I had the pleasure of attending the "Advanced Workshop in Chronic Inflammatory Illness" on April 23, 2022.  The event was taught by Neil Nathan, MD, Jill Crista, ND, and Lyn Patrick, ND. 

This was a superb event with a focus on heavy metals, PANS/PANDAS, and Cell Danger Response taught by some of the leaders in the field.  

Disclaimer: Nothing in this text is intended to serve as medical advice. All medical decisions should be made only with the guidance of your own personal licensed medical authority.

Disclaimer: This information was taken as notes during the training course and may not represent the exact statements of the speakers. Errors and/or omissions may be present.

Note: As this information may be updated as any errors are found, I kindly request that you link to this single source of information rather than copying the content below. If any updates or corrections are made, this will help to ensure that anyone reading this is getting the most current and accurate information available.

Lyn Patrick, ND spoke on "The Role of Toxic Metals in Immune Dysregulation and Disease: Assessment and Treatment" and shared:

  • Metals damage innate immunity; never more relevant than with COVID
  • Metals damage the gut; the seed of the immune system; the lining of the intestines can be damaged
  • Metals and mycotoxins deplete glutathione and other co-factors needed for glutathione recycling
  • Oral glutathione can be problematic if you cannot reduce it
  • Zinc, selenium, C, E, NADPH, CoQ10, ALA are co-factors
  • Toxicant metals impact T helper cells; upregulate Th2 and increase allergies, asthma; alter Th17 to increase autoimmunity
  • All toxicant metals increase production of reactive oxygen species and damage DNA
  • Metals compete with thyroid hormones; cadmium is a common endocrine-disrupting metal
  • Metals impact HPA-axis; lead specifically alters production of cortisol in either direction
  • MCAS is common with mold, but also with metals; mercury, gold, and silver impact mast cells; including from dental materials
  • Gold is not an inert metal and can be allergenic
  • Inside of a dental crown has many different types of metals
  • Can perform a MELISA test to look for immunoreactivity to metals; no longer available in the US
  • Titanium sensitivity is an increasing problem; 30% of titanium implants eventually fail due to reactivity; leads to bone loss and the implant falling out
  • Metals lead to autoimmunity, decrease glutathione, increase lipid peroxidation, alter Th1/Th2 balance; can lead to auto-antibodies and even cancer
  • Metals deplete glutathione, D, magnesium, selenium, and zinc
  • Has never seen an environmentally-ill patient with adequate levels of magnesium
  • Tsunami of nutrient deficiencies that metals aggravate or cause; potassium, D, choline, E, K, magnesium, calcium, A, and C among the top (in that order)
  • Uranium can be found in water sources in some areas
  • Cesium has been found in increased levels since Fukushima
  • Most clinically relevant: arsenic, lead, mercury, cadmium, hexavalent chromium, and new toxicants: gadolinium, cobalt, thallium, cesium (in that order)
  • Gadolinium from tracer scans particularly impact the brain; metal sensitivity to gadolinium occurs
  • Thallium can be from water and green leafy vegetables
  • Many metals can be found in dental materials, vaccines, antacids, and dental implants
  • Can have low amounts of a specific metal but high immune reactivity/sensitivity; nickel, gold, silver, aluminum, titanium, chromium, cobalt, and palladium
  • 1 surface of a tooth is enough to cause higher than safe levels of mercury; does not take a lot of amalgams; amalgams are more of a problem than fish exposure
  • 1 in 6 women have mercury levels high enough that can create a neurologic risk for their children; fish and amalgam sources
  • Inorganic mercury = amalgams and air pollution; leads to higher levels of fasting glucose
  • High fructose corn syrup is a source of mercury exposure
  • With unprovoked metal testing, patients with levels at 95% or greater are more relevant; or greater than the reference value from the laboratory
  • Lab reference ranges are often highly irrelevant to clinical presentation
  • Best to avoid fish for 5 days prior to urine collection for metals
  • Cobalt implants can lead to systemic metal toxicity
  • Blood levels of lead over 2 are problematic
  • Mercury is the hardest metal to diagnose; blood levels over 5 may be observed in fish eaters; patients can be sick in the 75th percentile or above; levels of 1.8 or above can be associated with autoimmunity and neurological problems
  • Mycotoxins are severely immunotoxic and inhibit DNA and RNA production; metals are immunotoxic and autoimmunogenic through their capacity to "tank glutathione"
  • Metal hypersensitivity adds to the immunotoxic burden of patients
  • Metals increase production of autoantibodies against myelin basic protein 
  • Lead and arsenic are involved in many types of cancers
  • Every adult human born before 1990 will have a body burden of lead
  • Low levels of blood lead to 1/2 a million adults a year dying from cardiovascular disease
  • 400,000 deaths per year in the US are attributed to lead exposure
  • For lead, filter water with RO/charcoal and consider DMSA/EDTA chelation
  • High levels of miscarriage from lead exposures in Flint, Michigan
  • Lead exposure leads to lowering of IQ
  • Anything over 1 mcg/dL is correlated with ADHD
  • Anything over 2.5 mcg/dL is correlated with death from MI and stroke
  • Do not use urine lead levels; there is no science behind it; standard of care is whole blood lead level
  • There is no safe level of lead period
  • Arsenic can contribute to gout, prostate cancer, pancreatic cancer, diabetes, and bladder cancer; non-provoked urine testing can show high levels; water, rice, chicken; serious carcinogen, diabetogen  and obesogen
  • 35% of the population has a risk level of arsenic that is related to disease
  • Can be benign arsenic from urine testing if still eating fish; best to stop for 5 days prior to collection

Dr. Patrick continued with "The Role of Other Toxicants in Mold Patients: Assessment and Treatment" and shared"

  • Mycotoxins and other chemicals are found in adipose tissue, muscle, brain, organs, ovaries, and testes; continue to do damage
  • Organochlorine pesticides such a DDT and others increase as we age; body burden of DDT goes up due to toxin accumulation; DDT increased risk of obesity in granddaughters of grandmother exposed to DDT
  • Chlordane has been used in millions of homes as a pesticide for termites; mostly in 1950s-70s; air levels in homes were higher than safe; increases risk for diabetes by 8 times; 50 years later had high levels from foundation
  • Brain and liver have a lot of fat and toxins are often stored in fat
  • There are no lab tests currently for organochlorine pesticide testing
  • PCBs are persistent organic pollutants; used in commerce in the 1930x-40s; later found to be significant carcinogens; children born after they were removed from commerce still high; eggs, butter, farmed salmon, or other animal products may contain PCBs as these are persistent pollutants; diabetogens, carcinogens, immunotoxins, respiratory toxins; found in those that eat a lot of butter
  • Butter is not a good food; significant amounts of PCBs
  • Immune burden: PCBs, organochlorine pesticides, solvents, plastics/bisphenols, Per/Polyfluorinated compounds; deplete glutathione, increase inflammation
  • EMFs are immunotoxic via nitric oxide; potent cause of MCAS!; exposure to EMFs lead to a document increase in histamine levels; MCAS patients must reduce EMFs; antioxidants such as CoQ10 and vitamin E can be helpful
  • Need to keep cell phones 6 feet away from the body
  • We are breathing hazardous air; acrylamide comes from air pollution much more than toast and other sources; need air filtration
  • Water filtration is necessary to optimize health; can no longer survive without air and water filtration 
  • Conventional almonds are a source of propylene oxide
  • Need an all organic diet; not just the Dirty Dozen
  • Pesticides are endocrine disruptors extraordinaire; alter estrogen, thyroid receptors, progesterone, prolactin, androgen receptors
  • Toxicants upregulate inflammation throughout the entire body; improve diet, water, and air
  • Film "Dark Waters" is a true story of Per/Polyfluorinates; these compounds are now in the air everywhere
  • "Forever Chemicals" are in drinking water of 200 million Americans; these were created to be permanent; they do not breakdown over time
  • Menstruating women have half-life of PFAS of 2-3 years as compared to men and post-menopausal women where it is 27-35 years
  • Vista Analytical is a lab that tests for PFAS; test for 24 analytes
  • PFAS cause high cholesterol, colitis, cancer, preeclampsia, liver damage, thyroid disease, decreased vaccine response, asthma, decrease fertility, low birth weight
  • One study found higher levels of PFAS (specifically PFBA) in the lungs, liver, and brain of those that died from COVID
  • Cholestyramine has been shown to decrease blood levels of PFAs over time
  • Therapeutic phlebotomy can be helpful for reducing PFAS
  • Phthalates and BPA from air, food, and water; immunotoxicants, reproductive toxicants, obesogens, diabetogens, and renal toxicants
  • Canned coconut milk is the highest food source of BPA

Some of the items discussed during the Q&A included:

  • Prefers liposomal glutathione; has been published as effective in human studies; has not seen data on S-Acetyl Glutathione
  • Bismuth is not absorbed through the gut
  • Titanium implants; dental implants fail 1/3 of the time; not the same for other titanium implants; titanium is a sensitizing metal
  • Chronic Fatigue can be related to metal sensitivity
  • Cannot treat titanium, sensitivity; must be removed
  • Uses Doctor's Data Urine Toxic Metals and QuickSilver Tri-Test and Doctor's Data Whole Blood Metals; RBC chromium for metal testing 
  • Dr. Nathan has found provocation testing important; DMPS and EDTA IV  or oral DMSA
  • Provocation testing is helpful only for what is stored in the kidneys; not for body burden; cannot use for diagnosis; should also have unprovoked levels
  • IV DMPS has been approved as a compounding agent; not for oral DMPS which can be a good intervention
  • Titanium dioxide is added as a whitening agent; processed food is "food we shouldn't eat"; overwhelming addition of metals and allergens added to processed foods; is a gut irritant
  • Only saw a copper deficiency in one patient
  • Dr. Nathan suggests the zinc/copper ratio is very important; excess copper can play a role in anxiety; measure serum zinc and copper levels; giving zinc can deplete the high copper level if present; 25mg zinc
  • KPU is common in mold and Lyme disease and may need to add B6 and magnesium in addition to higher doses of zinc; caution with long-term use of over 100mg/day of zinc
  • Lab testing can be done for sensitivity to materials prior to orthopedic surgery
  • Difficult to filter water being used for bathing and showering; hot water also vaporizes chlorine
  • Benefits of Epsom salt baths outweigh the toxicity concerns if you use a bath ball filter; not ideal to use tap water
  • Whole house water filtration would be provided to everyone if Dr. Patrick ruled the world
  • Domestic water is only safe for washing clothes
  • Prioritize filtering of water for drinking and cooking and then bathing/showering
  • Recommendation for gadolinium is EDTA chelation after a scan; continued until the gadolinium is gone; another source https://www.richardsemelka.com prefers zinc and calcium DPTA; also uses sauna, supplements, and botanicals
  • Hexavalent chromium is entirely different from nutrient chromium
  • Metals ranges are based on a spot urine
  • Inorganic arsenic is the toxic arsenic
  • Flu vaccine still contains mercury
  • Aluminum in vaccines is delivered directly to the CNS
  • Dr. Nathan mentioned Ledum 30C, Hypericum 30C, and Thuja 200C for vaccine reactions
  • Used to say that arsenic was the number 1 cause of gout; now believes it is lead
  • Dr. Nathan mentioned Candida feeds on sulfur; can lead to reactions to DMSA and other sulfur-containing materials
  • QuickSilver IMD can be helpful for mercury; not sulfur-based
  • Clifford Labs was acquired by Russell Jaffe, MD at ELISA ACT Labs and can do metal sensitivity testing
  • The most mercury toxic patients she has are those in Hollywood eating regular sushi 

Jill Crista, ND spoke on "PANS, PANDAS & Autoimmunity" and shared:

  • "Homeopathic Drug Pictures" book by Dr. Margaret Tyler
  • Conventional perspective is that these conditions are related to Strep; it is much more; including environmental toxicants
  • Top 4: glyphosate, mold, EMF, mercury
  • PANDAS and PANS are autoimmune encephalopathies
  • Autoimmune triggers are infection, toxin, and microbiome disruption
  • Immune deficiency is an antecedent state; it is not always "acute onset" as commonly suggested if you look closely
  • Brain stem (including limbic system), GI, possibly kidneys are involved
  • Symptoms: relapsing/remitting pattern averaging 3 months; relapsing could be a flare or new exposure; remitting could be effect of treatment or a typical pattern
  • Separation anxiety, concentration issues, urinary frequency/urgency, handwriting deterioration, sleep issues, behavioral regression, hyper-alert/enlarged pupils, hyperactive, inattentive, tics, learning difficulties, short-term memory issues, aggression, sensory alterations, disordered eating, hallucinations
  • Vocalizing through humming can increase nitric oxide on mucosal surfaces which is antimicrobial; can use as a nasal spray for tics
  • Clinical diagnosis; no labs required
  • High rate of seronegativity in PANS/PANDAS patients due to immune deficiency
  • Need to match the PANDAS criteria (with the exception of the suddenness)
    • Presence of OCD and/or tics
    • 3 y/o to puberty
    • Acute onset or episodic
    • Group A Strep association
    • Neurological abnormalities
  • Comorbidities: anorexia, urinary frequency, dilated pupils, insomnia, abdominal pain
  • Spinning tic or arm circles may be associated with Borrelia; a spiral-shaped bacteria
  • Has seen first onset of PANS at 21 years old
  • Strep is often perianal 
  • PANS Diagnosis Criteria
    • Category 1: Abrupt, acute OCD or severely restricted food intake
    • Category 2: Concurrent presence of additional neuropsych symptoms
    • Category 3: Symptoms not better explained by a known neuro or medical condition
    • Category 4: no age requirement
  • High risk of suicide in this patient population
  • Compulsion to take back control of thoughts
  • Listening to the compulsions can provide insights to where the body needs support
  • Kids get extremely adrenally burned out
  • Pets do not carry Strep but can lick someone and lick someone else and transmit Strep on the skin
  • Often very sick children with very inflamed brains
  • 2/3 of brain immune system is glial and 1/3 neurons
  • Microglia, astrocytes, oligodendrocytes
  • Microglia get rid of debris; astrocytes involved with glutamate and GABA as well as BBB integrity; oligodendrocytes are myelinators and provide axonal metabolic support
  • Innate immune system activation: pathogens, vagal pathways (bottom up), inflammatory cytokines, heat-shock proteins
  • Obese mice become skinny with microbial transplants from skinny mice
  • Antibiotics, mold, infections, neurotransmitters, vagal fibers, cytokines, and essential metabolites convey information about intestinal state to the CNS
  • Microbes outnumber human cells in both cell count and total DNA
  • Th17 is associated with increased risk of autoimmunity
  • Naïve CD4 T cells differentiate into TReg or Th17 cells
  • Group A Strep triggers a Th17 response
  • Mycotoxins do not have a scent; can ride directly into the olfactory bulb
  • Olfactory targets include the limbic system as well as other parts of the brain
  • Still should consider Strep in PANS even though it may not be the initial trigger
  • Immunity to one type of Strep does not confer immunity to others
  • Mechanisms
    • Pre-existing immune deficiency
    • T-cell mediated damage to brain triggered by infection/toxin
    • Microglial activation
    • CNS alterations
    • Damage to dopamine receptors and cholinergic interneurons
    • Alters dopamine pathways
    • Excitatory neurotransmitter state
    • Chronic or primed neuroinflammation
    • Possible chronic glomerulonephritis
    • "GALT"itis in the gut
  • Increased IgA deficiency in those with OCD, alterations on GI microbiome, association between antibiotic treatment for Strep and later risk for mental disorders, possible genetic predispositions
  • Antibiotics may not be the best tools for these conditions
  • T-cell mediated damage to the CNS from infections; can have autoimmune attack on basal ganglia
  • Microglial activation get stuck in inflammatory M1 state; remain more sensitive to systemic inflammation for the rest of the microglial cell's life
  • Chronic neuroinflammation in those with OCD from controls; generalized brain inflammation
  • Glyphosate leads to GI dysbiosis and impacts the CNS
  • Conventional Treatment Approach
    • Control inflammation with NSAIDs or steroids; Ibuprofen, Dexamethasone; Stanford PANS Clinic uses IV steroids
    • Prevent infection with antibiotics; Augmentin; Stanford PANS Clinic uses IM Penicillin
    • Remove reservoirs of infection; tonsils (the toilet of the sinuses)
    • Correct neurotransmitters; SSRIs/SNRIs, EMDR
    • Manage behaviors; CBT; modified-CBT; EMDR, EFT, limbic system retraining much more effective
    • Modulate immunity; IVIG, Rituximab (for IVIG failures), Plasmapheresis (Ochratoxin is a persister bound to albumin; sees in tests that control for creatinine; bioflavonoids/astaxanthin denature Ochratoxin from albumin)
  • "Core 4"
    • Guard the Gates
    • Anti-Bug       
    • Anti-Flame
    • Core Immune
  • Upcoming Book - "A Light in the Dark For PANDAS & PANS"

 Some of the items discussed during the Q&A included:

  • Adults with PANS and PANDAS follow the same approaches
  • If IgG subclass deficiencies, can use IgG oral such as SBI Protect
  • Bed wetting is definitely seen; associated with the mechanism and actual regression; ADH deficiency with mold can play a role as well; homeopathic Vasopressin can be helpful
  • Secretory IgA testing in stool is not a validated marker
  • If Ochratoxin is bound to albumin in the blood, binders may not be effective until it is dislodged with bioflavonoids; primary detoxification via kidneys, then gut, then liver
  • Spore-based probiotics can help rebalance the gut milieu and assist with production of butyrate 
  • Melatonin, CoQ10, and globe artichoke, parietaria for kidney support
  • Mold-affected PANS patients are more likely to have autism
  • Regular use of homeopathic flu nosodes during flu season have been helpful for her patients
  • 3 days in a row was shown to be optimal for IonCleanse; every 1-2 weeks; trace minerals on days off
  • Likes DHA Junior by Nordic Naturals along with SPMs
  • Often need to get patients out of mold exposure before one can address SIBO/SIFO
  • Uses Herbal Vitality brand for many herbs

Neil Nathan, MD spoke on "The Role of Mitochondrial Dysregulation in Chronic Disease: The Cell Danger Response Model" and shared:

  • Vast majority of people he is working with are profoundly out of balance and far away from any semblance of health; putting the ship back on course may not suffice
  • Most profound model of rebooting is "The Cell Danger Response Model" from Dr. Robert Naviaux
  • Before a cell is broken, mitochondria in an infected or toxic cell sense the presence of an intruder via voltage drop; not only energy factories but also a monitoring and signaling system
  • Mitochondria decrease their oxygen consumption and dissolved oxygen concentration in the cell begins to rise making cellular redox chemistry more oxidizing to help shield the cell from further injury
    1. Cells shift from polymer to monomer synthesis
    2. Cell membranes stiffen
    3. Antiviral and antimicrobial chemicals are released
    4. Mitochondrial fission and autophagy are increased
    5. DNA methylation is changed
    6. Endogenous retroviruses are mobilized
    7. Neighboring cells are warned
    8. Host behavior is altered
  • Methylation is often less than optimal but this is a protective mechanism
  • There is a seasonal shift in metabolism from mTOR and protein synthesis in summer to AMPK and recycling or autophagy in winter
  • Recent popularity of intermittent fasting to improve metabolism is soundly based
  • Cell Danger Response
    • ATP is released from cells under stress
    • Sulfur metabolism shifts so that glutathione is consumed and cysteine diverted; interfering with methylation
    • Vitamin D metabolism is altered; low vitamin D is intentional by the system
    • Histidine decarboxylase enzyme yields histamine; predictable that MCAS will occur
    • Mitochondrial heme centers are released from damaged cells; KPU is common
    • You cannot turn off the CDR until you convince the cell that toxins and infections are gone and stress is lessened
    • The body may not respond or respond badly to mitochondrial support when it is in survival mode
    • Tryptophan can be metabolized to serotonin or melatonin or to kynurenic acid and quinolinic acid which are inflammatory compounds
    • Antiviral component is regulated by lysine; dietary lysine opposes the CDR; may be an important part of treatment
    • CDR produces low plasma levels of P5P which increases kynurenine/tryptophan ration and keeps CDR going
    • Heavy metals accumulate and sequester with an activated CDR
    • Most or all patients in CDR will have heavy metal toxicity; fixing CDR recovers normal mechanisms to improve improvement in detoxification efficiency
    • Getting rid of heavy metals may not be the first thing you want to do
    • With a sick host, there is a sick biome; can't fix the biome until you address what is making the biome sick - toxins, infections, or stress
    • Will have trouble getting patients to respond to traditional approaches until you first deal with toxins, infections, and stress
    • Working on methylation, viruses, mitochondria, heavy metals and gut may lead to getting nowhere until you look for and find the root cause
    • CDR is adaptive but can become maladaptive once the danger is gone
  • For decades, ROS have been viewed as causative; they may not be the cause but a protective mechanism to be honored
  • The metabolome is the collection of all metabolites in cells, tissues, or organisms which are the end products of cellular processes
  • Metabolomics studies the chemical fingerprints that are left behind
  • Mice with autism normalized their CDR with the use of Suramin
  • Studies have shown distinct chemical signatures in males and females with CFS; but the males and females had different metabolites
  • Proves without any doubt that CFS is not a psychological illness; there are metabolic differences
  • 80% of metabolites where decreased consistent with hypometabolism
  • CFS is a metabolic illness, not a psychological illness
  • Triggering events are biological, chemical, physical, psychological trauma
  • Biological triggers are common, but there is no one agent that was more prevalent; there are multiple causative factors
  • Studies done in men do not apply to women
  • Decreases in sphingolipids and glycosphingolipids observed in both; critical in membrane physiology
  • May represent a response to oppose the spread of viral and intracellular bacterial infections by stiffening the membranes
  • Altering of sphingolipid structure impacts cell membranes
  • Bacteria and viruses use sphingolipids to affect their relationship to the host; can facilitate entry and exit of viruses into/from cells
  • Have to reverse the biochemical issues set off by the triggering agents
  • Dr. Naviaux currently studying Lyme disease
  • The metabolomic pattern is different in each condition; a unique fingerprint
  • These profiles may be available commercially in the next 5 years
  • 19 purinergic receptors; ATP, ADP, and other purines
  • Only herb studied for purinergic receptor blocking is Chinese Skullcap; can be useful in turning off purinergic signaling to address CDR
  • Suramin blocks all 19 purinergic receptors
  • Vitamin D, lysine, methylation support, P5P, treatment of metals, toxins, infections, and KPU could be helpful tools once out of the CDR or coupled with Suramin; cannot use these when in survival mode
  • Treatment of acute illness is not the same as the treatment of chronic illness; treating an injury vs, unblocking the healing cycle
  • High viral titers are commonly seen, but stress, toxin, or other infection may be the root issue keeping them going
  • The original trigger may no longer be present, but the biological reaction leads to persistence of the condition
  • Every chronic disease is a systems problem that cannot be resolved with the old paradigm
  • Cells that cannot communicate are lost to the tissue and leads to more damage and disease
  • You are well, get an exposure, and the CDR kicks in; what is called CDR1 which is the stuck phase
  • When the body senses it is "safer", then it can move to CDR2 which uses more effective energy production and begins a healing phase
  • Full differentiation and development occurs in CDR3 and there is a move back to complete healing
  • Mitochondria have 3 forms
    • M0 - uncommitted
    • M1 - proinflammatory (defense)
    • M2 - anti-inflammatory
  • Healing cycle has a beginning, middle, and end
  • extracellular ATP or eATP is the key signaling molecule; "danger, danger"
  • All stressed cells leak ATP
  • eATP is critical in all stages of the healing cycle
  • In CDR1, mitochondria are M1; stuck in primitive glycolysis for energy production; initiate oxidative shielding and inflammasome activation which keeps the cycle going
  • Cells that are in CDR1 must disconnect communication with neighboring cells; cells, tissue, and organs are "lost"
  • In CDR2, less oxidizing; lost cells from CDR1 must be replaced; M0 mitochondria; damaged cells apoptose
  • In CDR3, cellular differentiation, detox, tissue remodeling, adaptive immunity, metabolic memory, sensory/pain modulation, and sleep architecture; new cells must be "educated" by the "old pros"; eATP must decrease to move to the health cycle 
  • Exercise is medicine and reminds the body how to heal
  • Sleep is medicine; disruptions are a risk factor for illness
  • End organ resistance to hormone signaling is part of the CDR; reestablishment of hormone sensitivity begins in CDR3
  • When CDR is activated, coordination between the two limbs of the vagus nerve is disrupted; sympathetic nervous system predominates; POTS/PANS/PANDAS observed
  • Virtually every chronically ill patient has mitochondrial dysfunction, but when will supporting it be helpful?
  • Treatments directed at any one checkpoint may backfire
  • 200mcg of 5MTHF and 2000mcg HB12 lead to normalization of glutathione in an earlier study
  • Cells may resist healing as it may be perceived as a threat
  • The material they may need and benefit from may lead to a reaction that is not truly a Herx but the system doesn't know what to do with the material; in those cases, continuing the treatment may be the right path forward
  • Triggers of CDR may be: infections, fever, MCAS, cytokines, pesticides, flame retardants, air pollution, genes
  • The longer he treats patients, the more he questions that other factors could be responding; same antibiotics for Bartonella may work for other infections as well
  • Mold toxicity looks like it responds to binders.  Could it be reducing other toxins that are the reason for the improvement?
  • Mold and Lyme disease are two of the major triggers of CDR; other environmental toxicants such as heavy metals play a role
  • Some will respond to treatment with binders alone, but some may need to treat colonization of mold and Candida in the sinuses and gut
  • Failure to look for Lyme associated infections will leave patients stuck in CDR1 with no path forward without causal resolution
  • Future is exposomics to look for pesticides, flame retardants, phthalates/plasticizers, POPs, personal care products, RX and veterinary drugs 

  Some of the items discussed during the Q&A included:

  • Tends to avoid mitochondrial supplements early in treatment
  • IV NAD, peptides, ozone, stem cells, fecal transplants are all popular; doing them in early CDR will often backfire or do nothing
  • HBOT and oxygen therapies are not logical tools early in the CDR; would work better at end of CDR
  • When Suramin becomes available, it could be a game changer if used properly
  • There is no test yet to know which stage of the CDR a patient is in
  • When there is observed improvement and are 50% better, may then do a trial of CoQ10, L-Carnitine, D-Ribose and observe the response; if no response or a negative response, may still be "stuck"
  • For patients that tolerate glutathione, it can be very helpful; he has an equal or larger group of patients that feel horrible when they mobilize toxin faster than they can process it; double-edged sword
  • Glutathione is the end product of methylation; sends the message that the body can stop methylating; use caution in sensitive patients
  • Long COVID follows the CDR model and is identical to what is seen in Lyme, mold, and similar conditions
  • If still living in mold, you won't be able to get out of the "stuck" phase of the CDR
  • You cannot get well from mold toxicity if you are living in a moldy environment; can improve to a limited extent with treatment while still exposed
  • Vast majority of his patients are stuck in CDR1; Chinese Skullcap may work better in CDR2 or CDR3
  • Can use DNRS and limbic system retraining in CDR1; limbic, vagal, and MCAS tools need to be addressed in that order
  • Limbic system retraining can help the body and the cell to feel "safer"
  • Initially thought that patients with mold and Lyme could be significantly impacted by COVID; that did not happen; people that got really sick from acute COVID had a cytokine storm that they were unfamiliar with where those that already have inflammation did not have the same rise; long COVID is a factor in keeping patients sick longer; mold and Lyme could perpetuate long COVID
  • Mushrooms as food are a signal to shift from mTOR to AMPK; we no longer honor the natural shift of the seasons
  • Different areas of the body can be in different stages of the CDR at the same time
  • Dr. Crista agrees mold has to be addressed first; difficult to get the body to calm down when it knows there is still a problem
  • Most people want to start with what they know; often, that is Lyme, but experience suggests that mold should be addressed before Lyme; symptoms are so similar that what you think is Lyme/Bartonella could be mold; if you address mold, you may not need to address Lyme; treating mold is easier and less harsh than treating Lyme
  • Sensitive patients often cannot treat mold and Lyme at the same time
  • Mold toxin interferes with the body's ability to absorb and utilize thiamine; ideally taken with magnesium
  • Rare for people to get well sooner than a year; often 2-3+ years
  • In his sickest patients that do not respond to limbic system, vagal, or MCAS work, there is often an energetic or psychological component to explore

Some of the items discussed during the case studies included:

  • Fusarium mycotoxins can be a contributor to PCOS and estrogen dominance
  • Zearalenone may not appear on urine mycotoxin testing when supporting glucuronidation
  • Bioclinic Naturals EstroVantage EM can be helpful for Zearalenone
  • Cinnamon, clove, oregano, and thyme can be helpful for Fusarium
  • Metformin binds thiamine and potentially leads to thiamine deficiency
  • Trichothecenes intensify iodine deficiency
  • Depleted uranium is high in the jet stream and bumps out iodine
  • T3 has a protective effect against damage from mold; high normal T3 range
  • Dr. Crista likes QuickSilver EDTA which contains Alpha Lipoic Acid
  • High copper can be from water source if not being filtered
  • Where there is mycophenolic acid, there is actively living, growing mold
  • Cryptolepis can help for Borrelia and Bartonella and also help with ear ringing which can be triggered by Bartonella
  • Dr. Crista sees Saccharomyces boulardii flare neurological symptoms in her patient population
  • Low MSH can benefit from GTex Green Tea and vitamin E (for protection) and then followed by the use of tanning bed
  • Integrative Therapeutics Y-Formula contains oregano and thyme
  • Once MCAS has been triggered, supplements alone may not be enough; may need to work on limbic and vagal systems
  • When mold is treated and inflammation goes down, Bartonella may become activated; can lead to increases in MMP9
  • Topical DHEA is not well-absorbed; oral often works better
  • Elevated liver function tests are not always a concern; unless they are more than 3 times the upper limit of normal; should be closely monitored

Disclaimer: While I attempted to accurately represent the statements of the various speakers, it is possible that the above contains errors or inaccuracies. If you have any corrections to the content listed above, please Contact Me.   


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  BetterHealthGuy.com is intended to share my personal experience in recovering from my own chronic illness.  Information presented is based on my journey working with my doctors and other practitioners as well as things I have learned from conferences and other helpful resources.  As always, any medical decisions should be made only with the guidance of your own personal medical authority.  Everyone is unique and what may be right for me may not be right for others.   

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