detection of other types of EMF exposure,
e.g. due to RF transmitter sites or the electric or magnetic
fields from electric wiring, generally requires measure-
ments. In principle, questions should be asked to assess
EMF exposure at home and at work and when on holidays
and so on, keeping in mind that the degree of EMF expo-
sure may vary at different times.
Medical examinations and findings
We do not have any clinical findings yet that are specific
to EMF, which makes diagnosis and differential diagnosis
a considerable challenge.
A method that has proven useful is to use stress-
associated findings for diagnosis and follow-up and to
evaluate them synoptically. Basic diagnostic tests should
be carried out as a first step, followed by measurements of
EMF exposure as a second step. The core diagnosis should
focus on investigations of nitric oxide production (nitroty-
rosine), mitochondriopathy (intracellular ATP), oxidative
stress-lipid peroxidation (MDA-LDL), inflammation [TNF-
alpha, IFN-gamma-inducible protein 10 (IP-10), IL-1b, his-
tamine], and the melatonin status (24 h urine melatonin/
creatinine ratio).
Then additional diagnostic tests can be considered.
Due to the differences in normal ranges between labs and
different practices as to the units of measurement in dif-
ferent countries, we do not provide levels to be considered
relevant in EHS. It is recommended to interpret them in
context, focusing not only on out-of-range values. For
example, when several parameters are simultaneously
close to the border of the normal ranges, this could be
instructive for forming a therapeutic or diagnostic opinion.
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Functional tests
Basic diagnostic tests
Blood pressure and heart rate (in all cases resting
heart rate in the morning while still in bed), including
self-monitoring, possibly several times a day, e.g. at
different locations and with journaling of subjective
well-being for a week.
Additional diagnostic tests
24-h blood pressure monitoring (absence of nighttime
decline)
24-h ECG (heart rhythm diagnosis)
24-h heart rate variability (HRV) (autonomous nerv-
ous system diagnosis)
Ergometry under physical stress
Sleep EEG at home
Laboratory tests
Basic diagnostic tests
Blood
ACTH
Bilirubin
Blood count and differential blood count
BUN
Cholesterol, LDL, HDL, triglycerides
Coenzyme-Q10 ratio for oxidized-CoQ10/total-CoQ10
Creatinine kinases (CK-MB, CK-MM)
High-sensitivity C-reactive protein (hs-CRP)
Cystatin C (glomerular filtration rate)
Electrolytes
Fasting blood glucose
Ferritin
Glutathione S-transferase (GST)
Reduced glutathione (GSH)
Glutathione peroxidase (GPX)
HBA1c
Histamine and diaminoxidase (DAO)
IFN-gamma-inducible protein 10 (IP-10)
Interleukin-1 (e.g. IL-1a, IL-1b)
Intracellular ATP
Liver enzymes (e.g. ALT, AST, GGT, LDH, AP)
Magnesium (whole blood)
Malondialdehyde (MDA)-LDL
Nitrotyrosine (NTT)
Potassium (whole blood)
Prolactin
Selenium (whole blood)
Testosterone
TSH
T3, T4
Tumor necrosis factor alpha (TNFα)
Vitamin D3
Zinc (whole blood)
Standard urine
Leucocytes, erythrocytes, albumin, urobilinogen,
pH, bacteria, glucose, microalbumin
Second morning urine
Adrenaline
Dopamine
Noradrenaline
Noradrenaline/adrenaline ratio
Serotonin
Beta-phenylethyleamine (PEA)
24-h urine
6-OH melatonin sulfate
Creatinine
6-OH melatonin sulfate/creatinine ratio
Saliva
Cortisol (8 a.m., 12 a.m., and 8 p.m.)
Additional diagnostic tests
Urine
Metals (depending on case history, e.g. mercury,
cadmium, lead, arsenic, aluminum)
Second morning urine
Gamma-aminobutyric acid (GABA)
Glutamate
Cryptopyrrole
Saliva
Dehydroepiandrosterone DHEA (8 a.m. and 8 p.m.)
Alpha-amylase
Blood
8-Hydroxydeoxyguanosine (DNA oxidation)
Biotin
Differential lipid profile
Folate
Holotranscobolamin
Homocysteine
Interferon-gamma (IFN-γ)
Interleukin-10 (IL-10)
Interleukin-17 (IL-17)
Interleukin-6 (IL-6)
Interleukin-8 (IL-8)
Intracellular glutathione (redox balance)
Lactate, pyruvate incl. ratio
Lipase
NF-kappa B
Vitamin B6 (whole blood)
Provocation tests
Special facilities with the use of a variety of signals, e.g.
DECT or Wi-Fi exposure (e.g. 20–60 min, depending on
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the individual regulation capacity, susceptibility, and
observed response)
Heart rate variability (HRV) (autonomous nervous
system diagnosis)
Microcirculation
Oxidative stress (lipid peroxidation, malondialde-
hyde, oxo-LDL)
For diabetics, plasma glucose
Live blood analysis (red blood cell aggregation in the
form of rouleaux, blood viscosity, macrophage activ-
ity, lysis of red blood cell membrane)
For people with neurological problems and problems
with fine or gross motor coordination, a video of them
walking before and after provocation and a photo-
graph taken of a sample of handwriting before and
after provocation.
Individual susceptibility
Blood (genetic parameters and actual function)
Glutathione S transferase M1 (GSTM1) – detoxifi cation
Glutathione S transferase T1 (GSTT1) – detoxification
Superoxide dismutase 2 (SOD2) – protection of
mitochondria
Catechol-O-methyltransferase (COMT) – stress
control
Measurement of EMF exposure
The evolutionary development of the human species took
place under the presence of the natural electromagnetic
spectrum (Earth’s magnetic field, Earth’s electric field,
spherics, Schumann resonance). Those influences have
been part of our biosphere like the oxygen content in the
air or the visible light spectrum, and they have been inte-
grated into the biological functions (14).
By now, nearly all non-ionizing parts of the electro-
magnetic spectrum are filled with artificial, technical EMF
sources due to electrification and (wireless) communica-
tion technologies, but are very rarely found in nature (see
Figure3). EMF measurements and/or exposure damages
are usually not covered by statutory health care insurance.
In general, a wide variety of EMF exposure types
(static fields, ELF, VLF, and RF) should be considered.
ELF magnetic fields may originate from, e.g. 12 V
transformers, transformer stations, net currents on
the electric wiring, water pipes, and other conduc-
tive materials, infrared heaters, heating blankets and
different types of power lines.
ELF electric fields may originate from, e.g. electrical
wiring, lamps, and appliances.
VLF magnetic fields (”dirty power”) and/or VLF electric
fields (“dirty electricity”) may be emitted from electronic
Electromagnetic spectrum
Natural and artificial sources
1 Hz
100
10 Hz
101
100 Hz
102
1 kHz
103
10 kHz
104
100 kHz
105
1 MHz
106
10 MHz
107
100 MHz
108
1 GHz
109
10 GHz
1010
100 GHz
1011
1 THz
1012
100 THz
1014
10 THz
1013
1 PHz
1015
10 PHz
1016
100 PHz
1017
1 EHz
1018
10 EHz
1019
100 EHz
1020
1 ZHz
1021
10 ZH
z
1022
0 Hz
Electromagnetic fields and radiation Ionizing radiation
Optical radiation
ELF RF / MW Radiation
VLF
Earth’s magnetic field
Alpha, beta, and
gamma radiation
Direct electr
ic current of the Earth
Figure 3:Examples of natural (green) and artificial (red and blue) EMF sources along the electromagnetic spectrum (256).
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devices like energy-efficient lighting, electronic trans-
formers, induction cooker, variable speed frequency
drives, light dimmer switches, power line communi-
cation (PLC) connected to the electrical grid. These
devices use current and/or voltage in short pulses that
might produce harmonics and VLF transients on the
electrical circuits, earthed materials and the ground.
Typical RF radiation sources include, e.g. cordless
phones (DECT), wireless Internet access (Wi-Fi),
mobile phones and their base stations, radio and TV
broadcast antennas, radar (military, airport, marine,
and weather), Bluetooth, and the microwave ovens.
In the sleeping area, the most important exposure point
is the head and trunk region followed by all other points
with chronic or high exposure.
EMF measurements should be planned and carried
out by specially trained and experienced testing special-
ists and always in accordance with relevant standards, e.g.
the VDB Guidelines of the German Association of Building
Biology Professionals (257). In addition to the measure-
ment results, the measurement report should also include
suggestions on how to possibly reduce the EMF exposure.
To clarify certain issues, personal dosimeters with a
data logging function are available to measure ELF mag-
netic fields and radio-frequency radiation.
After the measurements have been commissioned
by the person and carried out, the results should be dis-
cussed with a physician familiar with the EMF issue.
EMF guidance values
In each case, the following aspects should be individually
taken into account when evaluating EMF measurement
results (27, 26):
A person’s individual susceptibility, which, e.g. may
be based on previous history of trauma (electrical,
chemical, biological and physical).
A person’s individual total body burden (e.g. expo-
sure to noise, chemicals like neurotoxins)
Duration of EMF exposure
EMF exposure during the night and day
Multiple exposure to different EMF sources
Signal intensity: watt/m2 (W/m2), volt/m (V/m),
ampere/m (A/m)
Signal characteristics were taken into account in the
EMF guidance values – see Supplement 3 (258)
Frequency
Risetime (ΔT) of bursts, transients, etc.
Frequency and periodicity of bursts, e.g. cer-
tain GSM base stations (8.3 Hz), Wi-Fi networks
(10 Hz), DECT cordless phones (100 Hz)
Type of modulation (frequency modulation,
amplitude modulation, phase modulation)
Regardless of the ICNIRP recommendations for specific
acute effects, the following guidance values (Tables 1–3,
5 and6) apply to sensitive locations with long-term expo-
sure of more than 20h per week (259). They are based on
epidemiological studies (9, 10, 27, 221, 260–262), empirical
observations, and measurements relevant in practice (258,
263), as well as recommendations by the Seletun State-
ment (40) and the Parliamentary Assembly of the Council
of Europe (42). The proposed guidance values are based on
scientific data including a preventive component and aim to
help restore health and well-being in already compromised
patients. All levels provided are for incident intensities and
whole-body exposure.
ELF magnetic fields (extremely low frequency) (ELFMF)
Measurement specifications
Frequency range: /Hz mains electricity, up to  kHz. .Hz
railroad systems in Austria, Germany, Switzerland, Sweden, and
Norway, Hz on airplanes
Type of measurement: Magnetic induction or flux density [T; mT;
μT; nT]
Field probe: Isotropic magnetic field probe (three orthogonal axes)
Detector mode: RMS (root mean square)
Measurement volume: Bed: Short-term measurements across entire
sleeping area. Workplace: Short-term measurements across entire
work area (e.g. sitting position). Long-term measurements: e.g.
point close to the head/trunk in bed or at workplace
Measurement period: Short-term measurements to identify field
sources. Long-term measurements during sleep and work shift
Basis for evaluation: Long-term measurements: maximum (MAX)
and arithmetic mean (AVG)
Precautionary guidance values
In areas where people spend extended periods of time (> 4h
per day), minimize exposure to ELF magnetic fields to levels
as low as possible or below the precautionary guidance
values specified below.
Table 1:Precautionary guidance values for ELF magnetic fields.
ELF magnetic
field
Daytime
exposure
Nighttime
exposure
Sensitive
populations
Arithmetic
mean (AVG)
 nT
( mG)),),)
 nT
( mG)),),)
 nT
(. mG))
Maximum
(MAX)
 nT
( mG)),)
 nT
( mG)),)
 nT
( mG))
Based on: 1)BioInitiative (9, 10); 2)Oberfeld (262); 3)Seletun Statement
(40), 4)NISV (264); 5)Precautionary approach by a factor of 3 (field
strength). See also IARC 2002 (30), Blank and Goodman (17), and
TCO Development (265).
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Evaluation guidelines specifically for sleeping areas
Higher frequencies than the mains electricity at 50/60Hz
and distinct harmonics should be evaluated more criti-
cally. See also the precautionary guidance values for the
VLF frequency range further below. If applicable, mains
current (50/60 Hz) and traction current (16.7 Hz) should be
assessed separately but added (squared average). Long-
term measurements should be carried out especially at
nighttime, but at least for 24 h.
ELF electric fields (extremely low frequency) (ELFEF)
Measurement specifications
Frequency range: /Hz mains electricity, up to  kHz..Hz
railroad systems in Austria, Germany, Switzerland, Sweden, and
Norway
Type of measurement: Electric field [V/m] without ground reference
(potential-free)
Field probe: Isotropic electric field probe (three orthogonal axes)
Detector mode: RMS (root mean square)
Measurement volume: Bed: Nine points across sleeping area.
Workplace: Across entire work area (e.g. sitting position three or six
points)
Measurement period: Spot measurements to assess the exposure
as well as to identify field sources. Since electric field exposure
levels in the ELF frequency range usually do not change, long-term
measurements are not needed.
Basis for evaluation: Spot measurements (maximum) at relevant
points of exposure
Precautionary guidance values
In areas where people spend extended periods of time (>
4 h per day), minimize exposure to ELF electric fields to
levels as low as possible or below the precautionary guid-
ance values specified below.
Table 2:Precautionary guidance values for ELF electric fields.
ELF electric fieldDaytime
exposure
Nighttime
exposure
Sensitive
populations
Maximum (MAX) V/m), ) V/m). V/m)
Based on: 1)NCRP Draft Recommendations on EMF Exposure
Guidelines: Option 2, 1995 (261); 2)Oberfeld (262); 3) Precautionary
approach by a factor of 3 (field strength). See also TCO
Development (265).
Evaluation guidelines specifically for sleeping areas
Higher frequencies than the mains electricity at 50/60Hz
and distinct harmonics should be evaluated more critically.
See also the precautionary guidance values for the VLF fre-
quency range further below.
Radio-frequency radiation (RF)
Measurement specifications
Frequency range: Radio and TV broadcast antennas, mobile phone
base stations, e.g. TETRA ( MHz),GSM ( and  MHz),
UMTS ( MHz),LTE (, , , – MHz), cordless
phone base stations, e.g. DECT (), Wi-Fi access points and
clients ( and  MHz), WiMAX (– MHz). Above
frequencies in MHz refer to European networks.
Type of measurement: Usually electric field [V/m] -> calculated power
density [W/m; mW/m; μW/m]; for conversion units see Table .
Field probe: Isotropic, biconical or logarithmic-periodic antennas
Detector mode: Peak detector with max hold
Measurement volume: Point of exposure across bed and workplace
Measurement period: Usually short-term measurements to identify
RF field sources (e.g. acoustic analysis) and peak readings
Basis for evaluation: Band-specific or frequency-specific spot
measurements (peak detector with max hold) of common signals at
relevant points of exposure (e.g. with spectrum analyzer or at least
band-specific RF meter)
Precautionary guidance values for selected RF sources
In areas where people spend extended periods of time (> 4h
per day), minimize exposure to radio-frequency radiation to
levels as low as possible or below the precautionary guid-
ance values specified below. Frequencies to be measured
should be adapted to each individual case. The specific
guidance values take the signal characteristics of risetime
(ΔT) and periodic ELF “pulsing” into account (258). Note:
Rectangular signals show short risetimes and consist of a
broad spectrum of frequencies. The current density induced
in the human body increases with increasing frequency in
an approximately linear relationship (266).
Table 3:Precautionary guidance values for radio-frequency radiation.
RF source Max Peak/
Peak Hold
Daytime
exposure
Nighttime
exposure
Sensitive
populations)
Radio broadcast (FM) , μW/m μW/m μW/m
TETRA  μW/m μW/m μW/m
DVBT  μW/m μW/m μW/m
GSM (G)
/ MHz
 μW/m μW/mμW/m
DECT (cordless phone)  μW/m μW/mμW/m
UMTS (G)  μW/m μW/mμW/m
LTE (G)  μW/m μW/mμW/m
GPRS (.G) with
PTCCH* (.Hz pulsing)
 μW/mμW/m. μW/m
DAB+ (.Hz pulsing)  μW/mμW/m. μW/m
Wi-Fi ./. GHz
(Hz pulsing)
 μW/mμW/m. μW/m
*PTCCH, packet timing advance control channel.
Based on: BioInitiative (9, 10); Kundi and Hutter (260); Leitfaden
Senderbau (221); PACE (42); Seletun Statement (40). 1)Precaution-
ary approach by a factor of 3 (field strength)= a factor of 10 (power
density). See also IARC 2013 (24) and Margaritis etal. (267).
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Table 4:Conversion of radio-frequency radiation measurement units.
Conversion
of RF
Measurement
units
mW/m....
μW/m,.
μW/cm.....
V/m ......
Magnetic fields in the VLF range (VLF MF)
Measurement specifications
Frequency range:  kHz– MHz. Frequency-specific measurements
(spectrum analyzer/EMF meter), e.g. “dirty power”, powerline
communication (PLC), radio-frequency identification transmitters
(RFID), compact fluorescent lamps (CFL)
Type of measurement: Magnetic field [A/m] – > calculated magnetic
induction [T; mT; μT; nT]
Field probe: Isotropic or anisotropic magnetic field probe
Detector mode: RMS (root mean square)
Measurement volume: Point of exposure across bed and
workplace
Measurement period: Short-term measurements to identify
field sources. Long-term measurements during sleep and work
shift
Basis for evaluation: Long-term measurements: RMS detector,
arithmetic mean and maximum at relevant points of exposure
Note: If an elevated exposure is detected, power quality analyzers
and oscilloscopes can be used on the actual wiring to trace the
source of the dirty power.
Precautionary guidance values
In areas where people spend extended periods of time (> 4h
per day), minimize exposure to VLF magnetic fields to levels
as low as possible or below the precautionary guidance
values specified below.
Table 5:Precautionary guidance values for VLF magnetic fields.
VLF magnetic
field
Daytime
exposure
Nighttime
exposure
Sensitive
populations
Arithmetic
mean (AVG)
 nT
(. mG))
 nT (. mG)). nT (. mG))
Maximum
(MAX)
 nT
(. mG))
 nT (. mG)) nT (. mG))
Based on: 1)The current density induced in the human body
increases with increasing frequency in an approximately linear
relationship (266). Therefore, the guidance value of the magnetic
field in the VLF frequency range should be lower than the one of
the 50/60Hz magnetic field, e.g. for 100 nT RMS/100=1 nT. For the
rationale of 100 nT (avg) and 1 μT (max), see section ELF magnetic
fields. 2)Precautionary approach by a factor of 3 (field strength). See
also TCO Development (265).
Electric fields in the VLF range (VLF EF)
Measurement specifications
Frequency range:  kHz– MHz. Frequency-specific measurements
(spectrum analyzer/EMF meter), e.g. ”dirty electricity”, powerline
communication (PLC), radio-frequency identification transmitters
(RFID), compact fluorescent lamps (CFL)
Type of measurement: Electric field [V/m]
Field probe: Isotropic, biconical, logarithmic-periodic electric field probe
Detector mode: RMS arithmetic mean
Measurement volume: Point of exposure across bed and workplace
Measurement period: Short-term measurements to identify field
sources. Long-term measurements during sleep and work shift
Basis for evaluation: Long-term measurements: arithmetic mean at
relevant points of exposure
Note: If an elevated exposure is detected, power quality analyzers
and oscilloscopes can be used on the actual wiring to trace the
source of the dirty power.
Precautionary guidance values
In areas where people spend extended periods of time
(> 4h per day), minimize exposure to VLF electric fields to
levels as low as possible or below the precautionary guid-
ance values specified below.
Table 6:Precautionary guidance values for VLF electric fields.
VLF electric field Daytime
exposure
Nighttime
exposure
Sensitive
populations
Arithmetic mean (AVG). V/m). V/m). V/m)
Based on: 1)The current density induced in the human body increases
with increasing frequency in an approximately linear relationship
(266). Therefore, the guidance value of the electric field in the VLF
frequency range should be lower than the one of the 50/60Hz elec-
tric field, e.g. for 10 V/m/100 = 0.1 V/m. For the rationale of 10 V/m
and 1 V/m, see section ELF electric fields. 2)Precautionary approach
by a factor of 3 (field strength). See also TCO Development (265).
Reduction and prevention of EMF exposure
Preventing or reducing EMF exposure after consulting a
testing specialist is advantageous for several reasons:
(a) To prevent and reduce risks to individual and public
health,
(b) To identify any links to health problems,
(c) To causally treat the EMF-related health problems.
There are numerous potential causes of relevant EMF expo-
sures, and this EMF guideline can only give a few examples.
Further information can be found, for instance, in the docu-
ment “Options to Minimize EMF/ RF/Static Field Exposures
in Office Environments” (268) and “Elektrosmog im Alltag”
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(269). For detailed information on physics, properties, and
measurement of EMF, see Virnich (270); regarding reduc-
tion of radio-frequency radiation (RF) in homes and offices,
see Pauli and Moldan (271).
In most cases, it will be necessary to consult an expert
(e.g. qualified EMF/RF engineer/ consultant) and/or elec-
trician who will advise the person on what measures could
be taken to reduce EMF exposure.
EMF exposure reduction – first steps
As a first step, recommendations are given (also as preven-
tive measures) to eliminate or reduce typical EMF expo-
sures, which may help alleviate health problems within
days or weeks. The following actions may be suggested:
Preventing exposure to radio-frequency radiation (RF)
Keep mobile phone/smartphone and cordless phone
calls short; use the speakerphone function or a hands-
free kit.
Avoid wearing the mobile phone/smartphone close to
the body.
Deactivate all non-essential wireless mobile phone
apps, which cause periodic radiation exposure.
Keep mobile phones/smartphones in “airplane mode”
whenever possible or deactivate mobile data, Wi-Fi,
Bluetooth and near field communication (NFC) in the
smartphone settings.
Disconnect (unplug) the power supply of all DECT
cordless phone base stations. So called “ECO Mode”
or “zero-emission” DECT phones are only condition-
ally recommended because the exposure by the hand-
set is still present. A “traditional” corded phone is
recommended instead.
Disconnect (unplug) the power supply to all Wi-Fi
access points or Wi-Fi routers. Many LAN routers
now come equipped with additional Wi-Fi. Call the
provider of the LAN router and ask to have the Wi-Fi
deactivated. It is usually also possible to do so online
by following the provider’s instructions.
In case of external RF radiation sources, rooms –
especially bedrooms – facing away from the source
should be chosen.
Avoid powerline communication for Internet access
(dLAN) and instead use a hardwired Ethernet cable
(LAN).
Avoid exposure to RF radiation (e.g. wireless devices
like, home entertainment, headsets, baby monitors,
computer games, printers, keyboards, mouse, home
surveillance systems) at home, in offices, and in cars.
Avoid exposure to energy-efficient lighting (compact
fluorescent lamps as well as some LEDs generate high
frequency transients). These types of lamps can be
replaced with incandescent or line-voltage halogen
incandescent lamps until good-quality lighting energy-
efficient lamps become commercially available.
Preventing exposure to ELF electric and magnetic fields
Move the bed or desk away from the wiring in the
walls and power cords. A minimum distance of 30cm
(1 ft) from the wall is recommended.
As magnetic fields can pass through walls, make cer-
tain that there are no magnetic sources immediately
beneath or above a bed or in an adjacent room.
Another simple complementary action is to discon-
nect the power supply to the bedroom (turn off cir-
cuit breaker or fuse) for the nighttime while sleeping;
try it for a test phase of, e.g. 2 weeks. In general, this
measure is not always successful because circuits of
adjacent rooms contribute to the electric field lev-
els. ELF electric field measurements are required to
know exactly which circuit breakers need to be dis-
connected. The benefits should be weighed against
the potential risk of accidents; therefore, the use of a
flashlight for the test phase should be recommended.
Disconnect the power supply to all non-essential elec-
tric circuits, possibly in the entire apartment or house.
(N.B. See note above.)
Avoid using an electric blanket during sleep; not only
turn it off, but also disconnect it.
Avoid extended exposures close to running electric
motors. As a first step, keep a minimum distance of
1.5m (5 ft). As a second step, establish a safe distance
based on magnetic field measurements.
Preventing exposure to static magnetic/static electric
fields
Sleep in a bed and mattress without metal.
Avoid sleeping close to iron materials (radiator,
steel, etc.)
Wearing synthetic clothing and, e.g. rubber-soled
shoes and not regularly being in contact with the
earth can result in build up of static electricity. Cotton
clothing and leather-soled shoes will help avoid static
electricity.
EMF exposure reduction – second steps
As a second step, EMF measurements and mitigation
measures should be carried out. Typical examples are:
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Measure the ELF electric field in the bed. Based on
the measurement results, install automatic demand
switches in those circuits that increase the exposure.
Measure the ELF electric field at all other places that
are used for extended periods at home and at work. If
necessary, choose lamps used close to the body with
a shielded electric cable and a grounded lamp fixture
(metal). Especially in lightweight construction (wood,
gypsum board), electrical wiring without ground-
ing (two-slot outlets) might have to be replaced with
grounded electrical wiring or shielded electrical wir-
ing. In special cases, shielded wiring and shielded
outlets may have to be installed in the whole building.
Measure the ELF magnetic field close to the bed, e.g.
for 24 h. If net currents are detected, the electrical wir-
ing and grounding system of the building must be cor-
rected to reduce the magnetic fields.
Install a residual current device (RCD) or ground-fault
circuit interrupter (GFCI) to prevent electric shocks
(safety measure).
Measure radio-frequency radiation and mitigate high
exposure levels by installing certain RF shielding mate-
rials for the affected walls, windows, doors, ceilings,
and floors. For example, in a multiunit setting (condo-
miniums or highrise apartments, townhomes), proxim-
ity to neighbors can contribute to inhome exposure.
Measure dirty electricity/dirty power (electric and
magnetic fields in the VLF frequency range) and iden-
tify the sources in order to remove them. If this is not
possible, appropriate power filters in line with the
source may be used.
Diagnosis
We will have to distinguish between EHS and other EMF-
related health problems like certain cancers, Alzheimer’s,
ALS, male infertility, etc. that might have been induced,
promoted, or aggravated by EMF exposure. An investi-
gation of EHS and other EMF-related health problems
will largely be based on a comprehensive case history,
focusing, in particular, on correlations between health
problems and times, places, and circumstances of EMF
exposure, as well as the progression of symptoms over
time and the individual susceptibility. In addition, meas-
urements of EMF exposure and the results of additional
diagnostic tests (laboratory tests, cardiovascular system)
serve to support the diagnosis. Moreover, all other poten-
tial causes should be excluded as far as possible.
In 2000 the Nordic Council of Ministers (Finland,
Sweden, and Norway) adopted the following unspecific
ICD-10 code for EHS: Chapter XVIII, Symptoms, signs and
abnormal clinical and laboratory findings, not elsewhere
classified, code R68.8 “Other specified general symptoms
and signs” (Nordic ICD-10 Adaptation, 2000) (272).
Regarding the current International Classification of
Diseases (ICD), ICD-10-WHO 2015, we recommend at the
moment:
(a) Electromagnetic hypersensitivity (EHS): to use the
existing diagnostic 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.”
(b) EMF-related health problems (except EHS): to use the
existing diagnostic codes for the different diseases/
symptoms plus code Z58.4 “Exposure to radiation
and/or Z57.1 “Occupational exposure to radiation.”
Regarding the next ICD update to be published in 2018
(ICD-11 WHO), we recommend:
(a) To create ICD codes for all environmentally induced
chronic multisystem illnesses (CMI) like multiple
chemical sensitivity (MCS), chronic fatigue syndrome
(CFS), fibromyalgia (FM), and electromagnetic hyper-
sensitivity (EHS) on the basis of their clinical and
pathological description (187, 192).
(b) To expand chapter XIX, Injury, Poisoning and Certain
Other Consequences of External Causes (T66-T78), to
include/distinguish effects of EMF (static magnetic
field, static electric field, ELF magnetic field, ELF
electric field, VLF magnetic field, VLF electric field,
radio-frequency radiation), infrared radiation, visible
light, UV radiation and ionizing radiation.
(c) To expand chapter XXI, Factors Influencing Health
Status and Contact with Health Services (Z00-Z99), to
include/distinguish factors as EMF (static magnetic
field, static electric field, ELF magnetic field, ELF
electric field, VLF magnetic field, VLF electric field,
radio-frequency radiation), infrared radiation, visible
light, UV radiation, and ionizing radiation.
Treatment of the patient including the environment
The primary method of treatment should mainly focus on
the prevention or reduction of EMF exposure that is reduc-
ing or eliminating all sources of EMF at home and in the
workplace. The reduction of EMF exposure should also be
extended to schools, hospitals, public transport, public
places like libraries, etc. in order to enable EHS persons
an unhindered use (accessibility measure). Many exam-
ples have shown that such measures can prove effective.
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With respect to total body load of other environmental
influences, they must also be regarded.
Beside EMF reduction, other measures can and must
be considered. These include a balanced homeostasis
in order to increase the “resistance” to EMF. There is
increasing evidence that a main effect of EMF on humans
is the reduction of their oxidative and nitrosative regu-
lation capacity. This hypothesis also explains observa-
tions of changing EMF sensitivity and the large number
of symptoms reported in the context of EMF exposure.
Based on currently available knowledge it appears useful
to recommend a treatment approach, as those gaining
ground for multisystem illnesses, that aims at minimiz-
ing adverse peroxynitrite effects. Measures that enhance
the immune system and reduce stress in combination
with detoxification will promote EHS recovery.
It should be stressed, that psychotherapy has the
same significance as in other diseases. Products that are
offered in the form of plaques and the like to “neutralize”
or “harmonize” electrosmog should be evaluated with
great restraint. Psychological stress generated by a lack
of understanding or support by family, friends and physi-
cians can exacerbate the symptoms of EHS as can stressing
about exposure. For rapid recovery, the treatments need to
apply to the body, mind and spirit of the individual.
In summary, the following treatment and accessibility
measures appear advantageous, depending on the indi-
vidual case:
Reduction of EMF exposure
This should include all types of EMF exposures relevant
to the person, especially during sleep and at work – see
Chapter “Reduction of EMF Exposure”. For more informa-
tion, see e.g. “Options to Minimize EMF/RF/Static Field
Exposures in Office Environment” (268) and “Elektrosmog
im Alltag” (269).
Environmental medicine treatments
Until now, no specific treatment of EHS has been estab-
lished. The following paragraphs are recommendations
based on the combined experience of the team. They can
be considered either as an attempt to restore the full regu-
lative capacity of the patients, as general advice for healthy
living (that could and should be adapted to the cultural
and individual situation of the patient), or as a more tar-
geted approach to address the specific problems of EHS
individuals according to the experience of the team.
Controlled clinical trials would be necessary to assess
optimal treatment and accessibility measures. Actual
data indicate that the functional deficits, which can be
found in patients with EHS, correspond to those we can
find in CMI such as MCS, CFS, and FM. The target of the
therapy is the regulation of the physiological dysfunction
detected by diagnostic steps (see chapter 2 “Examination
and Findings”). The main therapeutic target includes both
general and adjuvant procedures and specific treatments.
The latter are challenging and need special knowledge
and experience in clinical environmental medicine treat-
ments. Main therapeutic targets include:
Control of total body burden
Besides the reduction of EMF exposure, the reduction
of the total body burden by various environmental
pollutants (home, workplace, school, hobby), food
additives, and dental materials is indicated.
Reduction of oxidative and/or nitrosative stress
Reactive oxygen species (ROS) and reactive nitrogen
species (RNS) are free radicals naturally produced
in cells. Scavengers guarantee the balance between
the production of free radicals and the rate of their
removal. Many biologically important compounds
with antioxidant (AO) function have been identified
as endogenous and exogenous scavengers. Among the
endogenous AO, we distinguish between enzymatic
AO (catalase, glutathione peroxidase, glutathione
reductase, superoxide dismutase) and non-enzymatic
AO [bilirubin, ferritin, melatonin, glutathione, metal-
lothionin, N-acetyl cysteine (NAC), NADH, NADPH,
thioredoxin, 1,4,-bezoquinine, ubiquinone, uric acid].
They interact with exogenous dietary and/or synthetic
AO (carotenoids, retinoids, flavonoids, polyphenols,
glutathione, ascorbic acid, tocopherols). The complex
regulation and use of these substances is the thera-
peutic challenge (232, 273).
Regulation of intestinal dysfunction
Endogenous and exogenous scavengers act synergis-
tically to maintain the redox homeostasis. Therefore,
dietary or natural antioxidants play an important role
to stabilize this interaction.
Treatment of a leaky gut, food intolerance, and food
allergy is a prerequisite for maintaining redox homeo-
stasis (274) and also requires special knowledge and
experience.
Optimizing nutrition
Bioactive food is the main source of antioxidant com-
ponents such as vitamin C, vitamin E, NAC, carote-
noids, CoQ10, alpha-lipoic acid, lycopene, selenium,
and flavonoids (275, 276). For instance, the regenera-
tion of vitamin E by glutathione or vitamin C is needed
to prevent lipid peroxidation. The dietary antioxi-
dants only can have beneficial effects on the redox
system if they are present in sufficient concentration
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levels (273). Alpha-lipoic acid acts directly and indi-
rectly as a scavenger of free radicals including,
singlet oxygen, superoxide, peroxyl radicals, and the
breakdown radicals of peroxynitrite (232). It has been
shown that the number of free electrons in micronu-
trients determines how effective they are. In organic
food, the number of free electrons is higher than in
conventionally produced food (277). Especially in
the case of food intolerances, the tailored substitu-
tion of micronutrients in the form of supplements is
necessary.
Control of (silent) inflammation
Elevated nitric oxide levels and the reaction with
superoxide always leads to elevated peroxynitrate
levels, which induce ROS levels as no other substance
does (NO/ONOO cycle). As a result, the nuclear
factor κB (NF-κB) is activated, inducing inflammatory
cytokines such as tumor necrosis factor α (TNF-α),
interleukin-1β (IL-1β), interleukin-6 (IL-6), interleu-
kin-8 (IL-8), and interferon gamma (IFN-γ) and acti-
vating various NO synthases (232). Tocopherols (278,
279), carotenoids at low concentration levels (280),
vitamin C (281, 282), NAC (283), curcumin (284), res-
veratrol (285, 286), flavonoids (287) have shown to
interrupt this inflammatory cascade at various points.
Normalization of mitochondrial function
Mitochondrial function may be disturbed in two ways.
First: the high amount of free radicals may block pro-
duction of adenosine triphosphate (ATP), leading to
muscle pain and fatigue. Second: in the case of silent
(smoldering) inflammation, the demand for more
energy is elevated by 25% (236), causing a high con-
sumption of ATP. In this case, NADH, L-carnitine, and
CoQ10 are essential for ATP synthesis.
Due to the lack of ATP, the stress regulation of catecho-
lamines especially norepinephrine (NE) is reduced
because catabolism of NE by S-adenosylmethionine is
ATP dependent (288–290). Furthermore, stress regu-
lation has a high demand for folate, vitamin B6, and
methylcobalamine. Genetic polymorphisms of COMT
and MTHFR influence the individual need for those
substances (244, 291).
Detoxification
In humans, the accumulation of environmental toxins
has an individual profile of many different inorganic
and organic chemicals, which make up the total body
load (292).
Among the inorganic substances, metals and their
salts play the dominant role and might be of impor-
tance to patients with EHS. Elemental mercury (Hg°)
and other heavy metals such as lead (Pb) accumulate
in the brain (293), especially at chronic low dose
exposure. They may have toxic effects and can induce
various immune reactions (294, 295). Whereas no
specific active substance generally exists for the
detoxification of chemicals, there are two groups of
substances with more specific effects that can be used
for the detoxification of metals.
1. Substances with nonspecific physiological
effects: glutathione, NAC, alpha-lipoic acid, vita-
min C, and selenium.
2. Chelating agents for detoxification of metals
(296–298): the most important chelating agents
are sodium thiosulfate 10%, DMPS (2,3-dimer-
capto-1-propanesulfonic acid), DMSA (meso-
dimercaptosuccinic acid), and EDTA (2,22,23,232-
ethane-1,2-diyldinitrotetraacetic acid).
It should be noted that these substances should be
used only by those designated as experts in this par-
ticular field.
Adjuvant therapies
1. Drinking water
For detoxification reasons, a higher intake of high-
quality drinking water with low mineral content and
no CO2 is needed. The intake quantity should range
from 2.5 to 3.0 L (1012 8-oz glasses) daily.
2. Light
Most of the people in central and northern Europe
are depleted of vitamin D. Sufficient natural daylight
exposure during the vitamin D-producing months
(spring to fall) is one important factor. At the same
time, prevention of actinic damage to the skin is nec-
essary. In addition to natural sunlight, light therapy
and low level lasers can promote healing, reduce
inflammation, promote circulation, and enhance cel-
lular ATP production.
3. Sauna
Sauna and therapeutic hyperthermia is an adjuvant
therapy for the detoxification of almost all xenobi-
otics. These therapies have to be carefully used. An
interaction with detoxifying drugs takes place. Sauna
helps to regenerate tetrahydrobiopterin from dihyd-
robiopterin, which is essential for the metabolism of
catecholamines and serotonin (299). However, not
all saunas are alike. Traditional saunas or infrared
saunas with low electric and low magnetic fields that
do not use toxic glues and chemically treated wood
are recommended.
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4. Oxygen
A part of patients with EHS suffer from mitochondrial
dysfunction. Sufficient natural oxygen is helpful. As
both hypoxia and hyperbaric oxygen can produce oxi-
dative stress, hyperbaric oxygen therapy should only
be performed if the patients are treated with sufficient
antioxidants at the same time.
5. Exercise
The optimal amount of exercise is still being debated.
A person’s physical capacity should be assessed by
ergometry in order to prescribe an individual exercise
regime. Environmental medicine experience indicates
that for sick people only low-impact aerobic exercise
should be used. In general, start with a workload of
20–30 watts that often can be finished at 60–70 watts.
Exercise on an ergometer allows better control of
the consumption of energy compared to walking or
running. No fatigue should result from exercising, at
least after half an hour.
6. Sleep
Sleep problems are very common in patients with
EHS. Sleep disturbance is associated with a reduced
melatonin level. In the case of chronic inflammation,
the activation of IDO (indolamine-2,3-dioxygenase)
reduces the production of serotonin and, in turn, it
also reduces melatonin levels. EMF exposure might
block the parasympathetic activity while sympathetic
activity persists. Concerning sleep disturbances, any
therapy has to follow the pathogenic causes. Optimal
sleep is necessary to save energy and to regulate the
functions of the immune and neuroendocrine systems.
7. Protection from blue light
Wavelengths of visible light below 500nm are called
“blue light”. Low doses of blue light can increase feel-
ings of well-being, but larger amounts can be harmful
to the eyes. In natural daylight, the harmful effects
of “blue light” are balanced out by the regenerative
effect of the red and infrared content. The escalating
use of electronic light sources – such as fluorescent
tubes and compact fluorescent lamps (CFL), computer
screens, laptops, tablets, smartphones, and certain
LED bulbs – has increased our exposure to “blue
light”, which at this level is suspected of playing a
role in the development of age-related macular degen-
eration and circadian misalignment via melatonin
suppression, which is associated with an increased
risk of sleep disturbance, obesity, diabetes mellitus,
depression, ischemic heart disease, stroke, and
cancer. Extended exposure to artificial “blue light”
in the evening should therefore be limited. Antioxi-
dants, especially melatonin (300, 301), and blue light
screen filters (302–304) could be helpful.
8. Exposure to the natural electromagnetic fields
of the Earth.
Most people in urban centers are disconnected from
the Earth’s natural grounding/magnetic fields by
walking with rubber-soled shoes, wearing synthetic
clothing, driving in metal boxes with rubber wheels,
and living and working in concrete buildings that are
permeated with artificial electromagnetic fields and
radiation. Spending time in the woods, walking bare-
foot along a beach, lying on the grass, sitting on rocks,
or strolling outside after a rain shower help ground
a person and help balance the often enhanced posi-
tively charged ions that are associated with ill health.
Dental medicine
Dental medicine still works with toxic or immunoreactive
materials, e.g. mercury, lead oxide, gold, and titanium.
Environmental dental medicine demands that these mate-
rials not be used (305–308). The removal of toxic dental
materials must take place under maximum safety condi-
tions (avoid inhalation!). The elimination of particularly
heavy metals from the body might be indicated. In general
terms, endoprosthetic materials should be inert with
respect to immunoreactivity. Based on our current knowl-
edge, zirconium dioxide seems to be a neutral material.
However, mechanical abrasion of the coated surface by
the dentist should be avoided.
Immunotoxic metals show a similar pathophysiology
with respect to oxidative stress, mitochondriopathy, and
inflammation.
Lifestyle coaching
Lifestyle coaching may include balanced exercise, nutri-
tion, reduction of addictive substances, change of sleep
habits, etc. and stress reduction measures (reduction
of general stress and work stress), as well as methods
to increase stress resistance via, e.g. autogenic training,
yoga, progressive muscle relaxation, breathing tech-
niques, meditation, tai chi, and qigong.
Treatment of symptoms
A well-balanced treatment of symptoms is justified until
the causes have been identified and eliminated. However,
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it is of paramount importance to realize that the reduction
of symptoms may put the person at risk for an increased
environmental EMF load, thus generating possible future,
long-term health effects, including neurological damage
and cancer. The treating physician faces a very diffi-
cult ethical task when doing so, and the associated risks
must be pointed out – in an equally well-balanced way
– to the patient in question. From an ethical perspective,
treating the symptoms is, of course, a very good start to
provide immediate relief, but – without a concurrent envi-
ronmental exposure reduction and lifestyle coaching –
it may prove counter-productive in the long run. For a con-
ventionally trained physician, this might seem a very new
way of reasoning, but it is the only way to successfully and
effectively alleviate symptoms and to achieve complete
clinical recovery when dealing with chronic multisystem
illnesses (CMI) and EHS. Though even if the causes are not
known at the outset, it is already important at this stage
to provide advice on how to reduce a person’s exposure to
electromagnetic fields and other environmental stressors
to prevent further damage and promote healing.
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... All these symptoms have been described in persons with EHS [6,7,19]. This person contacted our research team and we judged it to be pertinent to make EMF measurements at her work place. ...
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