Addressing Mold Illness in the Complex Patient

Addressing Mold Illness

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Dr. Hoffman

Well welcome everybody. Today I’m going to be talking about complex patients and in the setting of mold illness, but I want you to know that this isn’t going to be about how to diagnose mold illness, sirs, and the steps A, B, C, D, E, F, G, which you can get, and I’ve listed some of the fabulous sites that are out there that you can go to to reference some of the logistics of how to diagnose mold illness and what to do about it every step of the way. This is more of just about what I, as a physician who treats complex illness, find when people present to me with a diagnosis or suspicion of having mold illness as a trigger for the complex symptomatology. And what I found problematic and difficult sometimes to negotiate when trying to understand where the mold may fit into the complex scenario. So these are some websites that you can go to Dr. Andrew hymens YouTube videos on SIRs are fabulous. Richie Shoemaker has been teaching mold illness for a very long time. The ici website has got some amazing people that belong to that group and present on mold all the time. They have an annual conference coming up soon. And then many of you may know Neil Nathan and his approach, real time lab have lots of information. And Dr. Dennis is an EMT surgeon who does a lot of work on sinus colonization of mold and performance surgery and treats mold illness as a occupant of hollow spaces. So those are some references for you.

But here’s the scenario. A patient presents at your office, this is what I see. This is what I see all day, every day. I’ve seen patients this week already with this type of presentation. patient presents, they say I have mold illness. So I suspect mold is playing a role in my symptomatology. And they’ve got many symptoms. You know, as we all know, when dealing with chronically ill people, they fatigue, they got body pain, they got brain fog, mood disorders, got GI tract is always involved, immune systems always involved, they feel inflamed, they hurt, they saw, they ache, and they very symptomatic. And they’ve often been that way for a very long time and have seen every specialist in the book and seen many times many naturopaths, chiropractors, you name it. They’ve been there. And then they show up with a host of lab tests and specialist letters and special investigations.

And now I once but to sort of sift through this and try and make sense of it and see where does mold fit into this complexity. So this is a common thing I get patients say I’ve got mold illness, and they’ve seen everybody. They’ve tried everything, and they always want to get onto Colas tyramine. I don’t know why. It’s a very common presentation. Can I get a colostomy today? Can you prescribe it for me, and I’ll show you as this presentation progresses, that this is probably the very last thing that you want to be doing. So the most common way people are presenting now is with a mold urine test. And they think that from this urine test of the mycotoxin, which is a toxic byproduct of mold, that they could have mold illness, and this is one of the biggest mistakes ever made. In my clinical career when it comes to dealing with complex patients and etiology of disease processes. This test cannot determine whether you have mold illness or not. And I hope my presentation will enunciate why I say that.

So where do we begin? So I’m not going to go straight into SIRs or mold illness right away. I’m going to just give you some background to how I sort of orient myself to these complex patients. You know, where do we practically begin? When we know in systems biology that everything’s connected to everything else? Everything’s embedded in deep chains and networks and systems and we are very tempted as physicians or clinicians to plunge into the typical n square D square approach to medicine, name of disease, name of drug, and this sort of prescribing an allopathic way, something to help relieve the patient’s symptomatology.

But over the years, I’ve developed a system of trying to work through complexity. And I adapted the eidetic model of the cultures or bodies, these different layers or levels to our reality model somewhat on a bit antic literature. It is very training that I’ve done in the past and also German biological medicine as developed by Dr. Dietrich Klinghardt. So I’ve sort of melded all these models together. And I look at the person presenting in front of me having different layers and levels of of their, to their reality.

So the first level is the environment. Outside, we can’t just do an exchange with our environment. So we all the toxicology issues come into play. Level two is the biochemistry and the structure, the physicality of our being. Level three is the energetics the sort of biophotons that radiate from us squeeze DNA, and the interaction with our nervous systems and brains. Stage four has everything to do with our emotional body and how we’ve been seen or not seen in our early developmental years, and what our attachment disorders may or may not be, and how we’ve oriented ourselves to the world in terms of developing a window of tolerance for self regulation in the midst of complexity and challenge. Level five is the the ego, the the operational sense of self that gets us through life. And that has our value systems, our defenses, our beliefs, or morals or values. And there’s a lot that goes on at that level.

And then level six is the so called Soul the most authentic part of yourself, that part of you, which is calling union, psychology the daemon. It’s your true authentic self that sort of, sort of holds yourself together consciously or unconsciously, it’s usually only accessible in the second half of life, I’m afraid to say. And I don’t mean that flippantly, it just seems to be that as we progress through life, the first 30 years or ego based, we driven to become something. And so we have these drives that that force us to be seen by our parents to be seen by our peers, to find a mate to procreate to educate and create some stability and safety in the world. But the second half of life is all to do with authenticity. Who are we really, and how much of our true self that we leave behind in this in this search for authenticity, or in the search for gaining something in the world and procreating the species.

And then the last level is that which is above and beyond and has nothing to do with our individual reality, which we call God or the grand organized design. And some people are very connected to that aspect of their non-local reality and other people aren’t. And it plays a role in diagnosis and therapeutics. So this is the model I use. When a person sits in front of me, can I use a practically very practically. And it looks like this on a map. Where we this is what it looks like when I when my book eventually comes out, this will be there. But this so these are the seven stages of reality and all the experiences anatomical designation sciences, diagnostic methods and treatment methods. And so here we have a lady to make it more practical and less easy to Tarek, a woman may present say, in her 50s with mold illness. And she’s got all these complex, additive diagnostics. That when you go through the layers and levels, they sort of show up. At the first level. Yes, she’s been exposed to mold. She’s lived in a moldy environment for 10 years and it’s deadly well since. But she also has other toxic exposures, mercury from fillings. organophosphates because she like lives next to a farmer’s field. She got a lot of dental issues, she’s lived in tick, bite country, and so forth and so on. You’ll see a lot of these different in functional medicine we call them antecedents, mediators and triggers of illness. Level two or two you know, we all know about food, gut, brain immune system issues, level three auditor electromagnetics and, and brain function, level four all about early trauma and inherited trauma from ancestors, level five or to do with ego strengths, personality disorders or mood disorders, and then level, that’s level five, and then level six, inherited family trauma, meaning and purpose in life.

Some people have no idea why they get up every day. And so people without that drive to, towards what we call a strange attractor, people get driven, there’s a biological urge to become something. And some people feel very disconnected from that, and that has vast diagnostic and therapeutic implications. And then at level seven, this woman had no connection to anything outside of her own reality. And so these sort of these, this sort of presentation becomes very palpable, very practical. I had a patient just last week, and she came to see me with severe muscle activation syndrome and reacting to foods she had, she was eating like three foods, she was breastfeeding her 15 month old son, who was also had very little to eat. Because everything was rejected.

He vomited continuously, she could only hold on a few foods. And this person was never sleeping through the night. She lived in a moldy home food was an obvious trigger as well electromagnetic fields, which as you’ll see are huge triggers of my cell activation and the so called Cell danger response, which we’ll get to in a minute. In a bit upon deep inquiry, it was apparent that she’d had a tumultuous upbringing with with lots of trauma, and interrupted bonds with the parents, their parents got divorced when she was three. And she spent the next two decades going to court and having to choose sides between her wearing parents. And she had allergies from a very young age.

And then I was just talking to her and I said, Oh, you know, I think we’re going to have to use a tighter, firmer h1, first generation h1 blocker for your son at night to help him with his micelle quietening. And to help him sleep. But she said to me, I just Google that in my chat group, and I heard that it’s gonna induce rage in children. So immediately, her fear based brain her amygdala was on high alert, she was already rejecting a potent life transforming treatment. Ketotifen is amazing when it works. And she had no trust in any allopathic intervention, she already had rejected it. And this you will see, when children had Don’t be unseen, and don’t have limbic resonance with parents, they often have, they’re not able to self regulate, and inhibit, they fear or they fight flight responses. And so they see everything as a threat. And they often have these very distorted relationships with their parents and projected onto therapists, doctors naturopaths, because our profession is very paternalistic, to put it mildly, in that we direct and tell people what to do. And so we act as authority figures. And if this person from a very young age has not been regulated appropriately by the parental influences, and there’s a lot of confusion and inability to self regulate, she will project her fear onto you as a parental figure. And she won’t be able to take anything in. So no matter if she has mold illness or anything else, it doesn’t matter what the diagnoses are, if no trust is established, and if no limbic resonance is established with her as a client, and no stable ability to self regulate is established, you will never get anywhere, no matter what the illness, you have to start at a much deeper level to try and really see that patient and understand the defense’s and understand the trauma before we drop into western or alternative functional medicine diagnostics.

So that’s one of the clinical pearls I would like to introduce when dealing with complex patients when they come in with a urine mycotoxin panel and say can we use code and stymied take a deep take a big step backwards we you know, we familiar with ranch rushing in and going you know, we take functional medicine, even a western medicine diagnosis and then we we want to treat it in diagnosis and then treat it but use a much larger or wider lens when you’re sitting in In front of these people and really start to see who this person is that’s sitting in front of you, what story is wanting to be told through this presentation? And where do you have to really start relating to this person? How many layers and levels are at play? Do they trust you?

Now, obviously, trust is a huge issue. And nobody’s going to trust you on their first visit, they’re going to not trust you on their first visit. So trust is earned. But if they were never seen by their mothers or their fathers, they won’t trust you. And so you can’t come on all strongly occupying the hero archetype and say, you know, I know what’s going on. And I’ll just, let’s do this and that, you have to really enter into the field and create the limbic resonance with them, and hear them and listen to them. They are dying to be heard and seen. So please don’t make that fundamental error of imposing all your knowledge on them. Right out the gate, really, really hear what they say. And these people, as you all know, have been to so many places and just got a sliver of information and not being able to do anything with it. Because in systems biology, there’s nobody practicing systems biology work. It’s all compartmentalized into silos, and square d squared, kind of organ systems.

Very few people are doing complex workups and treating them in a complex way. And again, be aware of the projection of unresolved early issues, the relationship to parents, because this is recreated in the clinical encounter, you will very often be the object of unresolved parental complexes. The other concept that becomes very important is to understand Robert Nivas work on the cell danger response. And also Steven Porges, his work with the polyvagal dorsal response, people who have been sick for a long time, their mitochondria are stuck, they are stuck in CD one or CD two roads famous responses, and they just can’t get out of it. They stuck. Even though the initial trigger may be gone, they stay stuck in this shutdown response. And in this collapsed response, and that’s a whole nother skill set to try and recognize if they in this shutdown cell danger response or if they you know, polyvagal, dorsal shut down, withdrawal from the world. And then you’ve also got to ask yourself, are they cognitively capable? And do they have enough ego strength to really take on the complex workup and treatment protocols? 

So we do all sorts of things to try and help us we do heart rate variability, you can see this person is highly in high sympathetic dominance with parasympathetics in the Negative Zone, you can see her Moca score was 2323 out of 30 is not good, there are some you know, memory issues and the hippocampal decline in this person. And then we redid the CNS vital signs computerized executive functioning test, she was in the low average too low to very low functioning capacity. This is not normal for a young, you know, 50 year old person. And then we did the Toba which is a method of ability to concentrate and stay focused and fail this one miserably. And then looked at a Qt T and saw that she had very high the CETA brainwave which is a slowed brainwave, which occurs as a result often of toxic and capital apathy.

Oxidative stress and toxicity generally came from head injuries as well. And that was associated with very high beta brainwaves with joy, anxiety brainwaves. Often this whole part of the brain is lit up like a Christmas tree due to early trauma, which which shows up in brain to E G’s. And then if you look here at the Alpha brainwave this alpha brainwave, here is the brainwave that chills, people are to calms them down, and that’s deficient. That’s one to two standard deviations below normal. So this person’s in fight flight. Her brain is slowed. So she’s cognitively impaired and she can’t regulate her. Her her her physiology, her autonomic nervous system, she’s really, you know, very ill and very depressed and very anxious and can’t sleep and fatigue and so forth and so on. So without these additive insights, you know, if somebody just walks in the room and they go mold illness put me on Curtis datamine and you don’t have some background data at the sort of higher levels of functioning.

You can really run into a lot of trouble and to, I don’t want to say harm, but really not be of much help. In the autonomic nervous system, we meant to self regulate and have coherence between the sympathetic and parasympathetic nervous systems. But many of our patients are in this fight flight, or even hyper freeze where they are actually frozen, they just they shut down. This is poisonous polyvagal theory, dorsal vagal, shut down. They, they they freeze, they withdrawn, they dissociate, they really sick and they stack you can’t get out of it. So, so learn to recognize these states. What you will then want to do is help them build a window of tolerance. And this is a slow process, they often have to refer to particular practitioners like Somatic Experiencing practitioners and others. We do a lot of work with neuro biofeedback as well as refer to Somatic 

Experiencing people and help these patients, you know, develop some capacity, some resilience, before they either hyper aroused or hyper arousal was completely shut down. Many of our patients they, you know, they are not thriving, they’re not incoherence, they’re not solving, self regulating. They are in crisis, they struggle, I can’t keep this up, I can’t survive, really learn to know these people and also learn how to diagnose and how to enter into a therapeutic relationship with them because you can’t go touch them mold, or their micelle or their life, you cannot go near those diagnoses, until this person has developed some resilience or some capacity to self regulate. So that’s the first sort of big insight. We’ve got three brains, as you know, the the reptilian brain, the mammalian brain and the human neocortex. It’s the it’s the neocortex, the executive function that learns to inhibit the fears of the amygdala, and the fight flight from early trauma and lack of trust. But many people’s prefrontal cortices are very damaged from mold exposure, and they can’t inhibit the impulses in their peers and they stay constantly upregulated. So the second sort of Pitfall, if you will, I don’t like after I wrote this, I thought, using the word pitfalls, pretty negative, but I hope you don’t take exception to this. It’s not implying it’s a pitfall, but it’s a sort of, it could be a stumbling block in your therapeutic encounter.

You’ve also got to know yourself a little bit. And you got to be attuned to your own blind spots, your unconscious complexes, your defenses, and where your knowledge begins and ends and don’t try and occupy the hero archetype and just be all knowing and impose everything without really relating to the individual. Are you present? Are you related? Are you resonant? Are you tuned? Your whole thing with these masks, you know, Porsche has has developed this polyvagal theory of social engagement. The ventral vagus is all to do with our tone of voice and eyes and facial muscles. And here we are walking. Two years we’ve all been unrelated and dissociated from each other for the last, it’s I think there’s significant consequences and, and a lot of parents notice, hence wanting to remove masks and things. So that’s another whole saga. 

But there is a there’s a physiological price we pay when we don’t establish trust, by by looking at somebody in the eyes and looking at the gaze and, and seeing the smile and hearing the tone in the voice because those are the unconscious signals we used to attune to others missing for the last two years. The other thing I asked you is, symptoms aren’t, they don’t fall out of the sky. You’ll those of you who are more experienced know that symptoms often point to somewhere in the system of this individual where unconscious dynamics need to be made conscious. I take symptoms as highly highly teleological they have they have they have meaning and often teach my patients to actually go quiet and go into their symptoms and ask their symptoms. What is it I’m not seeing? And sort of like a conscious meditation if you will, and you’ll be shocked at how many patients will come back with saying you know, I did that and I heard something my dream showed me something some synchronistic activity showed up and guided me through the process.

So don’t take symptoms. There’s objective, like we learned, let’s call a symptom that has to be destroyed and gotten rid of No, you vote lean into your center, what is it, trying to tell you that you’re not making a conscious symptoms are often pointing to what is silent or hidden in a system, or highly defended against so, so use symptoms teleologically again, are you acting as a authority figure upon which your patient projects all the rage? You know, if you look at the stages of emotion, anxiety isn’t an emotion, it’s a defense against emotion. But beneath that comes sadness and depression, anger and rage, murderous rage. So people are often highly defended against feeling things they don’t want to feel because those things are so awful, or were awful. So they will suppress a lot of the emotional self. And then because it’s so uncomfortable projected on you because it was projected onto the parent that they couldn’t engage with for various reason.

Again, what stage of life are your patients in first half first, second half and what defenses are active in you and them when you when you find when you find yourself becoming dogmatic and insistent know that you probably in a defense, you you’re activating your own core complexes. And it’s very difficult sometimes to not become self righteous and sort of have that patriarchal approach. We trained to have that approach, forged. As we’re learning more about trauma and empathy. Many of us have done you know, our work on this and know that that patriarchal attitude doesn’t really get you very far. You wanted in an era when you have a heart attack, you want to patriarchal person takes control and does exactly what they need to do to save your life. But in a therapeutic encounter, it can be disastrous. So, again, establish who is in front of you established your body felt sensations or the way you feel in your own body in front of this person? Are you in limbic resonance with them? Or are you completely disconnected? Know when people are shut down, know when they struggling to even show up with appointment? Know what the ego strengths and cognitive abilities, if they’ve got low motor scores, and they’re not going to be able to take on your program, you’re going to have to make some decisions on how best to approach that.

Person personality disorders are which they are out there borderline personalities, narcissist, and those people are difficult, be careful and know your way around them. Because those are the three that threaten to be lentiginous they often aren’t. It’s just a threat that they can be they can take up a lot of your time. But do your very best to create a trusting relationship? Not? Not? You know, it’s not it’s a genuine relationship. It’s not a false sense of camaraderie or anything. It’s a genuine sense of getting to know this person and what’s really what’s it like for them? You know, what’s the internal dialogue? We have 60,000 thoughts a day? What’s What’s the content of that thought process? Is it despair? Is it rage, often, you know, because it’s hidden behind the fences, and then help them to self regulate and create windows of tolerance. To to coin a phrase from Somatic Experiencing world and learn about neuroplasticity and neuro modulation, how the brain changes it states, there’s a lovely video of a guy who learns to ride a bicycle. And when he turns right, bicycle goes left. And he took him. It’s like a party trick. He goes on stage and asked everyone to come up, nobody can do it. And he took eight months to learn how to change is fun when you turn right.

The bicycle went left and he learned how to ride this backwards bicycle but to him eight months to do it. And the same is with your brain and your neuroplasticity and your defenses and your psyche. You can’t just shift a person’s consciousness overnight. And you’ve got to really almost juice that relationship into being through multiple modalities of information and salience and education and empathy and referring out to the right people. So I mean, I’m not trying to make this complicated, but just be a healer first and not a doctor. You know, just just the healing archetype is very different from the from the doctor argue To become a very good doctor know your western based diagnosis and treatment protocols, but also approach it from an empathic point of view. And a related point of view and know that any change is going to be particularly with these complex people is not overnight. It takes time, and learn all the ways to treat this neuro plasticity and vagal tone. And many of you know all these modalities, but I just listed some of them. And then know about the cell danger response. It’s an incredibly important concept to take into account.

It’s the concept that Robert Novo has developed over the years of research, which basically says that, when you’re, you know, you’ve got 30 trillion cells. And each cell is surrounded by a cell membrane inside of which there’s been 100 to 2000. Mitochondria, also surrounded by membranes with an electrical charge of approximately 170 millivolts. And the mitochondria are the canaries in the coal mine are the first thing to detect oxidative damage or any incoming stress. And as the incoming toxins come in, the the voltage on the cell membrane changes. And then that launches a whole host of metabolic changes, which leads to mitochondrial autophagy, which leads to the intracellular contents of the mitochondria going outside the cell, which creates another whole pro inflammatory response, and then the body stays in the so called Cell danger response never being unstuck, because the triggers are never addressed, and the metabolic machinery is never addressed. And so learning the cell danger response, I think, has become a very therapeutically, almost essential, We fortunately have some labs now, that can show us some of this before it was just in the research phase. But now, we have labs that can show us how to note if somebody is in the cell danger response. And we have therapeutics that give assist body by being probably the main one that I know of anyway, to help repair cell membranes, and how the outer leaflet the inner leaflet, how to get rid of very long chain fats that are produced by toxic load.

By using beauty rates and taxes and things. We’ll get to that a bit later. The important thing I know this is a mold talk I’m getting. But the mold exposure initiates a cell danger response. If you’d see the CDR one, and that is initiated by chronic activation of the innate immune system, and that can stay stuck in the cell danger response. Long after the initial signal has passed, people can just stay there and not shift. Now Robert Navarro has incredibly listed a number of different scenarios like the cell danger response, one cell danger response to cell danger response, three different conditions that are in different phases of the so called Cell danger response. So he’s reframed this, as I said, the pathogenesis of chronic illness in this way as a biological systems response that maintains disease, rather than focusing only on the triggers or triggers that initiated the original injury. We want to run a chain and cheat mode, but what’s happened to the metabolism of the organism? How can we identify and treat that and that’s where cell membrane medicine in the body byproducts have a fantastic role to play?

Yeah, so that’s just some more graphs of the cell danger response. And he’s also came up with this incredible insight that you know, we’re always rushing in, in functional medicine to look at oxidative stress and antioxidant defenses. And this is the teeter totter. But he’s positive the theory that you know, and oxidative reactive oxygen species are released by the mitochondria to protect the cells from further damage in a dysfunctional cellular response, and it continues to be activated despite the neutralization of the threat and these reactive oxygen species act, dysfunctional, damaging healthy cells, and he says he had contrary to long held beliefs about the etiology of these diseases. This D redefines reactive oxygen species activity in the context as a defense mechanism and oxidative shield. Therefore reducing reactive oxygen species would not necessarily address the root cause of disease, which actually lies within the destruction of the mitochondria and they have normal cell danger metabolism. Many practitioners were rushing to quench free radicals. I know I did still do for various reasons, with antioxidants, but this can actually cause further harm, as these free radicals may be providing a protective response very important to keep that in. Here’s the oxidative stress markers we often measure.

These are the antioxidants we often use. Common. The another pitfall that we encounter when we rushed into diagnose mold illness, is we we don’t consider a background understanding of other possible differential diagnosis. I use a lot of questioners, this is the MS Q questionnaire, which you’re all familiar with, I believe from AFM. I really have found it essential to know about methylation. And I like to look at methylation through the eyes of William Walsh’s work that he he’s is still teaching right now. On is the old Carl Pfeiffer work with over and under methylation, zinc copper issues and crypto Pio issues. He’s done a fabulous job of initiating the whole methylation complexity. And we need to sort of know that when we addressing mold illness, whether the person’s under over methylator, whether they have cooked up piles, and that they they have copper overload or cryptic barrels.

And then we have to sort of know this methylation panel backwards, because if you see here, here’s the stressors and total toxic load of environmental toxicity level one in my model and stage one more is there more than juicers, peroxy, nitrate peroxy, nitrate being the or it’s also called no or No, which is sort of the nature of free radicals that initiates the destruction of the mitochondria. And we can measure peroxy nitrite. There it is right there. If you do a methylation panel, from a company called Health diagnostics, it measures the peroxy nitrate there we can see how high it is and how much damage is caused into the mitochondria and whether the mitochondrial contents are being released from the cell along with ATP and when that’s released, that then triggers the micelles that they perpetuate this ongoing cell danger response that goes round and round in circles.

So we do have to know our methylation pathways. In red all the bad guys or pro oxidant issues and in blue are all the sort of good guys good to find catalase superoxide, dismutase. We don’t want to go rushing in with all antioxidants, when we don’t understand the cell danger machinery and we don’t understand all the triggers that are initiating the cell dangerous buttons. But we do want to use them where we need to Lyme disease which is which is a biotoxin illness in the same camp as mold illness. Very important to differentiate between biotoxin illness and chemical toxicity. Explain that in a minute. I use a lot of questionnaires I use Dr harvesters, MC lime questionnaire, and I’ve made up my own sort of conglomerate of many other question is that the basis of the kanlaon questionnaire, this is an alternative activist, patient advocacy group in Canada called kanlaon. And I’ve used the equation added some things to I found the use of question is very helpful. And then you’ve got to know your mast cell activation issues, because most of these patients with illness can’t tolerate a lot of things.

And if you don’t down regulate and put a lid on my cell activation before you begin your therapeutics, this patient will never get better, just like if you don’t help them self regulate and go from sympathetic to parasympathetic, which is the healing state. You can’t you know, if you don’t help them and assist them in that process, and if you don’t help them damp and myself, my cells are a consequence of the cell danger response. They don’t have cause just like people walk in and say, Oh, I have mold. They also walk in and say oh, because I’ve written many blogs on myself. They will say, Oh, I’ve got my cell activation syndrome, and I’ll go really okay. What are the triggers? Then then starts the whole diagnostic complexity where the triggers of my selector, so my cell activation is a consequence of an upregulated oxidative stress pathways and it’s our task to find out all the triggers we have which there are many, in my cells being they release 1000 mediators of inflammation, which damage the mitochondria, as do mold toxins. If you don’t understand my cell activation, know how to dampen it.

That’s another patient you can’t treat because they can’t take anything. If you give them 10 supplements as a one sometimes forget about it, they won’t be able to handle, they will, you know, they’ll have all kinds of reactions, and you’ll get lots of phone calls. This is the paper Lawrence app. And one of the main researchers put out on on the consensus of my cell activation, which is different from there’s different ways to diagnose myself. And this is a paper a whole bunch of us, co authored with him, but he was the main author. It’s a good paper, it’s on my website, if you want to read it. Know About pots, POTS is extremely important. Postural Orthostatic Tachycardia Syndrome, if you don’t, if you’ve missed pots, that patient will never feel better. Learn about it, learn how to treat it. And always have somebody in your office do blood pressures, that 10 minute blood pressure test.

You get them to lie down, you take the pulse rate and blood pressure, get them to stay in that one minute, three minute, five minute 10 minutes pulse systolic diastolic blood pressure, and then you work out the difference between the two. If they’re stuck if they post rate increases by 30 beats per minute. That’s parts by definition. And this is this simple little test. This is as good as doing a talk table. And many people will come in with the pulse rate differential 4050 beats per minute, that person’s not diffusing their brain. They’re not confusing their periphery. They’re not confusing the mitochondria. They are sick, and they know they sick but nobody’s done the 10 Minute blood pressure test. So when I learned about it about 10 years ago, I now I won’t see a patient before this is done by my staff before they come in the door. And if I’m doing a zoom consult, they have to go by a blood pressure cap and do this. The question is do you get dizzy when you stand up? 50% of my patients with mold illness or myself illness? Say yes. You have to learn to differentiate between parts orthostatic hypotension and idiopathic Tachycardia Syndrome. That that’s another whole subset of issues know about hypermobility and Ehlers Danlos.

These patients are very different are very difficult sometimes to treat because they so loosey goosey and they got so much muscle activation and their collagen fibers I’m tired and so they got leaky guts and leaky brain barriers and they really can be in quite a lot of distress. And no Dr. Andrew Maxwell cardiologist has put together that triads and paint ads, people who have my cell activation pots and Ehlers Danlos, plus dysautonomia, plus autoimmunity. These are groups of patients that you’ll get to, you’ll get to see them over and over again. And if you go on his website, he’s done some beautiful PowerPoint presentations on this complexity of how to put these things together. Never work with a patient without knowing their dental history. The the lower jaw the job, the trigeminal nerve goes back into the brainstem. So toxins in the lower jaw affect the brain in a dramatic way, just like the vagus nerve in the gut goes back up into the brain. And the sinuses affect the brain tremendous way you can colonize hollow spaces with mold and Candida.

I think 80 to 90% of all chronic sinusitis is yeast or mold related. So you got to know this area of the body. A good panorex X ray or 3d Cone Beam or getting somebody to interpret it for you, a biological dentist who knows what to do can help you tremendously. Root canals cavitations these are all issues that you’ll learn about as you get more deeper into complexity. Know about sleep. This is you know everybody knows the sleep issue. You you don’t you know you don’t restore If you don’t go into deep sleep, you don’t restore a lot of your circadian rhythms and your detoxification through your glymphatic ‘s, this doesn’t, things don’t go very well if you don’t get enough sleep every night.

So I know how to assess the patient and know how to take a sleep apnea history and I refer probably 95% of my patients now to sleep clinics for sleep studies, 90 to 90 and then also know every diet in the book you got to be very clued up on your diets because everybody’s got something else going on. From carnivore to low oxalate to. It’s everywhere and low mode, Candida. Justin who works with me as a nutritionist health coach, and also is very connected to the body by a team. We use a mixture of paleo, Paleo autoimmune, low histamine and membrane stabilizing. Those are that sort of scenarios where we get our most benefit. When we start treating patients, we often have to do low FODMAPs, low oxalates. And most patients now seem to do better on a ketogenic approach. But some people are really sick. We go, we haven’t do carnivore diets for a month or two.

Now we get two more. Sorry, they took a little bit, but the topic was more and complexity. So I address the complexity part first, now we get into more. So this is a pitfall not understanding chronic inflammatory response syndrome. If you look at the immune system, here, we’ve got two new parts, the adaptive and the innate immune system. The innate immune system is the primitive, not too intelligent by the immune system. And it’s the first thing to go into action when any threat approaches. But the innate immune system hands off to the more sophisticated adaptive immune system to T cells, by the use of antigen presenting cells, when the antigen presenting cells of the innate immune system detected danger, they envelop little epitopes little DNA fragments and present them to the adaptive immune system to the T cell, which then triggers the B cells to create antibodies and memory cells. Now, this is this is SIRs or chronic inflammatory response syndrome. It’s a chronic, chronic more than six months inflammatory response, where people get sick and remain sick and don’t know why. And what happens is people with this condition often have a poor transfer of the innate to the nt body part of the immune system.

They have an inability to hand off to the adaptive immune system to call in the troops to put out the fires of inflammation, so they stay stuck in a chronic innate inflammatory response. They don’t create a transfer, they don’t create an anti inflammatory response. And this has been shown by Richie Shoemaker and others to be dependent on the nine gene sequence on chromosome six was houses the so called HLA set of genes, of which he believes about 22% of the population have this gene set. Now this, this theory of the HLA origin of innate immune activation has been contested by a number of practitioners who’ve sort of broken away from shoemakers original research. But I I’ve sort of returned to it recently, because when people have this set of genes is HLA a set of genes. I do think there’s something to be said by the fact that it is those set of people with those gene issues that don’t get out of the innate immune activation, they just don’t have an ability to turn off the inflammatory response.

And I do think there’s something to it, although as I said, it has been highly contested by other people as not being reproducible in terms of research. Once you stay in a chronic inflammatory response being triggered by mold exposures or any biotoxin, whether it be Lyme disease, secretario, or any, any biologically active substance. If this immune threat increases, you can’t turn it off. You’re constantly making inflammatory genes and proteins that circulate, they go to the liver, the biliary tract go emulsified by bile. Many people have Kali cystectomy. They don’t make bile, and it’s dumped into the GI tract. Then it either go out through the store, that’s your where people use their binders. And that’s where they want to call the stymy to bind the toxins or remove them, or it’s reabsorbed through the entropy circulation. And this goes round and round around in circles, you just can’t turn it off, you keep recycling toxins.

So what turns on this in the heat system is a biotoxin, an organism or a fragment of an organism? tick borne illnesses do it, some pathogens do it or multiple pathogens to turn on the innate immune system. This is not a chemical, it’s not a plastic. It’s not a heavy metal. It’s not an organic type. It’s not glyphosate. This is a biotoxin that turns on. It’s an organism this is important to realize. So pitfall number four, you confuse SIRs with chemical heavy metal toxicity. A biotoxin is not a toxin, as we learned, many people think this is a toxic problem, and they go rushing into detoxify without really understanding the biochemistry underneath it. So this is a chronic, persistent, innate inflammatory response induced by biotoxin. And these biotoxins can be mold. buildings contain over 30 Different inflammatory foods, many of which are bio toxins like actinomyces, etc. It’s mycoplasmas. They are not just mold, there’s many other inflammatory diseases can cause all kinds of trouble, really secretaria for stereo, and these people, they can’t turn off this innate inflammation due to these HLA gene problems. So it’s a genetic is genetically influenced, epigenetics turn on but genetically stays on, you won’t get these patients better by detoxifying them.

You won’t get them better by doing chelation therapy. So last thing you want to be doing, even though they may have a heavy metal burden that has to be addressed at some stage, you’ve got to address this chronic persistent innate immune system activation first, but you’ve got to measure it first before you can address it. So another problem that people often make is confusing mold allergy with SIRs are many of the mold remediation specialists, they end a lot of the even even practitioners risk virologists make this problem that patients will go see them with, say, I have sirs and they said no you don’t you’re IGE antibody to mold is negative, complete. The two ends of the spectrum serves as a chronic innate immune activation. mold allergy is an IGE antibody induced response to an allergen like mold. This shows up on an IGE test, which I do all the time. Very different from innate immune activation. If you’re allergic to mold, your immune system is overly sensitive to specific spores and treats them as an allergen. Ige is often upregulated. But the markers of serves the innate immune system, they’re not touched, and there’s no downstream damage to hormones and other parts of the body that occur with innate immune activation. And so the pitfall here is not fully grasping the subtleties of the SIRs diagnosis and the treatment options. Often, you’ve got to you got to ask yourself when you start treating and do these patients fit the SIRs criteria, and I’ll show you how to determine that in a minute.

There’s a patient for further criteria for a tick borne illness notoriously difficult to diagnose. Lab diagnostics are not reliable by any means. That the person get bitten by tick, turn on the HLA genes and then get exposed to mold very common. Are they still being exposed to mold or is it historical exposure? Often the disease the chronic disease, the ill health of the person, it’s the chronic inflammation itself. It’s not the mold of a lamp. It’s the fact that these HLA genes are turned on in a system which is just running with recirculation of the biotoxin nobody’s addressed it. Nobody knows what’s going on. And so there’s a lot of complexity involved in making the diagnosis and then how to treat it, which is on the other side of the slide, which I’ll get to. So how do we make a diagnosis for mold toxicity, or biotoxin illness? First of all, symptomatically. It’s a multiple unexplained multi system non responsive symptoms across many organs or regions of the body. And this question is that we use to determine that there must be a past or present history of exposure to a water damage building. You’ve got to exclude other diagnoses like putts, although they often coexist. And your mold score count the DNA probe for mold spores must pass a certain threshold the either it mustn’t be more than two, or the five molds that are pathogenic Aspergillus Penicillium IDs Aspergillus vesicular, ketone, yum, Stacie, vitalism Alinea together and there’s a scorecard they must be greater than 10 to 15.

These questions here and these diagnostic assumptions, they help you make the diagnosis. And then in order to assist you go over to the proteomics to the labs that help assist you in establishing, you’ve got to have three out of six do you have this HLA set of genes, this is a relative risk of susceptibility. Some people get sick from mold and they don’t have the HLA genes. Dr. Shoemaker said the prognosis is much better. But those of us who sort of broke away the ICI people that Neil Nathan people, we have found people with the so called dreaded gene that Dr. Shoemaker has spoken about get quite well. And we found people without that gene stay sick. So it’s not as cut and dried and as linear as one things. And then the next thing we need to measure are the direct and indirect markers of innate immune dysregulation. And sitting at the center of that is melanocytes stimulating hormone. This is a brain hormone that gets damaged by the innate immune system upregulation of cytokines that then cross the blood brain barrier and damage melanocytes stimulating hormone in the anterior pituitary. And that’s a neuro regulatory neuropeptide that is very much suppressed when the brain is on fire, which is in mold illness, and it starts to drop, and when it starts to drop, all sorts of things go haywire. I’ll enunciate those in a minute.

Another test is C four a, it’s an alternative pathway of complement activation, it’s an expression of huge inflammation. MMP nine is a is a molecule that gets expressed whenever there’s breakage in in blood band barriers, it it causes endothelial disruption and allows like the lime bags and the mold toxins and mycotoxins to penetrate your tissues, anti diuretic hormone and osmolality, which get affected by mold. These are people who pee a lot. They drop their blood pressure because they don’t concentrate the urine because they don’t retain salt. That’s where you get your pots. And they appear they pee a lot. And often those are the people who, when they touched door handles, I get shots quite frequently because of all the sodium that gets excreted because they don’t have that antidiuretic hormone. And then often when Msh drops, you get dysregulation of the ACTH and cortisol pathways with lack of loss of feedback, which is very closely related to the hippocampus in the brain. Cortisol originally goes up saturates the hippocampus, the hippocampus degrades, shrinks, and then you get hyper adrenal states. Now people come and say, Oh, but I’ve been diagnosed with low adrenals. Low adrenals are a consequence of chronic inflammation. They not a diagnosis. So if anybody says I got low adrenals No, there’s more going on. It’s a down regulation of the HPA Axis due to chronic ill health. It’s not a diagnosis, just like my cell activation is not a diagnosis. It’s a consequence of incoming toxicity not being regulated through the cell danger response and getting you out of being stuck. So these are the tests. Now this is the fabulous.

You must know this diagram to understand biotoxin illness and those of you who’ve dealt with mold or SIRs know this pathway backwards, and it sort of summarizes everything, if you will. Here’s the bio toxins in HLA systems trouble person 22 to 25% of the population affecting and inducing inflammation cytokines, those cytokines then have an inflammatory effect on the hypothalamus. And they down regulate leptin, leptin receptors called Dark. These are people who get heavier and heavier and heavier because they can’t regulate appetite. Not it doesn’t happen all the time, but it does happen occasionally. But most importantly, it reduces melanocytes stimulating hormone. This is the main neuropeptide, that when that goes haywire, the consequences are traumatic sleep gets affected, pain gets affected, and melanocytes stimulating hormone controls. Guess what? intestinal permeability, here’s your famous leaky gut or intestinal permeable gut, which is at the root of many chronic diseases is often because the melanocytes stimulating hormone has been suppressed due to a biotoxin load, that then creates a permeability issue. That also when your Msh is suppressed, it allows for the growth of resistant staph in the nose, which releases the toxin which goes up and affects the brain. And then here, it affects the antidiuretic hormone it affects is the sex hormones, you get decreased libido, and you go into premature menopause.

And here’s the cortisol and ACTH. And hear you get all these hormonal consequences to biotoxin illness, as opposed to the other 75 80% of people they have, they don’t, they don’t have the HLA gene, and they just get rid of toxins and they you know, husband of a spouse will go what are you complaining about I’m fine. And not understanding the genetic, multi heterogeneity of the gene process. They they, they just, they have an antigen presenting cell that sends it to the B cell. And a B cell mounts an anti inflammatory response. And that’s the end of it, they don’t get sick. But in 25% of the genetically predisposed, this is the scenario that’s installed for them. And all these cytokines are released. And you get all these immune system dysregulation, downregulated T reg cells and shifting of the th one th two axes, you also get hypoxia because of VEGF, another hormone. And oxygen isn’t delivered for the mitochondria to make use of to make ATP. And these are the people who can’t take a deep breath and often do well on oxygen supplementation. These you can really affect your hypoxia of your cellular tissue. Here’s the I mentioned this already. Another pitfall is not understanding other conditions, parts myself, hypermobility, etc, we’ve gone over that. And another pitfall is not using this questionnaire, I encourage you to fill out this questionnaire and get your patients all of them to fill it in.

If they come on this questionnaire, they’ve got 27 symptoms in 13 clusters. And they don’t pass the visual contrast test that Asians got says until proven otherwise. Very helpful. I had a patient this morning, who had this folded patient presented with a head injury. And this was form and no history of mold exposure. So no history of modern exposures. So this questionnaire of four, which is anything less than eight is considered a pass. I didn’t go down the mold pathway. I didn’t ask him. I asked him as a mold on the windows and things but there wasn’t so mold wasn’t an issue with him. But this question helped this questionnaire helped me. Now, you cannot, you cannot tell what the exposure is based on the surface questionnaire, all you can say is that if you have more than eight, you look here, the symptom clusters. If you have more than eight of these clusters symptoms in eight of these clusters, the probability of having SIRs goes up quite substantially and if you have the HLA set of genes, this confounds the diagnostic probability. And if you don’t pass the visual contrast test, or the visual contrast test this is a test that Dr. Shoemaker and Dr. Hudnall in 1997 they, they show that if you’re exposed to by a toxic illness, the neurological functioning of the optic nerve, from the retina to the cortex, you aren’t able to discriminate between shades of colors. And the more the by toxic load, the less the discrimination. And you want to pass a seven C and 60, you want this whole bottom part of the chart to be the tick mark. If you’ve got this all filled in the probability of having SIRs with a positive questionnaire, symptom cluster greater than age 98.5%, shown in multiple studies, first one in 2005.

So just by doing that, taking a history of knowledge pleasure. And doing this, you right there, you being launched into the probability of mold exposures being part of a differential diagnosis. And people. I do this a lot. And when people are being treated, I follow this. And you’ll see these bars clearing beautifully, and the patient feels better than they know. A few people 10% will pass the visual contrast but still show signs of inflammation. And some people have very good visual acuity. Professional baseball players apparently can have sirs and pass the test because they’re so used to having visual acuity. And some other occupational exposures can cause you to fail the visual acuity but generally speaking, it’s a very good test. And that can be done online at surviving mo.com $15 I believe. And then another pitfall is not doing some of the additional lab tests. Now encourage you to study with shoemakers group, or read up on this, I’m not going to go into all the different tests that we do in order to substantiate and gray the severity of the illness. But there’s certain ones that are very important. The Urmi test, which is a measure mold spores in the house essential marchands is a measure of the infected bacteria in your nose that that releases neurotoxin.

And then see for a TGF beta, I run these tests on most of my patients, if not all of them. And then the one at the bottom where it will do quite a lot is the neuro quant MRI, the neuro quant MRI pixelate the brain so that you can put the different areas of the brain the temporal lobes the frontal lobes, the gray matter, the white matter, you can put it into algorithms based on age match controls. And you can see if the brain swollen or atrophied and you get specific findings in mold illness of deterioration in some of the basal ganglia nuclear and inflammation of white matter. So I do neuro cleanse, and probably 80 to 90% of my chronically ill complex patients just to see the state of the brain as it’s been exposed to mold or head injuries. People with a lot of early trauma have a enlarged Amygdala on an MRI two to three standard deviations above normal because they’re always in a fear and fight flight response. You’ll see that all the time. 

And that correlates with a beta brainwave being upregulated on the QE G, people with muscle activation syndrome will have very high thickened thalamus is because the thalamus is richly innovated with micelles, and those with head injuries will have asymmetry of between the two sides of the of the brain with the ventricles being different. It’s important to look at these things. If you if you need to know if that brains on fire or not, which you do need to know. One big pitfall is not looking through the lens of standard medicine and through functional medicine. And these are the list of you’re probably quite familiar with this list. I run many or most of these tests all the time on everybody. There’s a stupid thing which you’ve been exposed to that you can’t manage what you can’t measure. And it’s true. We try and do it because everybody, you know, nobody can afford the test. And that’s a given. It’s just a given that you’ve got to try and establish a practice whereby you are comfortable with the amount of labs you’re running, to give you insight to help the level of patients that you see. If you seen somebody just for hormones or leaky gut, then that’s fine. But if you see complex, sick people, we’ve been sick for 1020 years and we’ve got binders this thick and Mayo Clinic console.

You cannot run your practice by doing a few tests just I don’t encourage you to do that. So you have to find the ways and means to spread your diagnostics quite far and wide. Now some people have, who do you know, trickling hearts muscle testing protocols find that they can cut their costs by doing muscle testing, which is, if you skilled at it, I believe it has significant validity and I studied it for 10 years with Dieter, I prefer to work left brain with labs. But the drawback is the cost. People have been sick enough will often shift their value systems to find the means to pay for what they need in order to get better. And you really do need a broad diagnostic brush to bring a lot of this complexity together. You cannot do a stool test and treat these people do you know VCs and the urine mycotoxin test and hope to to help somebody it’s just impossible in my experience anyway. And so here’s some of the labs and all the links that I found helpful but again, that’s subject for another election.

And here’s the biggest bugbear I have is using the urine mycotoxin test is proof of diagnosis answers. I know neon Nathan and the real time people believe that this is enough. But I I think I think that’s too simplistic. Why? Because many healthy controls have lots of mycotoxin in the urine. So just because you’ve got mycotoxins in your urine doesn’t mean you’ve got mold illness. foods contain mycotoxins. You don’t know if you had mycotoxins in your urine, whether they were three years ago, one year ago last night what you had oatmeal for breakfast. And you don’t know if you’re good or poor excreta. I much prefer the next test which is coming up soon as the AGL test which actually measures cellular toxicity, whereby mold mycotoxins get attached to DNA and mitochondrial membranes, and they affect the translation of genes. And you may be a terribly terrible excreta of mycotoxins have a negative test. But if you do the ideal cell test, you’ll see that these micro toxins are sitting right on the DNA affecting translation of proteins and fats.

That’s a much sicker patient, often with neurodegenerative type diseases than somebody who’s got some mycotoxins in the urine. So please don’t make the mistake of just doing this test and diagnosing mold illness. And now that this, these tests have become popular, I see it, it’s everywhere. And I get this test all the time. And I get told I’ve got mold illness based on this one test. It’s not you can’t diagnose mold on this on this test. I hope I’m not sounding you know, the negative on this test, but I think it has to be. I think it has to be the truth has to be told on this one. If you join the ICI group, they debate this test back and forth in the States. It’s a fabulous dialogue to be part of, because Richie shoemakers work originally when he put this all together, he was most indignant that people were using this test and he made us made as those of us who pass these exams, write essays or why this test was so useful.

But then people left his group because some of the things that he said couldn’t be correlated with other evidence. And then those who left his group started to use this test and just use this test for diagnosis. And so the field is in its infancy, just bear with it. I’m sure over time, things will shake out in the wash you know. Many foods contain mycotoxins so one of the things we do you know, people outs and corn and peanuts, I mean, it’s full of market toxins. So these are everyday foods that people eat. So people do get put onto a low mold diet and sup to some benefit. But it’s, it’s really, you know, if you got my cell activation, you got to be on low histamine diet. I find that people got mold illness going on low mold diet isn’t isn’t the therapeutic input that makes the big difference.

Now, here we are back to the cell danger response and membrane medicine. See when these toxins come in which mold is one of the causes oxidative damage, they they destroy the cell membrane, and the sum of these toxins attached to the DNA. And this causes poor translation of messenger RNA into the ribosomes. And then often the cell due to this ongoing toxic insult, undergoes autophagy due to the DNA and the ATP go outside the cell becoming pro inflammatory, inducing my cell activation with 1000 mediators of inflammation and further destroying the cell. And this is this perpetuation of the cell danger response. And so, here we have a lot of research showing how mycotoxins which are the byproducts of mold spores affect the mitochondria, causing the cell danger response has been published. Here’s some of the publications and these mycotoxins disrupt the the Krebs cycle and the electron transport chain and many, many different sites. This is all being published. So we know mold damages, ATP production and citric acid and mitochondria. There’s many papers published presenting that by the way, there’s a very good presentation on the GPL Great Plains laboratory website by Kurt Warner, on mycotoxins and mitochondria.

It’s worth watching I got the slide from him. Sorry to say I didn’t obtain permission. But I do know him and I will seek permission when time permits but I’m acknowledging that I got the slide from him. And he got the slide from a publication. So mitochondria are these micro toxins they affect the mitochondria in many different pathways in this Krebs cycle, they you know, we have our macronutrients that have to be eaten, shut fats, for instance, shuttled through by carnitine into the mitochondria across the cell membrane, and all these mighty micronutrients that activate these enzymes that then activate NID, NADH, that then go through the electron transport chain on the inner membrane of the mitochondria that make your ATP here, and these mycotoxins disrupt these pathways in multiple sites, they are crud toxin A affects ATP production inhibits ATP production. Many studies done on this now. So here’s this test, which is sort of revolutionized the way I practice medicine the last five years is a German based test and you can actually measure it can measure mold, fungal species and mold, fungal metabolites, by measures measuring lymphocyte sensitivity to these mold toxins. And you can see here that all at the level of the genome and the mitochondrial membrane, you can get mold. You can get your lymphocytes being high, react highly reactive to mold species and to the mycotoxins. And this is this test is what I rely on now. Apart from doing my traditional shoemakers sort of workup, I look here to see if this person is has mold still in their system. I only saw two patients this morning. Because of preparing for the lecture and get everything set up. One of the patients was from Switzerland, chronic fatigue syndrome, 10 years, supposed to mold in Lyme disease. And she was here in Calgary in December doing very well in Calgary home. Normal. We’ve done me tests looking for mold spores. She went back to Switzerland.

And I got this test, which she had done a week after leaving Switzerland and she had dramatic levels of mycotoxins that had gone from her previous one we did two years ago. The levels jump from 1500 to 500 600. And I just looked at this and I said so and so you’ve you’ve been exposed to mold, you are highly mold, toxic. And she said I knew it. This house I’m living in in Switzerland, there’s mold everywhere. I’ve tried to clean it up and it keeps reappearing. It’s in my shower. It’s on my window. I said, and she was told she was in bed 90% of the time. That’s and she moved back to Switzerland two years, two months ago. She’s her levels of mold are gone up five times. So this test showed me at the level of a mitochondrial DNA. She had mold lymphocyte sensitivity, and she clinically confirmed it. She said, I know I’ve tried to clean it. I said you try to clean it, don’t go near it. So get out of that house right away. I can’t say very well. And then we had a big discussion about what to do because many of these people are chronically ill for prolonged periods. The innate immune systems go round and round around in circles and they stand exposed and they often it’s the home that’s causing them to be sick, or it’s the quality They took from the home or is the couch they took from the home or something that they took from a home.

And they just go around in circles and never get better until the cycle is broken. This test also allows us to measure ATP production to see how blocked it is. And here’s the beauty of the test. It also measures mitochondrial numbers so you can see if mitochondria undergoing destruction and is less numbers than they should be. It also can tell us whether it’s the mitochondria, mitochondria are expressing abnormal proteins and lipids, very long chain fats. And it can tell us about some of the mineral deficiencies that are contributing towards the cell membrane voltage being affected. Here’s the ATP blocking active sites 21% You don’t want that block more than 14%. And here you can see that the DNA which gets released when the mitochondria undergoing destruction is at a level of 17. It shouldn’t be more than nine. So they their DNA is outside the cell triggering micelle and further oxidative damage. And here you can see after a toxin you can see one of the mycotoxins from Aspergillus is sitting on cardio lipid and actually the the enzyme that makes the inner membrane of of your, of your cell in your mitochondria. 

There’s a toxin sitting on on that enzyme affecting cardio lipid. And there’s your phospho title fo Alameen, which is found in the body by PC, low, the inner membrane along which the electron transport chain occurs. And there’s your plasma title choline, which is the external membrane. And this Melange, the height you can see that the fats, the lipids in the body are oxidized, deficient, and the cellular machinery that making the lipids is impaired. That enzyme also requires manganese to work that the manganese deficient. That’s why you use the body by minerals and electrolytes. So mineral sessions. And here on the DNA you’ve got sitting on the DNA, formaldehyde, and there’s aflatoxin, there is a micro toxin from mold affecting translation of messenger RNA sitting on the DNA. This is huge, you know, this is serious business. This is not lightweight testing.

This is serious. And when people it’s going to affect the metabolic machinery of the cell, and it’s going to put people into chronic ill health that gets a stain unless it’s dealt with. This person also had zinc deficiency was incorporations. Zinc is the largest role to play. Regulating DNA destruction, and immune function. And then you can also see here, I can’t see the slides so small that’s the same same one sorry. Keep repeating this. Here, you can also look at your antioxidant states glutathione. You can see that it’s low in the bloodstream, here superoxide dismutase, the good guy that is sis glutathione and putting up peroxy nitrate. Here you can see conatins low so shuttling your fat into the cell to active cellular energy is low. Here’s the mast cell membrane, the cell membrane of 159, the voltage of your cell is low. This is dramatic because the electron transport chain depends on the cell voltage being normal, and that’s low. This gets affected by mineral deficiency, intracellular calcium, intracellular calcium triggering the NMDA receptors and causing the excited toxicity and magnesium there, which is found in your minerals. Magnesium is a calcium channel blocker.

This person was highly exposed to electromagnetic fields, which induce high levels of intracellular calcium and mast cell activation, the cell membrane was depleted that phospholipids were depleted this this cell is in a lot of trouble. He has a heavy metal test, you can see the telephoning, which binds to heavy metals is high because it’s working overtime, binding to barium. And when the telethon is running around mopping of metals, it drops off zinc and you become zinc depleted. And here NID vitamin d3 which is central for the electron transport chain is depleted. That’s why everybody is now on to nitrogen and other NADH or energy supplements. And then another beauty of this testing is we can look at the cell membranes and we can see the deficiencies and excesses, we can tell what the saturated fats are doing this is not now the AGL test. This is the the test we do the Kennedy Krieger looking at lipid membranes, we call it the body by a red soul lipid membrane test. We can look at saturated fats and Omega sixes, look at total lipid content.

Now look at this total lipid content. The total lipid content of this person is completely negative. And I can’t tell you how many people come in. And they get put on colas, tyramine and crash. Because Patricia Kane, who initiated this therapy many years ago, made the statement I don’t know where she got it from. But she said that if your lipid content is less than minus 25, and you use curl to stymie, you’re going to crash that person’s lipid membranes and create tremendous damage to the mitochondria. And I believe that statement is true, because I’ve seen it. I’ve seen I’m treating a patient right now with an ALS condition and that that’s his total lipid profile. And he did have mold and he was put on polystyrene, and he’s much worse right now. So we had to repeat this lipid content. It is omega sixes up to scratch, saturated fats structural bets, we can also test by the myelinating, making making white matter. And we can also see how many abnormal oxidized bad renegade fats are being made. Here’s where your butyrate and your tadka come into play, because those help get rid of these very long chain fats. And as you get healthier and healthier, these go down and down. So this, this IGR test in the body via red cell membrane tests are extremely helpful. And this is where the whole membrane medicine comes into place. And we start to repeat cell membranes, sweep toxins off the DNA and repair as much as we can.

With various therapies, of which body via products take a central role, I can’t say enough about how I’ve benefited and how the patients have benefited by repeating outer inner membranes using peterites and tadka. Replacing minerals, just you know, I’ve developed a shake, which I’m sure tastes awful, but very competent is very beneficial. And to sell membranes, Justin has the job of making it taste pleasant by using the only thing that we use is coconut milk and, and blueberries because everything else most of our patients have my cell activation behind us much else that we put into the shake, you know, PC and body bio balance and electrolytes and minerals and glutathione and superoxide, dismutase and resveratrol. So we make a shake of it. And we use blueberries and chopped vegetables for poly phenols. And most people find this very nourishing if if they can get past the medicinal quality of it. So here’s another pitfall we’re nearing the end, so we’ll be done pretty soon. pitfall is using color styling, inappropriately, not only the synthetic color styling, which is full of aspartame. But if your lipid membranes are very low, using polystyrene will rarely crash a patient very quickly, so it’s not appropriate to use color stymie right out of the gate.

Just very quickly. Other pitfalls using the wrong test as sampling is absolute. No, no. The settle plates are worthless. tapeless, okay. But the real test is the Urmi test, which I’ll show you in a second. Another big mistake people make is I have a new home it doesn’t have mold. I live in Arizona, it’s not wet and damn. new constructions are often the worst. I had a new condo, which was put up in the boom they didn’t put events in a flat roof and I had mold in three floors, condensing down the sides. No visible mold does not mean the building is safe. No musty smell does not mean it does not have mold, or crawl spaces and basements usually have mold. ductwork is often contaminated. And this is the Urmi test where you measure dust spores by either swip upright or vacuum cleaner and you quantify that according to specific algorithms. People call in mold inspectors and they don’t do a thorough visual inspection. You’ve got to go from the attic to the basement and outside and have a look. And he has some of the questions you want to ask. If somebody comes in waves a sample meter and walks out and says you don’t have mold, run for the hills.

Look at baseboards, pull out dishwashers go up into the attic. Do you have a front end loader washing machine? Is there condensation? Did they use a water moisture meter, you know the day to do thermal imaging looking for wetness behind dry walls. Here’s some fabulous references for people who do good work, shall see acres with a whole bunch of web videos on YouTube about how she’s an architect you have mold on us. She’s very thorough, and patients report doing her series is very helpful. So, in summary, mold illness is ubiquitous. It’s everywhere. It involves genomics. transcriptomics. Proteomics involves abnormal regulation of micelles hormones, mitochondria, autonomic nervous system. These conditions are everywhere. Look around, you’ll find them. They’re ubiquitous. There’s just a summary of some of the pitfalls. Here’s some papers and links to articles I’ve written on mold. Things you can find. And that’s my details. And that’s it for me. Am I doing 68 minutes? I’m sorry.

Thank you so much. Dr. Ruffin, can you just click on can you make me the host again, so that I can go over some of these questions. I’m trying to turn on my video, but it doesn’t look like I’m able to unless you give me permission. What do I do you go to the top of your video, there’s three little circles. If you just click on that those three little circles it should show up to make me the host. If not, it’s okay. I’m I can say off camera as well.

Doesn’t say it says pause recording stop recording raise hand.

Okay, okay. We’ll just leave it as is I’ll go over there’s quite a few questions. So do you have a few more minutes to answer your question? Okay. So the first question is from Christy. And she just was asking what the German test costs? You can answer that one or I can choose?

No, it depends on how many panels you choose. So they range in price. If you just go to the Igel website, and you ask them for to send the cost the the extensive panel that I do, it’s 1000 or two euros. But you could do subsets of it to get what you want to look at. And then you go

in there they are. That lab is expensive. I mean, I think I just ran it in last year. And I think it was close to $2,000. Canadian for whatever panel I did. So it’s not an inexpensive lab, that’s for sure.

But remember that is many in when that’s not one panel that’s like 10 panels. So you can if you want to just know your first blood lipids, you can just do that little panel. But if you want to do a complex mitochondrial workup, then it’s going to cost a lot more.

So the question is what is the next question is what is the difference between ErmI and Emma testing?

The Emma testing measures mycotoxins and spores, whereas the Ermias just pause. I don’t do any testing because I just historically have stayed with micro metrics. I do use other lab for actinomyces. I haven’t run many Emma tests. I don’t think the tests been validated. And so I just stick with what’s been validated by the think by the FDA. Let me test

Okay, thank you. And then Shelley. Shelley Wilson, who we love. Thanks Dr. Hoffman to Justine excellent presentation. We adore you, Shelly. Um, okay. And then Chris, you had another question is Well, what is the extensive

sorry, surely didn’t ask me a bone crushing question.

So, if you have a question I’m Christy I will find out if you can. So she just asked what is the extensive one called the IG L so if you email me I will find out from the girls at the front desk and and I’ll let you know I don’t think I don’t know that. I’m right now and I don’t think Dr. would know that offense either. Okay, um, now in the chat there was lots of questions I’m going to have to go back. Um, do you have an MRI and the neuro quant software at the clinic?

No, you’ve got to get me the neuro quant is quite complicated because you’ve got to, you’ve got to get the MRI company to do specific settings on the MRI to read the neuro quant the neuro con software, but that requires certain settings on the MRI. So you’ve got to buy the software from neuro quant, you’ve got to get your MRI company to be willing to use the settings on the different Siemens devices. And once they change the settings you can read neuro quant but it’s two parts to it. So it took us two years to get neuro quant in Calgary. I tried to get it through healthcare, but they wouldn’t do it. So a private company doesn’t. Because they wouldn’t do it because it requires changing settings and they don’t want to do that.

Okay, Allison just asked where she can find the recipe to the shakes, or recipe for the shake. So Allison, you can send me an email as well. I’m happy to send you Dr. Hoffman’s template, if you can just make sure that you give him credit

for our upcoming book. No, we’ll give it

Yeah, that’s true. We’re doing a cookbook that should be out in a few months. And the recipe will be there’ll be plenty of recipes in there. When working on cell membrane, what daily oral PC dose Do you work patients up to?

It’s a It’s depends on so many things. If you’ve got a very high micelle population, they can’t tolerate much of anything. If you’ve got a robust population, they are often much more able to tolerate higher doses, but they often need assistance with lipase and bile Oxbo. That’s a tadka. And we use a product called Beta plus. And it had Kali cystectomy is that’s another whole puppy sub population of people who can’t tolerate high fats. But it say all those confounding variables are taken out, we always start them slow, like half a teaspoon. And then we work up to you know, I don’t really go more than two tablespoons a day of both of them. The body by a balance we use a lot on food, not in the shake, because it’s pleasant, you know after you’ve cooked it and cook it up. But put it on stir fries and salads. And the PC goes into the shake because some people just eat it off the spoon, but it goes on the shake quite nicely. But I don’t usually use more than two tablespoons. But keep in mind, I tracked labs, I tracked the red cell membrane tests and attract the AGL test. And also there’s another variable there. I’ll think of it in a second. I forget what it was, but there’s another variable to it.

Okay, in addition to body bio products, would you recommend adding an all encompassing Mito booster supplement like mitochondria and RG from designs for health? You can

well, so a lot of the supplements that boost mitochondrial function oh, here’s what I wanted to say before I get back to the question. Our OPC helps strip the cell membrane, or helps repair the cell membrane because it’s got the three phospholipids versatile ever elevate hospitality knows at all. Whereas IVP PC which I use a lot of help strip the DNA of the acts of the toxins. And that’s a general rule. So I do IV password title choline with phosphine or butyrate and glutathione. And I do aro PC and body by a balance for different purposes. There is some crossover, but there is a different therapeutic reason for each of them. Just I just wanted to emphasize that point. And then sorry, what was the question

is so there’s so many questions there. Oh, the other one was on mitochondrial support?

Yes. So much. So using the micronutrients that support the mitochondria, I find is false thinking. You can do it. But you want to sit back and look at that cell and see what state it’s in. Look at the state of the individual look at the state of the food gut brain axis. And you can’t just start stimulating enzyme pathways without first repairing cell membranes and look Looking at the toxicology of cell membranes and the viability of the electron, the voltage of the cell membrane, whether there’s deficient numbers on line. So I don’t go use a lot of mitochondrial traditional support, until I’ve helped repair the cell membrane. improvement in the AGL. And lipid testing, I tend to, I do use carnitine and 210. And nada, I do use them. But if you go use those without preparing the cellular toxicology and the soul structure, it’s a it’s a, it’s a losing battle. You won’t get anywhere.

Yeah, and that’s something that I’ve seen too, which was what really what drew me to membrane medicine because without, I mean, you’re really just throwing things that people do first don’t repair the self.

Find remove as many incoming stresses, and then balance the cell by much and modulating the homeostatic mechanisms, the allostatic load, you know, you’ve got to sort of work this whole system.

But there are specific nutrients like B one, b two and B three will support that front end of the mitochondria and carnitine. And then the electron transport chain is supported by Coenzyme Q 10. NAC. Creatine is helpful.

Nitrogen.

Okay, let’s see here. I think I’ve covered all of them. Is anybody? Did I miss a question? Oh, if someone has recovered from mold toxicity, is it helpful to use the LPC long term? I will say? I will say yes. But now let you answer.

You know, I’ve measured igvault, postmitotic, choline and fllo mean, I’ve never seen levels outside of the range. So people stay on it. We’ve constantly under salt. So as a lipid bilayer is are very much susceptible to oxidative damage. So I think a daily intake of phospholipids is crucial to maintain cellular health.

And then I think it was a question about cosmologists in here too. We do use cosmologists have you? So yeah, we have definitely heard of plasma halogens? Um, regard? Have you heard of plasma ologists with regard to membrane lipids? If so, can you comment on any overlap between plasma telogen deficiency and sirs?

So I’m assuming of Doctor good enough. I’m learning his plasminogen I take them. But as you know, a doctor good enough. He’s a biochemist with a lot of knowledge and where players margins fit in. That’s another whole level of complexity. I’m just starting to get my head around. Justine actually knows a lot more about origins than I do, because she has studied with him recently. But it is definitely appears very exciting. And I think plasma legends will be playing a huge role. In the future, just like peptides came up and exosomes. These things have the, you know, the waves of fashion, but I think plasma origins are going to be a big deal.

Well, and I’ll just quickly comment to that too. So with plasma halogens are a subtype of phospho lipids, so about 20 to 30% of the brain is made up of plasma halogens, so it’s third so they’re made by the ProxySG. They’re endogenous, and you can’t consume anything that’s going to help to support plasma telogen levels. And with SIRs with that chronic inflammatory condition you burn through a lot of those plasma halogens because they’re a very potent antioxidant. So you’re, you’re gonna want to support with plasma halogens likely if you have sirs, the other issue too is with that chronic inflammation you are going to have compromised paroxysmal functioning. So your proxy isms are not going to be making adequate amounts of plasma halogens and then what they are making is getting used up as antioxidants.

Good enough as a test now to measure all of those which we’ve just started to use.

Okay, um What would you recommend to move a patient into dorsal Oh, when we have it an H bot? I don’t know if you talks about H button the lecture by H bot recommended after stabled with mast cell. Do you recommend hyperbaric oxygen?

I think hyperbaric oxygen has a very definite role to play. But I never use it in the front of any protocol. I often use it as a cleanup down the line. Particular In traumatic brain injured patients, so I never use it in the front end, I usually wait one or one one and a half years before I start recommending age parts.

And I think we have all the questions. Let me just go through one more time. If anybody has something like pressing that I did not ask, you can raise your hand. Oh, sorry. Okay, the dorsal are your questions about please see the q&a. Okay. Oh, my gosh, there’s lots.

You don’t want person in the dorsal vagal shutdown response. That’s when they are compromised. The withdrawn they depress the stack. So everything we spoke about today is attempting to shift the dorsal vagal structure into more window of tolerance, self regulation between sympathetic, parasympathetic. And there’s a complexity to it. I did, there was a slide that says what to do. If you go back to that slide, I listed about 20 different therapies vagal tone exercises Somatic Experiencing safe and sound protocols. resi Max, there’s a whole list of them. But if a patient has undergone trauma, and they’re in PTSD type response that requires sophisticated therapeutic encounters, referred to professionals who work with trauma, because that’s very hard to shift if there’s an underlying traumatic etiology to the dorsal vagal shutdown.

Okay, and then we have a few questions about Oh, where did it go? Snowy? You had two questions. One was, okay, how to get patients to tolerate oral PC when they have resistant? dysbiosis?

Chris? You, resistant dysbiosis? I, I just keep working with the dysbiosis until something ships? This that’s a very big discussion. But yes, you’re right. People can’t handle anything coming into the GI tract when it’s severely dysregulated. So you have to go through the whole gut fiber or whatever methodologies you use treats CBOs and levers and CFOs. And there’s a complexity to it. So those people who are in sympathetic dominance with poor vagal tone will have massive dysbiosis. I work around the issue and try and find out what’s what is the problem? Do they have lower last days with low lipase? Are they not making bile? I get gallbladder motility studies. So there’s a lot of complexity to it. It’s difficult to answer that.

And then this question, I laughed when I read this, I shouldn’t I shouldn’t have laughed, but I did. Because I’m excited to hear your answer. The initial part of your discussion, what is the best way to build the patience and love for patients with limbic disorders, especially when you’re seeing many of them and they drain you and your staff tremendously?

This is the million dollar question. How do you stay regulated when your whole world around you is dysregulated? Well, here’s my answer to that. I’m in my I’m in my 60s, I mean 65. So the longer you live, the more resilient you become. So that’s that’s to my advantage. You also learn to know your defenses and as soon as your palms start sweating, you know you’re in trouble and your defenses are up and you’re in a complex. You delegate you delegate low priority items to other people and hopefully you find good people to help you manage the complexity of managing complex patients. And then I find having policies and procedures and systems that hopefully get followed with lots of sort of patient education helps somewhat dampen the chaos get again shoo, which you can never fight, you know, get rid of because any patient any clinic with treating complex patients has a one or two borderlines there At least five or six severely traumatized people with PTSD, myself everywhere you look. And so you will get complexity. And if you love what you do if you just get up every morning enjoying and loving what you do that itself is a buffer against some of the, the stresses that hit you on a daily basis. So there were other things you can do as you can read about in the self help books, but that’s been my experience. It’s just my age has helped me become more resilient, great stuff. Most of the times when you lose a good staff member, chaos ensues and then just loving what you do. If you love in what you do is a high priority. You You can withstand some of the slings and arrows that come your way.

Okay, who do you have run the neuro quant for you? I’m looking to access the test software here in Calgary in Canada.

The only neuro quant in Canada is in Calgary, you have to fly here or you have to go to the neuro quant company and ask them to find the nearest neuro quant in your vicinity. Have you in the US? There is one in Seattle as well I believe so my patients go to Seattle or come to Calgary? I don’t know if there’s anyone close. They may have they may have one in Toronto or Vancouver by now but I much I don’t know that.

Okay, I think we have finished all the questions. Um, let me just double check one more time. There was a comment about oral PVC is worse because it can cause translocation of LPs into the blood and then raise inflammation significantly. I was curious to hear your comment on that because I have never seen that.

I think theoretically that’s true. And I’ve been I haven’t seen I haven’t seen LPs. Well the only test I have for LPS is the Dunwoody one. And I haven’t seen any of the LPS IgG IgM. IGA is getting worse in ever since I’ve run the test, which is the last 10 years. So I can’t vouch for that it probably from an academic perspective, we know how high fat low carb diets increase oxidative damage for LPS, but I haven’t seen it clinically.

Okay, thank you. Thank you all for joining us, right or I’m staying with us right to the end. And thank you again so much for the really really informative, lovely presentation. We’re really grateful that you were able to do this for us today.

Thank you very much. Bye now.

A Discussion About Mold and Mold Exposure with Dr. Bruce Hoffman

A Discussion About Mold and Mold Exposure with Dr. Bruce Hoffman

We discuss how mold and mold exposure can be a trigger for Chronic Inflammatory Response Syndrome (CIRS), and Mast Cell Activation Syndrome (MCAS). We discuss ways to investigate and determine if you have been exposed to mold and what you should do if you suspect mold exposure is affecting your overall health.

To learn more about mold treatment, prevention, and recommendations, visit the Mold Illness section of our Hoffman Centre website.

Watch the Video

A Discussion About Mold and Mold Exposure with Dr. Bruce Hoffman

Reference Links

Transcript

I wanted to talk a bit about mold and mold exposure as a potential cause for chronic ill health. Mold is ubiquitous and, without question, many people are suffering from the effects of mold. Mold triggers Mast Cell Activation Syndrome (MCAS), and many people are suffering from that, which is why I feel that it has to be part of a differential diagnosis for chronic ill health.  

It’s shocking how many people have mold exposure as a trigger and as an ongoing mediator, keeping them in an inflamed state resulting in Chronic Inflammatory Response Syndrome or CIRS. There is a 34-page article on my website describing the diagnosis and treatment of mold illness or CIRS.  

I would recommend the following steps to people who feel they have mold exposure.

Do the CIRS questionnaire found on page 9 of the aforementioned article. You can see if you fulfill the criteria for the potential diagnosis of mold illness. Some of those symptoms are not just for mold illness. Some are more psychiatric based questions that can arise from mold. So, the questionnaire itself isn’t enough but it’s a good start. If you have more than eight symptoms in more than six of the subtypes on the questionnaire, consider mold as a potential differential diagnosis.

The second thing you can do is a visual contrast test. This too can be googled. Dr. Shoemaker’s website has access to a computerized VCS test. Take the test and if you fail it, consider mold as a potential illness or reason for feeling unwell.

Then, of course, the most important consideration is exposure. If you know that you’ve got a basement full of mold or your bathroom or your bedroom has mold on the windows from condensation, you have to consider that in your differential.

Not everybody gets sick from mold. Some people simply get allergy type symptoms,  but some people get true inflammatory response illness (CIRS). It’s been estimated that only 25% of people will have significant illness from mold. However, in my experience it’s more than that. People often downplay how important mold and the mycotoxins produced by mold are in influencing your health. 

So, what is important? Your exposure and your history. Is what you are exposed to visible mold? If it’s not visible, it could be hidden and so you often have to do your own homework and call in a mold inspector to look for the potential sources of mold. So, what can you do to potentially identify a problem? Look up at your pot lights. Is there a brown ring around your pot lights? Do you have buckled baseboards? Do you have black mold on your window frames? Is there mold in the grout in your shower? Do you have a front-end loading washing machine that smells musty? Does your house smell musty? Is there any potential mold in your air-conditioning system? Do you have a food composter in your kitchen? Because a lot of mold grows there. If you aren’t sure, it’s important that you call in a mold inspector, someone who will do a visual inspection and is armed with specific tools such as an infrared camera. Someone who is able to actually measure the dryness or wetness of drywall and put a small hole through drywall if you suspect mold or moisture behind the wall. The inspector will begin the examination of your home in the attic, looking at the insulation and at the condensation potential. Is your upstairs attic vented? A lot of the homes that we built in the Calgary building boom in 2009-2010, including my own by the way, didn’t have venting.  Condensation and wetness were ubiquitous and many people didn’t discover the mold until many years later, so get a good visual inspection. Find somebody to come in and inspect from the attic to the basement, someone who goes inside and outside and looks in multiple areas. If you go online, you’ll see how to do a visual inspection and a lot of it you can do yourself.   

Then you want somebody to do what’s called an ERMI test, which is a mold spore count. You want to do it either through a vacuum collecting dust from carpets or a swiffer cloth collecting dust off the floors. We recommend living rooms and bedrooms first. Some people do it in the basements although it’s not often recommended because a lot of basements are moldy. In my personal experience it’s important to know if your basement is moldy because through your furnace you’ll be pulling in mold through the furnace and pushing it throughout the house. Molds have also traveled from the basement through convection currents when your home heats up and so if the basement is a source, you want to know exactly how bad it is.  

Once you’ve done the visual inspection, once you’ve done ERMI testing looking for mold spores, once you’ve found mold (or not), the next step in the diagnosis is to do what we call the cytokine testing. Those aren’t done in Canadian labs, so we have to send them out. We call them the Shoemaker panel and we measure things like C4a, TGF Beta-1, MMP-9, VEGF, MSH and we do a nasal swab for something called MARCoNS, a coagulase negative staph. Basically, it’s a staph that lives in your nasal passages. It doesn’t produce overt nasal symptoms but can have significant cognitive effects and mitochondrial effects on your symptoms. So, we do those inflammatory markers.  

Recent advances have been very controversial regarding the use of urinary mycotoxin testing. In the original workup by Dr. Shoemaker didn’t believe that urea mycotoxin testing had any role to play in the diagnosis of mold illness. He has personally moved on to transcriptomic testing for definitive diagnosis but many other clinicians do urine mycotoxin testing to determine if there are any toxic mycotoxins of mold in the urine.  This is used quite extensively by the breakaway group that doesn’t adhere strictly to the Shoemaker protocol. There are two schools, which are the Shoemaker purists and then the group that has broken away. Like any good movement, there are always two camps, we can’t get away from that. Support and challenge exists throughout nature, exists throughout medicine, exists throughout clinical diagnosis and treatment.   

So, if you have a symptom profile that was suggested by the questionnaire, if you have a positive VCS test, if you have any signs of mold in your home, if the testing for mold spores in your home is positive, if your urine mycotoxin tests are positive and your Shoemaker labs are very positive, it’s highly likely that mold is playing a role in your illness. You need to find a practitioner who knows how to treat it. The treatment is extensive, requires lots of steps, and has to be followed in a specific sequence otherwise you can overload the detox pathways and get into increased symptom expression and feeling worse, not better.

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Mold Remediation: How to Identify and Remove Mold from Your Home

Mold Remediation

Mold exposure is an all-too-common problem that can cause serious health complications for your entire household. Unfortunately, it’s also a difficult and potentially expensive problem to solve.

Mold is composed of small spores that can grow into fuzzy patches of fungus if left unchecked in high-moisture environments. Mold thrives in warm, moist environments on organic matter like wood, paper, and even sheetrock. 

Unfortunately, some molds produce biotoxins that can seriously affect your health and that of your family. Mold illness also isn’t as recognized as it should be within the medical community. Consequently, it’s likely that mold illness affects far more people than can be accurately estimated. 

Consider if you’ve ever been exposed to mold. If not in your home, then perhaps in a school building, your car, your holiday cabin, your church, someone’s home that you visit frequently, or at your workplace. Maybe mold spores and mycotoxins still exist on the clothing or furniture that you moved to your new home from a previous residence that was infected by. As prevalent as mold growth is, especially in older or water-damaged buildings, it’s very possible that many of us have experienced sustained mold exposure at one point or another. However, not everyone is susceptible to the chronic inflammatory responses from which genetically predisposed individuals often suffer.

The symptoms of mold exposure vary widely from person to person, but may include fatigue, headaches, weakness, digestive issues, nerve and joint pain, anxiety, sleep disturbances, shortness of breath, and autoimmune problems, among others (1). Unfortunately, mold illness may often be one of the last considerations when a physician is presented with such seemingly disparate symptoms in a patient.

Of course, mold prevention is the best way to avoid mold illnesses. Mold comprises microscopic spores and as a result it can be difficult to completely remove. However, if there is mold in your home, removal is your best option unless you decide to move out.

“In order to reverse and prevent some of the deleterious effects of mold exposure, a complete mold remediation, or removal, should be performed in your home.”

In this article, you will learn what mold remediation is, what tests you need to identify mold growth in your home, how to hire a good mold inspector, and how to remove mold from your home.

What is mold remediation?

Mold remediation is the process of identifying and removing mold from your home. This process should be thorough and comprehensive.

“One of the most important steps in recovering from mold-related health issues is removing the mold so you’re no longer exposed to it.”

Mold remediation includes conducting some home testing to assess the extent of mold growth, followed by hiring a mold inspector. Mold is then removed from your home and the contents are all cleaned. 

Not only should you remove the mold, you should also seek to fix the problems that initially caused the mold growth in your home, such as excessive humidity, ventilation problems, or leaks. This process can be expensive but the only other viable alternative to mold remediation, especially if the mold is affecting you or your family’s health, is to move to a new house.

What’s the Environmental Relative Moldiness Index (ERMI) test?

This test is an easy way to measure the extent of mold growth in your home. It involves collecting carpet dust, which serves as a reservoir for mold spores, for a specified amount of time before sending it to a lab for testing. You can perform the collection yourself using an ERMI testing kit.

Within the dust sample, the ERMI test is able to detect 36 different types of mold. ERMI scores range from – 10 to +20, with 20 being the highest mold level. However, some extreme cases of mold contamination may have ERMI scores that are higher than 20 (2). A shortened form of the ERMI is called the HERTSMI-2 test, which measures only five species of what are considered the most pathogenic mold species to humans. These are Aspergillus versicolor, Aspergillus penicilloides, Chaetomium globosum, Stachybotyrs chartarum, and Wallemia sebi. A different score system is used to evaluate these five mold species but generally a score greater than 10 is considered problematic for many individuals.  

The presence of some mold in a home is to be expected, but the ERMI test helps you to determine if there are unhealthy molds present in your residence, even if they’re not visible to the naked eye.

This can offer a great starting point for you and help you to determine if you need to move on to the next step of mold remediation, which is hiring a mold inspector.

Hiring a mold inspector

A mold inspector will provide some additional insights into the causes and sources of mold growth in your home. 

A mold inspection will involve not only air quality tests, considered to be the gold standard of mold assessment but fraught with caveats, and most certainly an ERMI test if you haven’t completed one already. The process also involves a thorough inspection of the different surfaces or areas in your home where mold could be growing or where mold spores may collect.

A mold inspector will also look for signs of past and present water damage, which is a significant risk factor for mold growth. Mold requires moisture in order to propagate. Mold lives on drywall, paper, cloth, carboard, food compost, wood, and carpet. In Calgary where I live there has been massive flooding in the past, leading to many homes and offices becoming mold contaminated, in spite of remediation attempts. 

A good inspector can identify not only active mold growth, but also areas in your home that are susceptible to mold or conditions that are likely to promote mold growth. They may be able to provide recommendations regarding how to prevent further mold growth by conducting some home repairs, improving ventilation, and sealing up areas where moisture may be able to enter.

According to the Professionals Panel of Surviving Mold, inspection involves two key steps (3). An exterior inspection should be carried out from a distance and at at close range, examining the roof, gutters, seals around windows and doors, the foundation, and areas where water may be likely to pool. An interior inspection will involve the use of several specialized tools to measure moisture and humidity levels and to count the particles in the air. Close attention will be paid to walls, crawlspaces, areas around plumbing fixtures, and carpeting, looking for actual water damage and/or evidence of condensation on wooden window and door frames.

Mold does not proliferate as greatly in drier air. Within the home, it’s important to keep humidity below 50% and a dehumidifier may be needed in certain cases. Air conditioning units, heat furnaces, and air vents can house mold spores and mycotoxins. Regular maintenance, cleaning of vents, and use of HEPA filtration is crucial to maintain safe air quality. 

You should hire a trained and certified mold inspector with the experience and tools necessary to perform a comprehensive inspection of your home. A good mold inspector will take their time, inspecting everything methodically from inside the attic all the way down to the basement. Amongst other issues they will look for water staining on structural beams, the condition of fiberglass insulation, water staining around celling pot light fixtures, roof leaks, and buckled base boards. The inspector will uncover the toilet water tank looking for mold growth, examine the front-end seal on washing machines, pull out your dishwasher and washing machine looking for water leakage, and inspect your showers and bathrooms. They should come equipped with an infrared camera or a device to measure moisture ithat’s present in drywall. If someone comes to your house, looks around for a few minutes, and sets up a five-minute air sampling device, this is not the person you need! 

Removing mold from your home

The final step of mold remediation is the remediation, or removal, itself. This a multi-step process that in most cases will require hiring a professional mold remediation team. You may or may not be advised to move out of the home temporarily while the process is ongoing.

Removing mold from structures in your home

Unfortunately, according to the Professionals Panel of Surviving Mold, structures made from organic materials, including wood and drywall, will need to be completely replaced if they’re infested with mold or even if only a small amount of mold is present (3).

This can be quite costly and requires professional help, but is the only way to ensure that the remediation is complete. It’s also best to replace caulking and seals in areas that have experienced water damage to ensure that the mold is completely removed.

Water damaged carpeting should also be disposed of. In fact, carpeting in general is a poor choice for flooring because it serves as a reservoir for dust and inactive mold spores. If that carpet becomes wet then mold can rapidly grow out of control. If carpet becomes wet, it’s recommended that it’s replaced. If a home has been contaminated with mold but the carpet wasn’t wet, the carpet still has to be extensively HEPA filtered and cleaned appropriately with Benefect Decon-30 Disinfectant.

Flexible ductwork and air filters should be completely torn out and replaced too since these are difficult to clean completely. Inadequate cleaning can lead to the reintroduction of mold into the ventilation system of your home (3).

For the structures that don’t need to be replaced, Greg Weatherman, Certified Microbial Consultant (CMC), recommends the following steps regarding cleaning (4).

  • Vacuum using a high efficiency particulate air (HEPA) rated vacuum, not a ‘HEPA like’ vacuum cleaner. Regular vacuum cleaners will suck up the mold spores only to redeposit them back into the air. 
  • Vacuum the carpet in multiple directions.
  • Empty the vacuum cleaner outside. If using a bagless vacuum clear, you should be wearing a N-95 mask and clean the inside of the vacuum cleaner with Benefect or a similar compound.  
  • Wipe down vacuum cleaner with a residue-free cleaning agent using a damp cloth.
  • Clean porous materials and surfaces that have visible mold growth with a hydrogen peroxide or 5:1 water to vodka mix. Some people find Benefact, which contains botanical essential oils, mainly thyme, to be useful. Nonporous surfaces will only require additional cleaning if they are caked with residue.
  • Vacuum once more using a HEPA vacuum.

Multiple attempts at vacuuming may be necessary before the full benefit is realized.

Depending on the extent of the mold contamination, the cleaning crew may need to take additional steps.

  • Contain and seal the relevant area with plastic containment material. 
  • The HVAC system must be isolated from the rest of the building. Taping may be necessary to seal room leaks around windows or other openings. 
  • In order to allow technicians to clean equipment and change protective gear when going in and out of the work area, an anteroom should be established to serve as an entryway. 
  • The room requiring remediation needs to be at a lower pressure than the surrounding area. 
  • A negative pressure HEPA filtration extraction unit must be used. 
  • Personnel involved in the cleanup must wear personal protective equipment (PPE) up to and including respirators and protective suits (3)

After cleaning, porous surfaces such as wood should be sealed with antifungal paint.

Removing mold from your household items

Next, you’ll need to remove mold from your personal items and belongings. As a general rule of thumb in cases of mold contamination, you should throw away anything porous that you’re comfortable getting rid of.

However, there are steps you can take to clean items that you wish to keep. As with the structures in your home, the first step is to vacuum your belongings with a HEPA vacuum (4).

Inorganic, nonporous surfaces and items such as plastics and metals can be thoroughly wiped down with a residue-free cleaner. Porous materials with visible mold growth should be cleaned with a hydrogen peroxide cleaner, Benefect, or the vodka 5:1 mixture. Using a wet and then a dry cloth method is recommended. 

  • Use disposable wipes to clean the surface twice.
  • Follow up with a dry cloth to remove any moisture.
  • Throw the wipes away without cross-contaminating your clothes or other surfaces.
  • Clean the dry cloth with hot water and borax.

After cleaning, your items should be vacuumed once more with a HEPA vacuum (4).

Items generally considered safe to keep and clean include:

  • Jewelry
  • Cutlery
  • Dishware
  • Pottery
  • Statues
  • Hi-Fi equipment and electronics
  • Artwork, although this still needs to be wiped down and cleaned 

According to Larry Schwartz, council-certified Indoor Environmental Consultant (CIEC), certain household items may require special attention or consideration. Here’s some additional guidance for household items that you may not feel comfortable disposing of (5).

  • Papers and documents: Scan them electronically and place them in long-term storage.
  • Books: Wipe down the cover with mild borax soap and water. HEPA vacuum the outside and edges of the book.
  • Upholstered furniture: Vacuum with a HEPA vacuum and wipe down with borax, vodka mixture, or Benefact.
  • Mattresses: Vacuum with a HEPA vacuum although you should strongly consider replacing your mattress as it can collect moisture, dust particles, and mold spores.
  • Bedding: Wash in laundry borax and detergent or have bedding professionally cleaned. 
  • Electronics: Disconnect the wiring and clean the cables and the exterior of the electronics or have them professionally cleaned. Computers may blow mold spores around when the fan starts up when turned on.
  • Clothing: Wash in laundry borax (sodium borax) and detergent. Borax is a natural anti-mold and antibacterial solution. One recipe is to soak your clothing for half an hour in one cup of borax to one gallon (approximately four litres) of water before washing. Be sure to wash your hands thoroughly after handling borax. 
  • Shoes: Depending on their material, they can be wiped down with borax soap and water. You may also HEPA vacuum them.
  • Indoor plants: These should be disposed of since they retain mildew and mold spores.
  • Antique rugs: Rugs are a frequent source of mold spores and are difficult to clean.
  • Toys: Stuffed childen’s toys and animal toys should be disposed of. Plastic toys can be cleaned with the recommended solutions. 
  • Washers and dryers: If you have a front-end loader washing machine, check the inner seal for mold contamination and wipe down with borax.
  • Portable air conditioners or purifiers: New filters must be used when transporting these items from a moldy environment to another area. 
  • Food: Be sure to get rid of open food packets, jars of rice, and other grains, flours, or spices.
  • Animals: Pets may need to be boarded elsewhere while your home is undergoing remediation and then thoroughly washed before being reintroduced back into the home.

If you are unsure regarding what to do, place your questionable items in a sealed container and remove this from the area you’re attempting to remediate. Be sure to use an N-95 mask and even consider purchasing a hazmat suit when working with contaminated materials.  

Although a professional remediator will need to handle the structures in your home, you can clean most of your household items yourself. This will save you some money by decreasing the workload of the remediation team (5).

Fogging for mold

The final step in remediation is fogging.

“HEPA vacuums are powerful, but they are unable to filter certain particles that are too small or light.“

This can include mold spores (3). However, fogging or misting the home with an air purifying solution, once all other remediation steps are complete, can help ensure that even these smaller particles are disposed of.

There is a certain protocol that should be followed to ensure that fogging is as effective as possible, so it should be handled by a remediation professional.

Prevention and maintenance

After remediation, you should take steps to prevent further mold contamination by performing routine maintenance on your home and taking action to fix water leaks, ventilation problems, or changes in humidity.

Mold is a very common contaminant of water-damaged or damp buildings but it has been estimated that there are over thirty other contaminants that can be found alongside mold. These include, but are not limited to, volatile organic compounds (VOC’s), gram negative and positive bacteria cell wall components, glucans, mannans, hyphal fragments, inorganic xenobiotics, antinomycetes, mycoplasma, and chlamydia fragments. 

You may want to invest in HEPA filters for your home, which can help cut down on dust and mold spores settling on surfaces such as carpets and upholstery. It’s important to use HEPA filters that filter down to 0.1 microns. Most commercial HEPA filters only filter to 0.3 microns and will not be adequate for removing mold spores or mycotoxins. The Blueair Sense HEPA filter, the IQ Air purifier, and the Austin Air purifier are three recommended brands.  

If your home is humid, you should also use dehumidifiers to remove some of the moisture from the air, which will discourage mold growth.

Post-remediation, you may also choose to do follow-up EMRI testing or have a follow-up mold inspection to ensure that the remediation was successful.

Mold illness can be daunting, especially since treatment requires not only medical care but also a potential remediation of your home. As a Shoemaker protocol certified physician, I’m uniquely positioned to help you manage and treat your mold illness. My team can also help point you in the right direction to start the mold remediation process. Contact us today.

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References

  1. Hope, J. A review of the mechanism of injury and treatment approaches for illness resulting from exposure to water-damaged buildings, mold, and mycotoxins. The Scientific World Journal. 2013; 2013:767482. Published April 18, 2013. doi:10.1155/2013/767482
  2. Kamal, A, Burke, J, Vesper, S, et al. Applicability of the environmental relative moldiness index for quantification of residential mold contamination in an air pollution health effects study. J Environ Public Health. 2014; 2014:261357. doi:10.1155/2014/261357
  3. Schwartz, L, Weatherman, G, Schrantz, M, et al. Indoor Environmental Professionals Panel of Surviving Mold Consensus Statement: Medically sound investigation and remediation of water-damaged buildings in cases of CIRS-WDB. SurvivingMold.com
  4. Weatherman G. A condensed remediation plan for small microbial particles. AerobioLogical Solutions Inc. Published January 2013.
  5. Schwartz, L. Suggested protocol for preparation of home prior to fogging or ventilation treatments of the air. SafeStart Environmental.

Steps of the Shoemaker Protocol

Once the diagnosis of Chronic Inflammatory Response Syndrome (CIRS) from water damaged buildings has been established by history, physical, and labs, the Shoemaker protocol is the only peer reviewed published protocol shown to reverse the symptoms and laboratory findings. The steps are as follows:

Remove exposure from water damaged buildings

For many people, this is the most critical, yet most difficult step. Dr. Shoemaker has shown that the best test for determining the safety of a building is an ERMI test from Mycometrics. The ERMI stands for the Environmental Relative Moldiness Index. It is a quantitative PCR analysis that looks at spore equivalents of 36 species of mold. Shoemaker has determined from his database of thousands of patients that the cutoff for safety is an ERMI score of 2 if the MSH is < 35 and C4a is less than 20,000 and 0 if the C4a is greater than 20,000. He later developed a derivative of the ERMI score looking at 5 species, which he calls HERTSMI-2. This test is also done at Mycometrics and the cutoff for safety is a HERTSMI-2 of 10 for someone previously sickened by a water damaged building . More information can be found at http://www.survivingmold.com/diagnosis/hertsmi-2

I recommend that my patients test buildings that they spend a great deal of time at which usually includes their homes and workplaces. If the ERMI or HERTSMI-2 is over the safety cutoffs, I recommend that they remediate or move out of the building. Briefly, remediation involves identifying and correcting all sources of water entry, removing water damaged construction materials, and thorough cleaning of all contents of the building. After remediation, a HERTSMI-2 should be performed. The criteria for a successful remediation is a HERTMI-2 of 10 or less.

If patients choose to move, I recommend that they run an ERMI or HERTSMI-2 before moving into any new buildings.

The industry standard of sampling the air for spores is not an acceptable substitute for many reasons. One of the main limitations is that over 99% of the particles that carry the inflammagens from water damaged buildings are smaller than 3 microns. Spore traps can only detect particles that are larger than 3 microns and therefore miss over 99% of the inflammagens. Studies have shown that for every spore, there can be 100-500 inflammagen carrying fragments. The World Health Organization has stated that if one wants to do air sampling, it should be done in multiple locations per room, at multiple times of the day, multiple days per week. In other words, air sampling done properly is too time consuming and cost prohibitive. Finally, only the ERMI and HERTSMI have been associated with sequential activation of innate immune responses, not air testing. I have seen numerous patients who have been told that their air tests were “normal” yet they had high ERMI or HERTSMI scores and their bloodwork shows persistent inflammation.

Cholestyramine or Welchol

The next step is to interrupt enterohepatic recirculation of biotoxins using either cholestyramine or Welchol for at least a month. The dose of cholestyramine is 4 grams ½ hour before eating 4 times a day. If cholestyramine cannot be tolerated, a less effective alternative is Welchol 2 tablets three times a day with food. A number of people are sensitive to the fillers in cholestyramine so using compounded cholestyramine without fillers is a good alternative. The success of this step can be monitored by seeing improvements in the VCS (Visual Contrast Sensitivity) Test. If there is no improvement, the most common cause is persistent exposure to a water damaged building.

Treatment of MARCONS

MARCONS stands for Multiple Antibiotic Resistant Coagulase Negative Staphylococcus. It colonizes the deep nasal aerobic spaces of the majority of people with CIRS. This bacteria forms biofilms and releases biotoxins that can cleave MSH (melanocyte stimulating hormone), an anti-inflammatory neuropeptide. It is diagnosed by a deep nasal swab, which is sent to DLM labs in Massachusetts. If it is present and there are at least 2 classes of antibiotic resistance, the treatment is the use of compounded BEG spray (bactroban, edta, and gentamicin) 2 sprays three times a day for 1 month. Earlier versions of the protocol involved using Rifampin, but this is no longer necessary.

Correct anti-gliadin antibodies

If these antibodies are found on blood testing, the patient needs to avoid gluten containing foods for at least 3 months. I do find in my practice that most patients feel better avoiding gluten indefinitely.

Correct androgens

Many people with CIRS will have low androgens due to excessive activity of the aromatase enzyme. Dr. Shoemaker has shown that this will correct with VIP. In cases of those with low DHEA levels, supplemental DHEA may help correct androgen levels.

Correct ADH / osmolality

Most people with CIRS will have ADH (antidiuretic hormone) and osmolality levels that are out of proportion to each other. The most common pattern is a relative or absolute deficiency of ADH. Typically, one will see an ADH level either low or low normal with osmolality mid or high normal. ADH causes the kidneys to retain free water. Therefore, when levels are relatively low, patients will commonly experience excessive thirst and urination. In more severe cases, people will experience frequent static shocks.

The treatment is to use desmopressin 0.2 mg every other night. Sodium levels must be checked in 5 days then again in 10 days as hyponatremia can sometimes occur. If hyponatremia occurs, patients may experience poor appetite and nausea.

Correct MMP 9 (Matrix Metalloproteinase 9)

MMP is an enzyme that breaks down extracellular tissue. If MMP 9 is over 332 ng/mL, then this is treated with a low amylose diet and high dose fish oil (2.4 g of EPA, 1.8 g of DHA).

Correct VEGF (Vascular Endothelial Growth Factor)

This substance stimulates the growth of new blood vessels in response to Hypoxia Inducible Factor (HIF). In many people with CIRS, VEGF is suppressed to less than 31 pg/mL. The treatment is a high dose fish oil and a low amylose diet as listed in step 7.

Correct Complement C3a

This can be elevated if there is the presence of bacterial membranes such as those with acute Borreliosis. If high, the Borrelia needs to be treated first with antibiotics. If the levels remain high, a statin can be used to lower the level.

Correct Complement C4a if levels are greater than 2830 ng/ml

In earlier versions of Dr. Shoemaker’s protocol, erythropoietin (Procrit) injections were given. Now that VIP is available, VIP is the current treatment of choice. Note that this lab test needs to be run at National Jewish Hospital in Denver.

Correct TGF-B (Transforming Growth Facter Beta)

If elevated (over 2380 pg/mL), the treatment is losartan up to 25 mg bid. A metabolite of losartan called exp3179 lowers TGF beta.

VIP (Vasoactive Intestinal Polypeptide)

If the patient remains symptomatic after following all of the above steps, then the use of VIP is needed. It is a nasal spray that is dosed at 50 mcg/mL, 1 spray 4 times a day. The first dose should be given in the office. A TGF B and C4a should be drawn before the first spray and again in 15 minutes. If the levels rise, there is a hidden mold exposure.

According to Dr. Shoemaker’s paper published in 2013, administration of VIP will correct C4a, TGF beta, VEGF, MMP-9, estradiol, testosterone, vitamin D3, and PASP. More importantly, it improves the quality of life.

It is critical that there be no continued mold exposure before starting VIP otherwise it will be ineffective. VCS must also be normal and MARCONS must not be present to ensure that VIP will be effective.

Ou, Dave. MD Steps of the Shoemaker Protocol. Atlanta: 2014. Surviving Mold - Steps of the Shoemaker Protocol. Web. 10 Aug 2014. http://www.survivingmold.com

Allergen Avoidance Recommendations

Allergen Avoidance Recommendations

The following recommendations will help you minimize your exposure to toxic molds:

Eliminate Dampness In Your Home

Suggestion 1: Eliminate dampness in your home – check walls and roof for leaks. Waterproof walls and ceilings before painting.

Reason: Mold thrives in damp conditions

Do Not Wallpaper Walls

Suggestion 2: Do not wallpaper walls – paint instead.

Reason: Mold grows on wallpaper and in wallpaper paste.

Avoid Carpets As Floor Covering

Suggestion 3: Avoid carpets as floor covering. Replace with wood floors, vinyl or ceramic tile or terrazzo.

Reason: Mold grow sin carpet pile. Carpets also trap dust which can cause allergic reactions.

Allow Good Air Circulation In Closets

Suggestion 4: Allow good air circulation in closets. Leave space between hanging clothes and check leather clothing, belts, shoes and luggage for signs of mold growth.

Reason: Mold grows in damp, enclosed environments, especially on leather items.

Keep Bathrooms And Laundry Rooms Well Aired

Suggestion 5: Keep bathrooms and laundry rooms well aired. Spread out towels and washcloths for fast drying. Dry clothes as soon as they are taken from washer.

Reason: Mold grows rapidly in damp conditions and on damp fabrics.

Regularly Inspect Bathrooms And Laundry Rooms For Mold Growth

Suggestion 6: Regularly inspect bathrooms and laundry rooms for mold growth. Look for evidence of discoloration in tile grout and caulking. Do not forget to check under sinks, around the commode, shower curtains and shower door runners.

Reason: Mold thrives in damp environments.

Use a Dehumidifier in Humid Environments

Suggestion 7: In humid conditions, use air conditioning or a dehumidifier.

Reason: Mold does not grow well in dry environments.

Avoid Foods Which Contain Molds

Suggestion 8: Avoid foods which contain molds or are related to molds such as Mushrooms, yeast containing foods, fermented meats and pickles, smoked fish and meats, and blue cheese.

Reason: Inhalant allergy symptoms may be aggravated by consumption of these foods.

This list was originally written by the Longevity Medical Centre.

Frequently Asked Mold Questions

Frequently Asked Mold Questions

Q: Do I literally have to clean everything in my house (i.e. plastic storage containers, books, toiletries, candles, knickknacks, canned food etc.) or just the major things like clothing and furniture?
A: Yes, everything.

Q: Is it possible to clean electronic devices that may have mold spores inside of them, seeing as I have no way to clean the inside of these devices (i.e., DVD players, computers)? Is it good enough to simply clean the outside of them?
A: Clean the outside and vacuum the openings.

Q: Do pictures and documents have to be scanned/copied or can the originals be kept? Photos can be washed.
A: Porous frames are trash. Documents need to be copied.

Q: What about books, journals? How do you clean them? Or do they have to be thrown out?
A: Books are difficult. If the books are on a shelf and not opened, HEPA vacuum each one. Opened books are trash.

Q: Do I need to use a new cloth for every item that I clean (one clean cloth per moldy item) or can I use the same cloth for several items?
A: One cloth can be reused. You will be vacuuming, then wiping and vacuuming again anyway.

Q: Can leather furniture be cleaned since it is not porous like cloth?
A: Use quaternary cleaners on leather. Vacuum the nooks and crannies of the piece of furniture and do the same thing again. I know some people will say throw away the leather, but I have seen good results if the leather has a finished (not rough) surface.

Q: Is it likely that I have cross contaminated my car seeing as I drive in it, in my moldy clothes and with other items from my home on a daily basis? If that is the case, do I need to sell my car as well or can it be cleaned?
A: The trouble with cleaning for mold is where do you stop? There are many chemically sensitive people who have to get new cars. For most people the car isn’t the problem. Be careful about the antifreeze system in a car as that system’s glycol ethers are a real problem.

Q: Is it likely that I have contaminated my friends’ homes just by being there as well? If so, is that going to be problematic for me when I go to visit with them? I plan to move in with one of my friends for several months while I look for a new place to buy. I have slept at this person’s house already with my moldy clothes and suitcase quite a few times. Will I need to clean her floors and table tops etc., or is any possible cross contamination from my simply having slept there too minimal to worry about? Have I cross contaminated this person’s bed by sleeping in it?
A: Clothes are much less of a problem if they are laundered before wearing to someone else’s home. I get mold hits from families that come from moldy homes, but the risk of illness and cross contamination from clothes is less if the clothes are removed from the home, cleaned or dry-cleaned.

Q: I plan to purchase a HEPA vacuum cleaner. After I clean things with it will it need to be thrown out, or is replacing the filter sufficient?
A: Replace the filter. A good HEPA will last a long time. Better yet, invest in a central vacuum.

Q: I assume that plates, dishes, silverware etc. can simply be run through the dishwasher. If so, where do I clean them? My current moldy dishwasher before I move out or the dishwasher in my new place?
A: I have not seen people made ill by a cleaned dishwasher. Rub down the outside and vacuum it but the wash cycle is enough to safeguard your silver and china.

Q: I am a little worried that work could be moldy too. None of my coworkers are sick and I have asked about water damage. I am told there has not been any. But I have noticed tiles that you can tell have been wet. Any way to determine if the building is moldy short of doing a test?
A: ERMI is the key concept here. I don’t trust any building to be safe just because a landlord said so. Spend the $300 to know for sure.

Q: Would it be better to clean everything myself or to hire a mold expert?
A: As far as abatement and removal of materials, you need to learn the tricks of the trade. But there is no reason you can’t do the work yourself if you have carpentry skills. The cleaning you probably should do.

Re-posted from the Surviving Mold website, https://www.survivingmold.com/

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Toxic Mold Illness: Is Your Home Causing Your Mysterious Symptoms?

If you are suffering from chronic symptoms such as asthma, fatigue, or brain fog, and you’ve struggled to find a proper diagnosis or relief, it might be time to examine your environment more closely.

Toxic mold illness and its effect on the immune system, called chronic inflammatory response syndrome (CIRS) is a perfect example of the power of our environment to impact our health in a dramatic fashion.

Many toxic molds are formed in buildings that have suffered water damage through flooding, condensation or high humidity. It is estimated that as many as 50 percent of homes have poor indoor air quality with water damage and the resultant mold biotoxins and associated inflammatory particles being one of the major contributors. With indoor air pollution accounting for up to 50 percent of all illnesses in the United States, this is a very serious contributor to patients’ suffering, and deserves to be raised as a major factor when enquiring into patients’ health history and timeline of symptom presentation.

Globally, air pollution is an epidemic, killing an estimated seven million people and is responsible for one in eight global deaths each year. This is a staggering number, and the fact that mold illness is one of the contributors to this epidemic, is still relatively undiscussed and unknown in traditional medical clinics, needs to change. Let’s shed some light on this invisible illness.

The Invisible Illness – Mold Toxicity

Mold is quite literally an invisible killer because often you cannot see it. Caused by multiple different types of fungi, mold reproduces by forming tiny spores, which float away and are unseen by the naked eye.

Not only are mold spores invisible, but they produce even smaller secondary mycotoxins which are able to sneak through the body while wreaking havoc and remaining undetected by the immune system. These mycotoxins are extremely small, fat soluble molecules.

These molecules are particularly dangerous because they are capable of passing through your cell membranes without being carried through the bloodstream – making them extremely difficult for your immune system to identify.

Without identifying and helping your immune system recover from a buildup of toxin exposure, you could unnecessarily suffer from long term negative health consequences. Helping the public understand and become aware of CIRS is one of the best ways we can rectify unnecessary suffering.

Let’s examine the 13 symptoms of mold illness or CIRS, 4 common misconceptions, and 11 steps you can take towards effective treatment.

13 Toxic Mold Illness Symptoms

The problem with toxic mold illness is it can feel like a phantom illness. Mold toxicity symptoms seem unrelated and can cause doctors to look in all the wrong places for a diagnosis.

Many sufferers of mold illness or CIRS first endure years of misdiagnosis or are even dismissed as having an illness that’s psychosomatic (in the mind). If you are suffering from a myriad of seemingly unrelated symptoms, it’s time to consider your home and work environments.

Here are the 13 most common mold symptoms (Dr. Shoemaker has identified 37 symptoms in total). It’s time to see your doctor if you suffer from any of the following symptoms of mold sickness:

  1. Cognitive issues such as headaches, brain fog, memory problems, difficulty concentrating, and mood swings
  2. General fatigue and weakness
  3. Muscle aches, joint pain, and morning stiffness
  4. Numbness and tingling of the skin
  5. Light sensitivity, blurred vision or red eyes
  6. Asthma, persistent coughing, sinus issues or shortness of breath
  7. Skin tingling or numbness
  8. Vertigo and tremors
  9. Metallic taste
  10. Temperature fluctuations or night sweats
  11. Increased urination and excessive thirst
  12. Changes in appetite
  13. Abdominal pain, nausea, diarrhea, and bloating

As you can see, the symptoms of mold illness are varied and may even appear unrelated. It’s the nature of these broad reaching symptoms that keeps the cloud of mystery over CIRS.

Only through drawing more public attention and dispelling common myths around CIRS can we get closer to achieving better diagnoses and treatments. Let’s start that process by taking a closer look at the four common misconceptions surrounding mold illness.

4 Common Misconceptions of Mold Illness

Toxic mold illness is gaining traction in the media but with that come some misconceptions. Let’s clear up some of these fallacies regarding mold illness right now.

1.  Mold Illness Isn’t That Common

Even though mold illness isn’t widely discussed, it is very prevalent and the public needs more information on CIRS. Approximately one in four have the potential for developing CIRS if they are exposed to sufficient biotoxins and inflammagens (other toxic compounds released by water-damaged buildings).

And unfortunately, these biotoxins are estimated to impact as many as half the homes in the United States, making CIRS an illness of major concern. It’s important to spread awareness of mold toxicity and prevalence so that people can take the right steps to keep their family safe in their homes and places of work.

2.  Mold Illness is Caused by Mold

Even though “mold” is in the description, mold illness is actually a complex health condition that fits more appropriately under the title of chronic inflammatory response syndrome or CIRS.

Originally described by Dr. Ritchie Shoemaker in the late 90s, there are now over 1700 scientific articles on CIRS to date.

The causes of CIRS are collectively known as biotoxins and are frequently associated with water-damaged buildings, though they can occur without water damage.

These biotoxins include:

  • Fungi with mycotoxins
  • Bacteria with secondary endotoxins (including Borrelia and Babesia – organisms associated with tick-borne illness)
  • Actinomycetes
  • Mycobacteria
  • Beta Glucans
  • Hemolysins (toxins produced by bacteria, often residing in deep nasal passages).
  • Microbial Volatile Organic Compounds (VOCs)
  • Cell wall fragments
  • Protozoa
  • Building material VOCs

Not everyone will become sick if they are exposed to sufficient levels of any of these toxins. They are fortunate to be part of the 75 percent of the population whose immune system recognizes these toxins and is able to neutralize them.

However, those with specific human leukocyte antigen (HLA) genes have an immune system that isn’t able to identify these toxins. If your body can’t identify these biotoxins, then it is unable to eliminate them from the body. These biotoxins initiate a significant inflammatory response called CIRS.

3. CIRS Looks the Same for Everyone

Actually, it appears that everyone has differing levels of mold sensitivity. Genetic predisposition seems to play a role in how likely you are to develop CIRS.

About 25 percent of the population is genetically susceptible to developing CIRS, while two percent are highly sensitive and more likely to experience disabling symptoms when exposed to biotoxins.

The varying levels of sensitivity to biotoxins makes CIRS a difficult illness to diagnose. Furthermore, those suffering from mold illness are often misdiagnosed or their condition is overlooked altogether.

Only through additional studies, examination, and public awareness can we begin to improve diagnosis rates for CIRS.

4.  Removing Environmental Exposure Cures the Symptoms

It seems obvious that the first step of tackling your CIRS would be removing exposure to biotoxins. But that isn’t always enough.

Sure, removing the source of toxins is great in theory, but even professionals have a hard time fully eliminating all the mold and spores. If it’s at all possible, a complete move from the contaminated area is best. Unfortunately, many cannot afford to completely remove themselves from the toxic environment.

Luckily, there are other steps you can take to help your body repair some of the damage caused by harmful biotoxins or improve your health if you are not able to completely remove yourself from the environment.

Take Action – 10 Treatments of Toxic Mold Illness

If you’ve been diagnosed with CIRS there are steps you can take to help alleviate your symptoms.

The steps of the Shoemaker Protocol outlines a detailed treatment plan on the impacts of toxic mold. 10 treatments I recommend include:

  1. First and foremost, remove yourself from the environment to the best of your ability. Begin the process of remediation of your water-damaged environment. It is best to consult an expert in the field who has been trained in the Shoemaker method of mold remediation.
  2. Invest in a high-quality indoor HEPA air filter capable of removing particles less than 0.1 microns. Most commonly purchased HEPA filters only filter particles to 0.3 microns and above.
  3. Test for and treat any nasal bacterial growth, such as MARCONS .
  4. Use cholestyramine, Welchol (known as Lodalis in Canada) to aid your body in removing the toxins by binding to them. Be sure to avoid constipation while using binders. Add magnesium oxide or citrate powders to prevent constipation during your detoxification process.
  5. Eliminate gluten and remove mycotoxin-rich foods, including wheat, barley, rice, oats, rye, peanuts, and brazil nuts.
  6. Eliminate amylose rich food, sugar and alcohol.
  7. Correct androgens such as DHEA and testosterone.
  8. Correct your cortisol and ACTH levels.
  9. There are several other biomarkers that can be examined and corrected with the guidance of your doctor such as ADH/osmolality, MMP9, VEGF, C3a, C4a, TGF beta-1, and VIP. Be sure to discuss these factors with your doctor.

It’s really a wonderful thing to finally see a comprehensive look at human health begin to hit the mainstream. And while it’s an approach you’ve been following for some time now, it’s important that it continues to spread far and wide.

Through the 7 Stages of Health and Transformation we can examine health impacts such as toxic burden through a lens that’s more complete and acknowledges the complexity of human health.

Mold illness is a perfect example of how toxins found in the 1st stage – the Extended Body – can lead to an array of seemingly confusing symptoms. If you are suffering from chronic illness – especially any of the symptoms listed above – be sure to consider mold and its resultant toxic effects, as a possible contributor.

Do your symptoms improve when you’ve been on vacation? Have you been looking for solutions to an illness with little to no success? Mold toxicity is not usually a factor many practitioners look at first. Mold illness is quite literally “out of sight, out of mind” but it could be the solution to your mysterious health woes.

As we mentioned earlier, CIRS is still a relatively unknown illness and spreading the word is vital to helping those that suffer. Share this article to help spread awareness and aid in calling attention to a debilitating and misunderstood illness.

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Resources:

https://www.survivingmold.com/docs/HOFFMANESSAY1.PDF
https://www.survivingmold.com/docs/CONSENSUS_FINAL_IEP_SM_07_13_16.pdf
https://www.survivingmold.com/docs/MEDICAL_CONSENSUS_1_19_2016_INDOOR_AIR_KB_FINAL.pdf
https://www.truthaboutmold.info/statisticshttp://www.survivingmold.com/mold-symptoms/molds-mycotoxins-more
http://www.survivingmold.com/docs/Berndtson_essay_2_CIRS.pdf
https://hoffmancentre.com/wp-content/uploads/2016/12/Steps-of-the-Shoemaker-Protocol. pdf

Evidence-Based Medicine in the World of Mold Illness

The practice of evidence-based medicine (EBM) is held out as the gold standard of practice when it comes to evaluating how best to treat certain conditions. As this article will outline, nowhere is this standard in more disrepute than in the evidence-based practices currently in use on how best to treat mold related illness.

What is Evidence-Based Medicine? The term "evidence-based medicine" (EBM) was first used in 1990 by G.H. Gyatt, a professor from McMaster University Canada, but a broader description of EBM appeared in 1992 when the Evidence-Based Working Group published a new approach to teaching the practice of medicine in JAMA. (1) The article stressed that “evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiological rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research.(2)” The article emphasized that this would require “new skills of the physician, including efficient literature searching and application of formal rules of evidence evaluating the clinical literature.(3)” Tradition, anecdote and theoretical reasoning based on the basic sciences would be replaced by evidence from high-quality, randomised, controlled trials and observational studies, in combination with clinical expertise and the needs and wishes of patients.(4)

On the Internet, numerous articles discuss other potential definitions of the term "evidence-based medicine"(5). Sackett et al. define EBM as “the integration of best research evidence with clinical expertise and patient values”(6). Another definition states that “EBM is nothing more than a process of life-long, self-directed learning in which caring for patients creates the need for clinically important information about diagnosis, prognosis, therapy, and other clinical and health care issues.” A further definition suggests that EBM is “an evolutionary progression of knowledge based on the basic and clinical sciences and facilitated by the age of information technology.(7)”

Many of the above definitions arose from a BMJ article published in 1996, which stated that EBM is the conscientious, explicit and judicious use of the best current evidence in making decisions about the care of individual patients. The practice of evidence-based medicine involves integrating individual clinical expertise with the best available external clinical evidence from systematic research.(8)

Evidence-based medicine requires asking relevant clinical questions concerning the patient’s issues, performing a literature search for relevant research data to support or refute diagnostic and/or treatment approaches, critically appraising the literature regarding its validity and applications, and then implementing one’s findings and insights in a clinical setting.

Twenty-five years ago, evidence-based medicine, which involves utilizing the medical literature to effectively guide medical practice, was considered profound enough to be described by the initial authors as a paradigm shift in the way medicine was to be practiced. The authors reported Thomas Kuhn’s description of a scientific paradigm as “[a way] of looking at the world that defines both the problems that can legitimately be addressed and the range of admissible evidence that may bear on the solution”(9). When defects in an existing paradigm accumulate to the extent that the paradigm is no longer tenable, the paradigm is challenged and replaced by a new way of looking at the world.

Some of the shift toward evidence-based medicine was initiated due to a loss of confidence in the traditional medical model and the studies that had initiated those practices. Larry Dossey M.D. commented on many of the scandals that rocked the confidence of healthcare consumers at the end of the last century(10). “The uncertainties of medicine are cause for celebration,” Dossey wrote. “Modern medicine is losing some of its invincibility. Many of the rules of good health that have guided patients and physicians for decades have taken a beating from which they may not recover. The almost blind allegiance we once had to the treatments offered has been severely undermined by these studies — some of the absolute certainties are no longer as absolutely certain.”

First, there was the Vioxx drug scandal, in which many people died from heart disease after consuming what were thought to be relatively innocuous anti-inflammatory drugs. Compounding the problem was the fact that this particular drug had been marketed as being relatively safe. Furthermore, evidence emerged that the drug companies had known for some time that the drug had an increased incidence of cardiac side effects, but they had chosen to hide these negative findings to ensure a profit.

In the Women’s Health Initiative study(11), hormone replacement therapy (HRT), specifically Premarin and Provera, once a mainstay of post-menopausal symptom management and considered to be safe, was shown to actually increase women’s risk of heart disease, stroke, thrombosis and breast cancer. The risks of increased cardiovascular disease (CVD) and breast cancer were concluded to far outweigh the benefits of osteoporosis protection and colon cancer reduction. Millions of women, to the fanfare of massive nation-wide news coverage, were immediately withdrawn from hormone replacement therapy as a result of these findings. The sales of these two drugs dropped 50% in one month. The American Association of Clinical Endocrinologists, (AACE), the American Congress of Obstetricians and Gynecologists (ACOG) and the North American Menopause Society (NAMS) recommended HRT use only for short-term symptom control.

Later critiques of the study pointed out some bias and manipulation of data, including but not limited to the following:

  1. Many women chosen for the study were not in the typical age range for HRT – they were, on average, 12-15 years past the age of menopause and had significant baseline cardiovascular and coronary artery disease (CAD) at the initiation of the study.
  2. Approximately 74 percent of the women included in the study had never used HRT before and were outside the 3-4 year post-menopausal window of opportunity for HRT, in which cognitive and cardioprotection from HRT was maximal.
  3. Premarin was the estrogen used in the study. Premarin is a conjugated equine estrogen drug with 50 percent estrone (known to increase breast cancer risk prior to the WHI study), equilin and equilenin, both of which have unknown activity on human estrogen receptors. The WHI study was not undertaken with human estrogens (E1=estrone, E2=estradiol and E3=estrone). Premarin is an oral equine-derived preparation and is known to increase liver coagulation proteins, thus increasing the risk of stroke and cardiac events. Transdermal estrogen was not used, which has shown no association with the increased activation of liver clotting proteins. NAMS preaches that there are no randomized, placebo-controlled trials to support the claims of increased efficacy or safety of compounded, bioidentical hormones; however, there is a plethora of studies demonstrating the superior efficacy and safety of pharmaceutical bioidentical hormones over non-bioidentical, synthetic hormones.
  4. Progestin was the chosen progesterone preparation. This is a medroxyprogesterone acetate preparation that had already been shown to have an unfavorable effect on lipid profiles prior to the WHI trial.

Much criticism was levelled against the WHI study when the data were placed within a clinical perspective and further studies reached different conclusions. The results of the WHI and the Heart and Estrogen/Progestin Replacement Study (HERS) trial, when reassessed, were shown to not apply to younger women, specifically those aged 50-60. In most of the subsequent studies, there were no cardiovascular deaths among 6,000 women on HRT, as compared to several deaths in the placebo group (12). There was overwhelming evidence that the anti-atherosclerotic effect of HRT depended on the time of initiation and that early initiation was protective.

With regard to knee surgery, researchers proved that performing arthroscopic surgery on an arthritic knee, once a mainstay of surgical interventions for this condition, was no more effective than administering an anesthetic, making a skin incision, and performing a sham surgery. The outcomes in terms of pain and symptoms after either of these two procedures were virtually the same. The value of mammograms has also been seriously questioned, and it is unclear as to whether or not a mammogram has any influence on the number of women dying from breast cancer each year.

These observations are supported in the literature, which shows that many medical findings and treatment suggestions previously taken as the gold standard do not stand the test of time. John Ioannidis, known as a meta-researcher who has based his career on researching the validity of medical research findings, has shown time and time again in published studies that as many as 90 percent of the published medical information that doctors rely on is flawed (13). Eighty percent of non-randomized studies (the most common type of studies) turn out to be wrong, and 25 percent of gold-standard randomized studies turn out to be wrong, as do 10 percent of platinum-standard large randomized trials. One of his papers (14) discussed his belief that researchers were frequently manipulating data analyses, choosing career-advancing findings rather than good science and using the peer-review process to suppress opposing views (15). In perhaps one of the most ignominious examples of medical science undergoing a dramatic reversal in treatment approach, Dr. Egas Moniz received a Nobel prize in 1949 for his pioneering of the frontal lobotomy in 1936 to treat incurable mental illness (16). Times do change, and sometimes, they change radically.

A Wall Street Journal article written by Ron Winslow entitled Study Questions Evidence Behind Heart Therapies (17) discussed a study that revealed that less than 11 percent of 2,700 recommendations commonly made by cardiologists were supported by scientific evidence. Furthermore, many of the dogmatic recommendations and guidelines created by cardiologists are formed by individuals who are connected in some financial way with the pharmaceutical companies (18). Another study showed that 85 percent of individuals who had stents or angioplasties to treat their blocked coronary arteries did not need them. Furthermore, the group that did have the surgical procedures ended up much sicker than the individuals who treated their condition with drugs alone (19). Thus, more critical evaluation of standards of practice was needed.

The original 1992 Evidence-Based Medicine Working Group set out specific criteria for assessing the strength of evidence that supports clinical decisions (20). Has the diagnostic test been evaluated in a patient sample that included an appropriate spectrum of mild and severe disease, treated and untreated disease and individuals with different but commonly confused disorders (21)? Was there an independent, blind comparison with a gold standard of diagnosis (22)? Was the assignment of patients to treatments randomized (23)? Were all patients who entered the study accounted for at its conclusion (24)? Lastly, were explicit methods used to determine which articles to include at its conclusion (25)?

Evidence-based medicine utilizes specific steps to arrive at conclusions:

  • Ask the right question using an acronym PICO (26). P=Patient or problem, I=Intervention, C=Comparison intervention, O=Outcome.
  • Acquire the best evidence by searching various databases, including but not limited to PubMed, Embase and Cochrane Library. Evidence-based medicine has various levels or grades for use in assessing the strength of studies.
  • Appraising the evidence: Is the study valid and relevant? What were the results of the study? Will the results help in treating the patient?
  • Apply the evidence. Once the evidence is obtained, it must be filtered through the patient’s value systems and the level of the practitioner’s core competencies. Shared decision making is essential once the risks and benefits have been explained.
  • Performance assessment. Whether this approach is helping and assisting the patient to achieve his or her anticipated and expected health goals must be determined. This is done by assessing the four steps listed above.

There are four levels of evidence that are used when assessing the strength of studies via an EBM approach.

  1. Level I – This is considered the top level of evidence, and it is derived from randomized, double-blind, placebo-controlled trials and/or meta-analyses that combine the evidence from these trials. Meta-analyses are considered to be the most eligible for Level I status, but they too have come under some criticism as a means of evaluating critical evidence. Many studies that are combined in a meta-analysis are homogenous and lack sufficient outlying evidence.
  2. Level II – This evidence is not considered quite as reliable as that from Level I. This evidence comes from controlled trials without randomization, cohort or case-control analytic studies and multiple-series studies.
  3. Level III – This evidence is based on expert opinion from those specialized in one particular area under investigation. Most often, there are no control groups, and sample sizes are small. This approach can often lead to a large margin of error unless statisticians compile the evidence from all expert opinions.
  4. Level IV – This evidence is based on personal experience and is the least desirable source of evidence because it lacks statistical validity.
    The original working group emphasised that it would require a specific teaching course and orientation, as taught at the McMaster University Medicine Residency Program, Department of Medicine, in order to critical appraise journal articles and arrive at the bottom line regarding the strength of evidence and how it may bear on the clinical problems in question.

According to the original JAMA article, the residents “learn to present the methods and results in a succinct fashion, emphasizing only the key points. A wide-ranging discussion, including issues of underlying pathophysiology and related questions of diagnosis and management, follow the presentation of articles. They always substantiate decisions or acknowledge the limitations of the evidence and discuss the literature retrieval, the methodology of papers and the application to the individual patient. (27)” This article emphasised that this “new paradigm will remain an academic mirage with little relation to the world of day-to-day clinical practice unless physicians-in-training are exposed to role models who practice evidence-based medicine”. McMaster University recruited internists with training in clinical epidemiology and the “skills and commitment [needed] to practice evidence-based medicine. (28)” This is a tall order for a busy clinically orientated profession, and even this article agrees that practicing in this way is fraught with complexity and difficulty. Furthermore, when first published, the authors asked whether advocating evidence-based medicine in the absence of definitive evidence of its superiority in terms of improving patient outcomes is an internal contradiction (29).

One of the challenges facing a clinically trained and clinically based practitioner who does no in-house research and whose practice is full of competing demands is how to best evaluate the available evidence and make the best treatment decisions for patients who present every day with complex problems. The average physician spends far beyond 40 hours per week in the office, seeing patients, managing staffing issues and dealing with paperwork.

The available paths to researching evidence-based literature and applying that information to complex patients with a multitude of issues are as follows:

  1. Read journal article summaries at night with a critical eye on the quality of the research presented. Many doctors have a strictly clinical background, not a statistically oriented, research-based background, and therefore, they may lack the knowledge to interpret research articles critically.
  2. Read the opinion pieces or position papers of others who have read the original articles and commented on the quality of the research presented in association or interest group publications. Many of the position papers published by specific associations may not have the current best evidence and may not represent the best science available.
  3. Attend conferences where the presenters, one assumes, are leading the field that the conference concerns, have done the necessary research and are presenting information based on Level I and Level II evidence-based research.
  4. Listen to drug company reps who visit one’s office with the details of the research concerning their products, which is presumably biased due to vested interests whether the product in question is a supplement or a drug.
  5. Listen to patients’ summaries of their internet searches and attempt to interpret their evidence into rational decision making.
  6. Read up on what one’s colleagues are discussing and/or referencing in online discussion groups.

From these beginnings, evidence-based medicine has had some major achievements. The Cochrane Collaboration was established to collate and summarise evidence from clinical trials, methodological and publication standards for primary and secondary research were established, national and international infrastructures were built to develop and update clinical practice guidelines, resources and courses were developed to teach critical appraisal and new knowledge bases for implementation and knowledge transition were built (30).

However, since evidence-based medicine was first introduced and adopted, many cracks in the paradigm have appeared that warrant careful appraisal:

  1. The co-opting of clinical trials by invested drug manufacturing and medical device interests and the manipulation of data to suit endpoint outcomes has become more subtle and harder to detect. These companies often set the research agenda, decide what is counted as a disease (i.e., sexual arousal disorder, which is treated with sildenafil), decide which tests and treatments will be compared and choose the efficacy outcome measures (31). In addition, setting inclusion criteria to select those most likely to respond to treatment, manipulating the dosing of both intervention and control drugs and selectively publishing positive studies (while suppressing negative outcomes) in leading peer-reviewed journals, with the assumption that their trials are unbiased, creates serious legitimacy issues regarding the conclusions reached. One review of industry-sponsored trials of antidepressants showed that 37 of 38 had positive findings but only 14 of 36 trials with negative findings were published (32). Psychiatric prescription and drug trials are at the centre of many of these controversies (33). Among the RTC studies in psychiatric journals, those that reported conflicts of interest were five times more likely to report positive results. Large drug companies do not fund and are not interested in treatment interventions that do not support a pharmaceutical intervention.
    Many studies that show the long-term benefits of compounded bioidentical hormone replacement therapy interventions do not make it to mainstream medical journals for these very reasons. A very contentious JAMA-published article, a retrospective observational study, indicated the negative effects of testosterone replacement therapy on cardiovascular disease, and this article changed the way that testosterone therapy was used in male andropause, despite the fact that many prior RCT studies had shown no such impact or favourable outcomes (34).
  2. The co-opting of policy makers (politicians) by the drug industry affects the introduction of certain evidence-based policies (35).
  3. A surplus of evidence results in unmanageable clinical guidelines (36).
  4. Large trials are designed to achieve marginal gains in a saturated therapeutic field and may tend to overestimate potential benefits. After many of the large early gains in research (the use of antiretroviral drugs in HIV and the use of triple antibiotic therapy in H. Pylori), new research has had to shift its focus to marginal gains in often overpowered trials that tend to underestimate harm (adverse effects undetected) and overestimate benefits (effects that are statistically but not clinically significant (37)). GlaxoSmithKline was fined $3 billion for multiple criminal and civil offenses, such as false reporting, the unlawful promotion of medicines and failure to report safety data (38).
  5. The overemphasising of computerised decision support systems and defensive decision-making support technologies, as well as inexperience with complex presentations that do not comply with simple guidelines, may interfere with more experienced and nuanced clinical decision making on the part of an experienced practitioner who is somewhat accustomed to tolerating ambiguity and uncertainty in clinical decision making (39).
  6. Decision making may be driven by non-clinical staff who are incentivised by financial endpoints and not by the nuanced quality of care for complex individual patients. “Patients may often feel tyrannized when their clinical management is inappropriately driven by algorithmic protocols, top-down directives and population targets (40).”
  7. Simple and/or complex algorithms do not fully apply to an aging population with complex presentations and comorbid conditions. Each person is genetically and biochemically unique (as is only too well demonstrated in the CRS population), and although specific guidelines, as outlined by Dr. Shoemaker, must be followed to achieve success, there may still be many comorbid complexities that render the application of these same strict guidelines somewhat problematic, i.e., a patient with CIRS who has had a previous traumatic brain injury, complex early developmental trauma and a borderline personality disorder.

The authors of this critical 2014 BMJ paper, entitled “Evidence-based medicine: A movement in crisis?” suggest launching of a new campaign for what they termed “real evidence-based medicine”. According to them, this is how to best describe what they mean by real evidence-based medicine and the remedying solution:

What is real evidence-based medicine, and how do we achieve it? Real evidence-based medicine:

  • Makes the ethical care of the patient its top priority.
  • Demands individualised evidence in a format that clinicians and patients can understand.
  • Is characterised by expert judgment rather than mechanical rule following.
  • Shares decisions with patients through meaningful conversations.
  • Builds on a strong clinician-patient relationship and the human aspects of care.
  • Applies these principles at community level for evidence-based public health.

Actions to deliver real evidence based medicine:

  • Patients must demand better evidence that is better-presented, better-explained and applied in a more personalised way.
  • Clinical training must go beyond searching and critical appraisal to hone expert judgment and shared decision-making skills.
  • Producers of evidence summaries, clinical guidelines, and decision support tools must take account of who will use them and for what purposes and under what constraints they will be used.
  • Publishers must demand that studies meet usability standards, as well as methodological ones.
  • Policymakers must resist the instrumental generation and use of “evidence” by vested interests.
  • Independent funders must increasingly shape the production, synthesis, and dissemination of high-quality clinical and public health evidence.
  • The research agenda must become broader and more interdisciplinary, embracing the experience of illness, the psychology of evidence interpretation, the negotiation and sharing of evidence by clinicians and patients, and the prevention of harm from over-diagnosis.

I believe some of these revised criteria have been met by Dr. Shoemaker and his co-authors. Dr. Shoemaker has published critiques of what has passed for evidence-based medicine guidelines in the management of mold illness prior to his ground-breaking work. The American College of Occupational and Environmental Medicine (ACOEM) and the American Academy of Asthma, Allergy and Immunology (AAAAI) published in 2002 and 2006, respectively, guidelines reporting that mold exposure was not capable of producing human illness. Much of the ACOEM “evidence” was based on opinion papers by defense consultants in litigation regarding water-damaged buildings (Bruce Kelman and Ronald Gots) and cited no human studies as reference material (41). Dr. Shoemaker cited an article in the Wall Street Journal and an article by Craner that exposed the bias and concealed conflicts of interest of the ACOEM authors: “there is nothing evidence-based in either the ACOEM or AAAAI, as that process begins with the observation of affected patients.” Dr. Shoemaker is clearly using the criteria regarding the best way to practice evidence-based medicine in his criticism of their lack of fulfillment of these criteria in publishing these opinion papers.

I have relied almost exclusively on Dr. Shoemaker and various co-authors of certain papers to understand the complexity of this multilayered condition. Dr. Shoemaker is extremely insistent that the steps to be followed in the diagnosis and treatment of this condition must follow the guidelines set out by his own research, as well as clinical practice and treatment guidelines. It is obvious that he has followed an evidence-based approach in this undertaking. Dr. Shoemaker began his original work with CIRS when he observed that patients with a mysterious disease seemed to improve when prescribed a lipid-lowering drug, cholestyramine. Based on that original observation, he explored the biology and pathophysiology of the disease processes in patients, using the best evidence available at the time, without the influence of financial interests. As he learned, he explored further hypothesises, published numerus studies, wrote books, collaborated with other researchers and lectured on the subject. He continues to utilise the best evidence-based practices in an attempt to understand the genomics that underlie CIRS and how the use of VIP (and the rest of the CIRS protocol) influences the proteomic and Neuroquant findings of affected individuals.

The proof regarding whether an evidence-based approach is effective in managing CIRS patients is whether the patients involved in the study enjoy improved health as compared to controls. At present, there are no long-term randomized trials of the Shoemaker approach to treating CIRS. In other words, his research may not have fulfilled the Level I criteria regarding what type of research best characterises evidence-based medicine. However, his work has nonetheless systematically fulfilled most of the other criteria in that it is patient-centered and documents responses to care that are quantifiable and reproducible.

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Resources

(*1) Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992; 268: 2420-5.
(*2) Ibid
(*3) Ibid
(*4) Greenhalgh, T., “Evidence-based medicine: a movement in crisis?” BMJ 2014; 13 June, 348
(*5) http://researchguides.uic.edu/ebm
(*6) Sackett D.L., et al., “Evidence-Based Medicine: How to Practice and Teach EBM.” Edinburgh: Churchill Livingstone.
(*7) Doherty, Steve. “Evidence-based medicine: Arguments for and Against.” Emergency Medicine Australasia 2005; 17: 307-13.
(*8) Sackett, D.L., Rosenberg, W.M.C., Gray, J., Haynes R.B., Richardson W.S., “Evidence-based medicine: what it is and what it isn’t.” BMJ; 312:71-72.
(*9) Kuhn, T.S., The Structure of Scientific Revolutions. Chicago, Ill: University of Chicago Press; 1970
(*10) Dossey, L., Alternative Therapies Sept/Oct 2002, Vol. 8, No.5 32
(*11) Rossouw, J.E.1, Anderson, G.L., Prentice, R.L., LaCroix, A.Z., Kooperberg, C., Stefanick, M.L., Jackson, R.D., Beresford, S.A., Howard, B.V., Johnson, K.C., Kotchen, J.M., Ockene, J. Writing Group for the Women's Health Initiative. (2002). “Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial.” JAMA. 288(3):321-33.
(*12) Family Practice News. (2003). 33(11), 1-2
(*13) Freedman D., (2010). Lies, Damned Lies, and Medical Science. The Atlantic. Nov 2010 Issue.
(*14) Ioannidis, J.P.A., (2005). Why Most Published Research Findings Are False. PLoS Med 2(8): e124. doi:10.1371/journal.pmed.0020124
(*15) Freedman D., (2010). Lies, Damned Lies, and Medical Science. The Atlantic. Nov 2010 Issue.
(*16) Csoka, A., (2015). Innovation in medicine: Ignaz the reviled and Egas the regaled. Med Health Care Philos. Springer Journal, Dec 4.
(*17) Wall Street Journal |Feb 25th 2009
(*18) Rogers, S., (2009). Total Wellness. Aug, p. 1.
(*19) Boden et al., (2007). New England Journal of Medicine. Optimal medical therapy with or without PCI for stable coronary artery disease. April 12, 356; 15:5003-16.
(*20) Evidence-Based Medicine Working Group. (1992). Evidence-based medicine: A new approach to teaching the practice of medicine. JAMA, 268(2420), p. 2422.
(*21) Department of Clinical Epidemiology and Biostatistics, McMaster University. (1981). How to read clinical journals, II: to learn about a diagnostic test. Can Med Assoc J. 124:703-710.
(*22) Godfrey, K., (1985). Simple linear regression in medical research. N Engl J Med, 313, p. 1629-1636
(*23) Department of Clinical Epidemiology and Biostatistics, McMaster University. (1981). How to read clinical journals, V: to distinguish useful from useless or even harmful therapy. Can Med Assoc J, 124, 1156-1162.
(*24) Ibid
(*25) Ibid
(*26) University of North Carolina, Health Sciences Library. (2016). “Forming focused questions with PICO.”
(*27) Evidence-Based Medicine Working Group. (1992). Evidence-based medicine: A new approach to teaching the practice of medicine. JAMA, 268, p. 2420.
(*28) Ibid
(*29) Ibid
(*30) Ibid
(*31) Cohen, D., (2013). “FDA official: Clinical trial system is broken.” BMJ, p. 347.
(*32) Turner, E., Matthews, A.M., Linardatos, E., Tell, R., Rosenthal, R. (2008). “Selective publication of antidepressant trials and its influence on apparent efficacy.” N Eng J Med, 358, p. 252-60.
(*33) Perlis, R.H. et al., (2005). “Industry sponsorship and financial conflict of interest in the reporting of clinical trials in psychiatry.” Am J Psychiatry, 162(10), p.1957-60.
(*34) Vigen, R., MD, MSCS1, et al., (2013). “Association of Testosterone Therapy with Mortality, Myocardial Infarction, and Stroke in Men with Low Testosterone Levels.” JAMA, 310(17), 1829-1836
(*35) Le Couteur, D.G., Doust, J., Creasey, H., Brayne, C. (2013). “Political drive to screen for pre-dementia: Not evidence based and ignores the harm of diagnosis.” BMJ, p. 347.
(*36) Allen, D., Harkins, K. (2005). “Too much guidance?” The Lancet, 365, p. 1768.
(*37) Greenhalgh, T., Howick, J., Maskrey, N. (2014). “Evidence-based medicine: A movement in crisis?” BJM. p. 348.
(*38) Roehr, B., (2012). “GlaxoSmithKline is fined record $3billion in US.” BMJ. 345, p. e4568.
(*39) Greenhalgh, T., Howick, J., Maskrey, N. (2014). “Evidence based medicine: A movement in crisis?” BMJ. p. 348.
(*40) Ibid
(*41) Shoemaker, R. (2010). Surviving Mold: Life in the Era of Dangerous Buildings. Otter Bay Books: Baltimore, p. 310-311.