Lyme Association of Delmarva: Integrative Medicine For the Treatment of Tick-borne Diseases

Details: Created: June 01, 2018; Last Updated: May 04, 2018

I had the opportunity to attend "Integrative Medicine For the Treatment of Tick-borne Diseases" hosted by the Lyme Disease Association of Delmarva on April 20-21, 2018. This was the first event I have attended from the Delmarva group. The event was put on by Marilyn Williams, and she did a super job of bringing together great speakers, great exhibitors, and putting on a fantastic, informative event! I had an amazing time with some old friends and made some new ones.

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 conference 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.

Ann Corson, MD spoke on "The Chronic Illness Puzzle - Diagnosis and Management" and shared:

Mold exposure can lead to EMF sensitivity; we need to remove the mold.
Emotions can trap toxins; we need to release emotional issues.
Most patients are stuck below the biological divide in the German homotoxicology model.
If you fix the headwaters, the body can heal itself.
Any blood-sucking insect can transmit infection.
Babesia duncani can be difficult to eradicate.
In cryopreservation of animal semen, Borrelia survived better than the semen.
Borrelia cysts are biologically active.
Babesia and mold sweats can be drenching.
Sleep issues can be the results of infections in the CNS.
Borrelia generally impacts larger joints and Bartonella smaller ones.
Low back pain can be an indication of need for kidney drainage support.
She has only seen one AV block in 36 years of practicing medicine; it is not that common.
Prostate issues often refer pain to the tip of the penis.
Difficult periods can be related to hypercoagulation.
Periods are another way the body can move toxicity out of the body.
When one is sensitive to things like tags on clothing, this can be associated to Bartonella.
Kids living in mold may have stimming, rage, irritability, and related symptoms similar to autism; often resolves when getting out of mold.
When limbs fall asleep, that can be a sign of hypercoagulation.
Psychotic breaks can be a sign of an infected brain.
Cutting behaviors are often associated with Bartonella.
Borrelia may be sexually transmitted and should be considered an STD.
A fetus can acquire Borrelia and co-infections during pregnancy.
Babesia is a rapid onset with high fever, vise-like headache band around the head, day or night sweats or chills, air hunger, dry cough, profound fatigue, anxiety and panic, low grade anemia, elevated ferritin, and hypercoagulation.
Bartonella is likely an infection carried by most veterinarians.
Bartonella may lead to fatigue, headache, low grade fevers, abdominal pain, lymph enlargement, sore soles of the feet, twitching, seizures, tremors, rage, anger, mood swings, OCD, subcutaneous nodules or lipomas, rashes (often look like stretch marks), and increased VEGF.
Acne often improves with Bartonella treatment.
Ehrlichia and Anaplasma may be stabbing/shooting pains, seizures, low WBC, and low platelets.
Biofilms can lead to cold hands and feet, poor capillary refill, headaches and pain behind the eyes, scalp sores, sinus congestion, nasal drip, teeth pain, palpitations, shortness of breath, air hunger, dry cough, abdominal pain, nausea, IBS, bladder pain, joint pain, muscle pain, twitches, fatigue, sweats, chills, flushing, insomnia, brain fog, anxiety, OCD, and more.
What was thought to be Protomyxzoa is now believed to be more fungal in nature but seems to respond to antiparasitics.
When biofilms are an issue, Protomyxzoa and Funneliformis are often prevalent.
Root canals are "puss pockets".
For foods, look at IgA or lymphocyte testing; not IgG alone.
She does not do provocative testing for metals early on; if at all.
Strep is often on the bus, but is not the driver of the bus. Mold or Bartonella may often be the drivers.
Bifidobacterium can help to reduce histamine.
Boluoke is the only lumbrokinase that consistently works. Allergy Research Group Nattokinase softgels are also a good option for coagulation support.
Cholagogues are needed to increase fluid flows in the abdomen.
If you don't address mold, you won't get your patients better.
Hypercoagulation is the next most common thing people miss after mold.
The items that are often overlooked include mold, hypercoagulation, infections such as Protomyxzoa/Funneliformis, root canals, cavitations, metals, structural issues, methylation issues, and non-compliance with the treatment protocol.
She uses urinary mycotoxin testing with RealTime Labs and is exploring the Great Plains MycoTOX.
If you do not remove yourself from mold, you WILL NOT get better.
1 in 4 are predisposed genetically to a biotoxin illness. 1 in 5 are predisposed to hypercoagulation.
Mold exposure leads to more hypercoagulation. Moving metals or mold in the body can lead to hypercoagulation.
Ridges on the tongue can be related to hypercoagulation.

Kristine Gedroic, MD spoke on "Methods of Maintaining the Gut Microbiome and Detoxing" and shared:

A healthy gut is key to a healthy body.
IL-6 is related to hypersensitivity syndromes; light, sound, touch.
There are a multitude of anti-inflammatory effects of butyrate.
Glyphosate impacts the production of Bifidobacteria which creates butyrate; butyrate is our gut anti-inflammatory.
Our ancestors had more butyrate than we do today.
In terms of vitamin D, VDR turns on 1,000 antimicrobial peptides.
Vitamin D 25 is turned into 1,25 by activated macrophages.
When calcitriol binds, the bug dies.
The bugs block the receptor, and calcitriol turns on but cannot get to the receptor, and there is no feedback loop to turn it off; as a result, it rises.
It binds to other receptors and can lead to low testosterone and other hormones.
When there is no more bacterial burden, 1,25 goes down.
She is hesitant to give vitamin D in those with infections.
Autoimmune patients have elevated 1,25 levels.
We are all missing butyrate; there are oral and IV options that can be explored.
Sodium Potassium butyrate requires caution in those with blood pressure issues.
Molds make a fat that block folate receptors. High B6 and high B12 may be seen in patients that are not taking these B vitamins. These are often mold patients, or Candida may be blocking receptors. If you unblock the receptors, the B vitamins will be taken up.
Molds and viruses make VLCFAs (very long chain fatty acids) that lead to cell membrane stiffness. Butyrate gets rid of these fats in the lipid rafts.
Interfering with lipid raft formation may have implications in helping Borrelia treatment.
If you kill bugs but don't fix the terrain and architecture, you will still have issues. Adherent fatty acids are often very significant.
Borrelia steals PC (phosphatidylcholine) from human cells; Borrelia takes the PC and unloads its "junk".
Recovering lipid balance may require PC, Balance Oil, Prometol, Butyrate, and Evening Primrose Oil.
She often uses "The Power Drink" which includes protein powder, PC, SR3 Oil (Balance Oil), Evening Primrose (in some), and electrolytes.
Recovering the gallbladder often includes bitters to get the bile flowing. Ox bile, butyrate, and colonics may be helpful.
For intracellular burden, may use tools like Beyond Balance BAR-1 or BAR-2, Byron White A-BART or A-RMSF, TOX-EASE, TOX-EASE GL, Pekana products, or Beyond Balance MC-BFM-1.
Antibiotics create biofilms.
Many PANS kids are glyphosate kids.
Diet: need to eliminate sugar, reduce carbs, and incorporate pre and probiotics, bone broth.
Icelandic and Mountain Valley Water are the two best options.
Gallbladder ND is a good cholagogue. Himalaya Liver Care can be helpful.
May use Allergy Research Pancreatin and/or Ox Bile (Allergy Research or Vital Nutrients).
Cholagogues are best taken on an empty stomach; doesn't have to be before meals.
We should have calcitriol release antimicrobial compounds and then break down.
The biggest part of the health epidemics we face today is mineral deficiency.
BodyBio has good mineral options, MegaFood Mineral, and BioPure.
When looking at PCs, lecithin-based PC breaks down in the gut and does not get fully absorbed.
If actively treating infections and D 25 is over 20, she does not give vitamin D.
Wants 25 and 1,25 to be within 10-20 points of each other; which is a sign that the patient is not struggling with a lot of issues.
Ideal Calcitriol may be 40-60.

Ying Zhang, MD spoke on "Persisters" and shared:

Borrelia persisters are an explanation for treatment failures.
Most LLMDs don't cure a patients, but instead put a patient into remission.
The debate is whether this is PTLDS (Post-Treatment Lyme Disease Syndrome) or a treatment failure.
Dormant forms cannot be readily cultured but do replicate.
Small minor populations not killed by antibiotics are called persisters.
When removing antibiotic therapy, the persisters start growing again.
In TB, drug combinations of 3-4 drugs are used for many months and include the persister drug Pyrazinamide.
A persister drug is like a shovel to uproot the daisy rather than a lawn mower that cuts it off but still grows back.
Cefuroxime and Ceftriaxone were good options in his research.
Daptomycin, Clofazimine, Cefoperazone, Carbomycin were all good.
Clarithromycin appears to be better than Azithromycin.
Tetracycline was better than Doxycycline.
Persister drugs used alone have limited activity.
Daptomycin + Doxycycline + Cefoperazone was the best combination.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373819/
Pulse dosing does not work for persisters and biofilm forms.
A drug combination approach is needed.
His research looked at 34 different essential oils and some were really effective - even more than Daptomycin.
Oregano, Cinnamon Bark, and Clove Bud were the top three.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641543/
They seem to kill the persisters and dissolve the biofilm.
Other essential oils that have been evaluated include garlic, allspice, cumin, palmarosa, myrrh, hedycheim, amyris, thyme white, litsea cubeba, and lemon eucalyptus.
https://www.biorxiv.org/content/early/2018/02/06/260091
His team has a paper coming soon on agents that may be helpful in treating Bartonella.

During the Q&A, Dr. Corson mentioned that allopathic antimicrobials may cause more damage than herbal options. She shared that stool IgA, serum IgA, and lymphocyte stimulation testing may be helpful for food allergies.

Dr. Zhang mentioned that methylene blue showed good activity against persisters when combined with other drugs. He continued that minocycline penetrates the blood brain barrier better than Doxycycline but may or may not be of notable additional benefit.

Dr. Corson mentioned that Morgellons may be associated more with Bartonella than Borrelia - all with Morgellons appear to have both microbes. You can see different fibers with a 60X microscope/magnifier. She suspects glyphosate may also play a role.

Rosalie Greenberg, MD spoke on "Psychiatric and Behavioral Manifestations of Tick-borne Diseases in Children and Adolescents" and shared:

Note: I was unable to attend most of Dr. Greenberg's lecture and thus my notes are only a partial representation of her broader discussion.
3/4 of her bipolar kids are positive for tick-borne infections.
She herself was positive for Barotnella with Galaxy Labs and confirmed those results with a second test and biopsy.
She feels that Galaxy is a very good test for Bartonella.

Simon Yu, MD spoke on "Parasites and Dental Problems as Contributing Factors in Chronic Illness" and shared:

He sees Lyme patients after they are treated for "Lyme".
Uses Acupuncture Meridian Assessment energetic testing as one of several evaluation tools.
The pattern on the AMA in autism is an inflammatory state (56+ on the EAV scale).
He has a mom that gave her child her anti-parasitics and the ASD-child recovered.
Think parasites when the latest Lyme therapy fails.
Think dental when the latest Lyme therapy fails.
Some people are more impacted by EMFs due to heavy metals in the mouth which make them more susceptible.
He uses dental testing from DNA Connexions.
Doxycycline, Clindamycin, and Amoxicillin are often what he finds needed to balance the AMA testing for dental stress; often a combination used on Lyme treatment as well.
He is not sure about "rope worms" but is doubtful that it is a new worm. He called it a "Russian hoax" and suggested that it may be epithelial cells from the GI tract sloughing off.
Parasites have their own set of organisms inside of them.
Have to consider emotional and spiritual parasitic relationships.
4.46 billion people are infected by parasites, and parasites are a leading cause of mortality on a global scale.
Cancer patients often have a parasite problem.
Some parasites can be transmitted through the inhalation of eggs.
Stool analysis for parasites is simply not a reliable test.
Most parasites are outside of the intestinal tract.
When he was in the army and used Pyrantel and Mebendazole, many people got better.
He has given up on doing parasite tests as it is a waste of money and often misleading.
The symptoms of Lyme and symptoms of parasites overlap.
After parasites are addressed, he often sees a fungal problem emerge.
Fungus are often more than Candida and yeast; he may used a combination of Nystatin, Fluconazole, and Itraconazole in some patients.
So many autistic children have parasite problems.
Parasites are the top of the food chain and control our behavior and our mind.
He never uses Ivermectin alone - always combined with Pyrantel, Praziquantel, Mebendazole, Albendazole, Tinidazole, or similar.
Have to be aggressive with dosing to be therapeutic or the parasites go deeper.
He referenced the site http://debugyourhealth.com as a source of information based on his work on parasites.
You have to get rid of parasites and dental issues to recover health. Then he may look at food allergies.
He likes the book "The Plant Paradox".
Ivermectin has been shown to help reduce certain cancers.
Dental and GI issues lead to silent inflammation in the body.
Don't look at Lyme alone when attempting to recover health.

Bob Miller, CTN spoke on "Epigenetic Factors Combined With Genetic Variants That Contribute To Chronic Illness" and shared:

He commonly finds genes for over-absorption of iron; HFE variants.
They then looked at glutamate and found there was more of a predisposition for higher glutamate in those with Lyme.
Iron leads to hydroxyl radicals.
Found more NRF2 and KEAP1 variants in those with Lyme.
Higher free radicals and lower antioxidants.
Increased mTOR and reduced autophagy.
Acetylation weaknesses impact the clearing of histamine.
Leads to mast cell activation.
Our modern environment stimulates mTOR and weakens autophagy.
Increased mTOR and environmental factors lead to mast cell activation.
The focus is to balance mTOR and autophagy and to stabilize mast cell activation.
Genetics is accurate when you look at the patterns.
mTOR is growth; authophagy is cleanup.
It is often required to slow mTOR and increase autophagy.
Caloric restriction and ketogenic diets can support balance.
Xenoestrogens from plastics in water stimulate mTOR.
We eat more sugar in a week than our ancestors had in one year.
Cell towers stimulate mTOR; calcium voltage channel genes make some more sensitive to EMFs.
Bone broth can stimulate glutamate which stimulates mTOR.
PON1 helps to clear pesticides; with variants, one may be less able to clear glyphosate which can disrupt the biome and increase glutamate.
In general, people have gotten carried away with a focus on MTHFR - too much folate stimulates mTOR.
Iron in excess creates massive amounts of inflammation.
Fenton Reaction - iron combined with hydrogen peroxide; if you don't make enough catalase or glutathione, this lead to hydroxyl radicals.
Hydrogen water takes the hydroxyl radicals and turns them into water. This is an issue in 70-80% of those with Lyme.
Blood levels can look anemic as iron turns into free radicals; supplementing with iron makes things worse.
Cysteine or NAC are often used as a precursor for glutathione. In some cases, cysteine + hydrogen peroxide leads to free radicals.
"It is better to make it than to take it."
Nrf2 is like your sprinkler with a water pipe behind it. KEAP1 is the sprinkler; Nrf2 is the water. Genetic variants in KEAP1 are probably the most clinically significant.
Supporting the glutamate to GABA conversion often leads to much better sleep.
ABP1 gene makes DAO, not DAO genes.
He loves honokiol as it supports the conversion of glutamate to GABA and supports longevity and sleep.
Fermented foods can be bad if one is low in DAO.
In chronic Lyme, there is often difficulty making pantethine and Acetyl-CoA.
He predicts that the PANK genes will be as significant or more significant than MTHFR in the future.
Progesterone may help with MCAS; estrogen may worsen.

Tom Moorcroft, DO spoke on "Detoxing the Brain" and shared:

Lyme disease is found in parasites.
Lyme and parasites can be associated with plaques in the brain.
Chlamydia pneumoniae leads to a 5 times increased risk for Alzheimer's.
Borrelia leads to a 4 times increased risk for Alzheimer's.
90% of brain detoxification happens while sleeping.
Increasing sleep increases IL-6 systemically.
Melatonin peaks in puberty and then declines; helps patients to improve their sleep hygiene.
Blue light suppresses melatonin and leads to insulin sensitivity.
Melatonin can decrease parasitaemia in those with Trypanosoma cruzi infection.
Turning off WiFi can lead to a worsening of symptoms the first couple of weeks due to a detox reaction.
Uses a compounded spray with ULDN (ultra-low-dose-naltrexone), RG3, and other ingredients to reduce inflammation in the brain.
Buteyko Breathing can be helpful both for sinus support and systemic effects.
Exercise promotes glymphatic clearance of amyloid.
More than one alcoholic drink per day may lead to cognitive decline.
Brain Detox 101 - sleep sanctuary, WiFi off, alarm clocks and phones in airplane mode, remove electrical items, consider an inclined sleep position, explore intranasal infections, exercise, nutrition (limit caffeine after 3pm), limit alcohol, and reduce stress.

In the Q&A, a question was asked about vaccinations. Dr. Moorcroft suggested that glutathione, vitamin C, and MitoSpectra can be helpful to support vaccine reactions, and Dr. Corson added that Phosphatidylserine and Phosphatidylcholine can also be very helpful.

Dr. Corson likes to have her patients breastfeed; as long as they are being treated if they have Lyme.

Neil Nathan, MD spoke on "How to Evaluate and Treat Unusually Sensitive and Toxic Patients" and shared:

If you can take care of the sensitive of the sensitive, you can take care of everyone else.
Dr. Nathan speaks for those who have become so sensitive that no one believes them.
IV Phosphatidylcholine in very small doses is one of his favorite treatments for sensitive patients.
When he cannot start treatment because the patient is too sensitive, he likes Annie Hopper's DNRS system; as patients do the DNRS work, they can often then tolerate other treatment options.
Many sick patients need to do spiritual and emotional work to get well.
Treating methylation pathways prematurely may not be tolerated.
Sensitivity may be to light, sound, touch, foods, chemicals, and EMFs.
Causes of sensitivity are often mold or Bartonella; can also be Mast Cell Activation Syndrome, porphyria, metals, viruses, Mycoplasma, Chlamydia, Cipro, cervical trauma Fibromyalgia (can be treated with Frequency-Specific Microcurrent; FSM), polyvagal theory/safety.
Those with MCS have mold and Bartonella until proven otherwise; not looking at these may miss an opportunity for cure.
Polyvagal theory is related to the autonomic nervous system; the ventral vagus component can override more primitive reflexes. The function is safety; if not safe, you either freeze or flee; sympathetic dominant.
The book "Accessing the Healing Power of the Vagus Nerves" by Stanley Rosenbery provides exercises that can help get the ventral branch of the vagus nerve working.
We need to feel safe in order to heal; can become a form of PTSD.
Frequency-Specific Microcurrent can quiet the vagal nerve.
Dr. Nathan made a plea to LLMDs to "please get interested in treating mold too".
If a Lyme patient is not getting well, they very, very likely have mold.
Practitioners have to ask if the diagnosis fully or mostly explains the patient's symptoms.
Environmentally-acquired chronic inflammatory illnesses are the triggers; http://www.iseai.org
The health effects of mold can be the result of allergies, infections, or toxins; one can have any or all of these.
Inflammation results from innate immunity; Shoemaker pathway.
Acquired immunity can lead to mold allergy which adds to mold toxicity.
Think about mold allergy as well as mold toxicity as it can be a limiting factor in treatment.
"Mold" is a soup of fungi, Actinomycetes, Mycobacterium, VOCs, beta glucans, hemolysins, mannans, proteinases; it is more than just mold.
25% of the population may be genetically predisposed to mold toxicity; have an inability to process mold toxins.
The more toxic molds include Stachybotrys, Penicillium, Aspergillus, Chaetomium, Fusarium, Wallemia, and Alternaria.
Mold interacts with Lyme and viruses; Lyme weakens the immune system to mold and vice versa; one sets the stage for the other.
Mold predisposes to MCS, electromagnetic dysthymia, food allergy, autoimmunity.
Mold makes everything worse.
Mold toxins can lead to fatigue, weakness, muscle aches, cramps, ice-pick pain, lightning bolt pain, headaches, sensitivity to light, tearing, blurred vision, chronic sinus congestion, cough, chest pain, shortness of breath, GI issues, joint pain and stiffness, cognitive issues, skin sensitivity, mood swings, night sweats, temperature regulation issues, numbness/tingling, metallic taste in the mouth, excessive thirst, static shocks, and more.
If there are parasthesias in non-anitomical areas (not the fingers or feet but in the nose, chin, or back), think mold and/or Bartonella.
Mold toxicity may look like Fibromyalgia, CFS, "atypical" MS/RA/Parkinson's/Alzheimer's, asthma, chronic sinusitis.
When you hear the word "atypical", think mold and/or Lyme/Bartonella.
If anxiety (not related to a specific stress), depression, depersonalization, cognitive impairment, mood swings, think mold.
Unique or hallmark symptoms of mold are electrical shocks, ice-pick pains, parasthesias in unexpected places, internal vibrations or tremors, and increased sensitivity to everything.
The biotoxin pathway is a brilliant understanding of how mold illness triggers the symptoms that it does.
Treatment is to remove the toxin and remove the exposure.
It is treatable, but complicated.
It is mandatory to remediate or leave the environment in order to get well.
In the Shoemaker world, one measures MSH, VIP, TGFb1, C4a, VEGF, MMP9, ADH/Osmo, MARCoNS, and VCS. These are not specific tests.
The tests can be positive with mold, Lyme, or Bartonella. They say you are inflamed but don't nail why.
MMP9 can be upregulated in Bartonella or mold.
The markers are not particularly useful clinically.
Mold, Bartonella, and Lyme impact the pituitary and the resulting hormonal picture.
Looking at adrenals, thyroid, and sex hormones can be helpful to improve symptoms.
Some people think MARCoNS really matters; he does not find that it matters much clinically.
It is often still culture positive after months (or years) of BEG spray.
He has not seen MARCoNS treatment do anything clinically; it is a trivial part of the larger picture; a commensal.
He has treated 2000+ patients with mold and Lyme.
Many value and routinely use the HLA-DR testing. He has not seen clinical correlation between HLA and clinical outcome and thus does not find it useful.
The term "dreaded" is something he dreads; it put unnecessary negativity into a patient.
Visual Contrast Sensitivity (VCS) testing can be helpful to monitor treatment as you can see it improve with effective treatment.
Urine mycotoxin testing, however, does not agree with VCS testing very well. You can be toxic with mycotoxins and still have a normal VCS.
Air sample testing is the worst option. Stachybotrys is the heaviest and does not stay in the air. Air sampling is used because it is so inaccurate.
ERMI is the gold standard. The vacuum sampling is better than the Swiffer. It looks for 36 toxic molds. You can then look at the HERTSMI-2 score which is quite valuable.
Immunolytics mold plates are helpful. You let them sit for 2 hours on the floor and then watch them for 3-5 days. 50% what grows is not toxic to humans; if there is growth, you will want to send them in to be evaluated.
The "Brewer Model" is more encompassing.
Measures urine mycotoxins which are much more specific; uses RealTime and Great Plains MycoTOX; very reproducible and accurate.
Even with the new Great Plains test, he prefers the use of challenge testing using liposomal glutathione for seven days twice daily and then collecting the urine on the seventh day. Sweating, sauna, or hot bath may help liberate mycotoxins so that they come out in the urine.
Many cannot tolerate the seven day challenge and as soon as they start to feel worse, the challenge is stopped and the test is performed. The objective of the provocation has already been met.
Anything positive is relevant and important in the urine mycotoxin testing.
The first test may be the tip of the iceberg. The second test can look much worse; you are detoxing. It is the norm for later tests to look worse; 70-80% look worse with later testing.
It reflects what is there and the body's ability to put the mycotoxins into the urine.
RealTime Labs uses ELISA. Great Plains uses LC-MS which may be more accurate but can be too specific in some ways. LC-MS is more reproducible. ELISA measures toxins and metabolites.
Except for Ochratoxin A, the tests are very different.
RealTime Labs accepts Medicare.
Doing both tests can be very useful.
Great Plains does not currently do gliotoxin which can be very useful. It is planned for later introduction.
Higher results in repeat testing may be related to re-exposure, improved detoxification, excessive binding, excessive killing of mold releasing toxins, or preferential binding of toxins. The results have to be put into context.
In the Shoemaker model, you evaluate the environment for mold and use binders. If not responding to binders, you then treat the biochemical markers per the Shoemaker protocol.
With Cholestyramine (CSM), you work up to 1 scoop four time daily. His patients often need to start with 1/4 scoop daily or even as little as 1/16 of a teaspoon.
Actos may be needed if there is an intensification reaction.
Heartburn and constipation are the main side effects; some start on Welchol which is better tolerated but not as effective.
Dr. Shoemaker suggests taking CSM 30 minutes before a meal with some fat in the meal.
Use magnesium or vitamin C if constipation becomes a problem.
VIP, when low, can be extremely useful; Dr. Shoemaker now uses it earlier in the clinical course.
In Dr. Nathan's approach, he uses mycotoxin testing as the cornerstone.
He uses VCS testing.
Evaluates the home with mold plates and ERMI/HERTSMI-2.
High protein, low carb with 20-60 grams of carbs per day may be ideal; Paleo preferred.
Does yeast (cheese, vinegar, mushrooms) matter when dealing with fungus? He doesn't think it likely matters.
There is some mold and mold toxin in food, but how much we don't really know.
Dried fruit, aged cheese, mushrooms, coffee, beer, wine, processed meats, tomato products, and fermented foods may have some.
In recent discussions with his colleagues, the consensus seems to be that food sources are not likely significant in terms of the results from urine mycotoxin testing.
Treatment is to eliminate the source of the exposure and use appropriate binders.
He then uses nasal sprays and oral treatments to address any colonization in the sinuses and GI tract. In a recent expert panel discussion, he mentioned that the consensus was that colonization does likely happen.
Given the colonization potential, moving out of the environment alone does not work in all cases. You may still have a mold toxin producing system within the body itself.
For ochratoxin, CSM and Welchol are preferred.
For aflatoxin and trichothecene, charcoal, bentonite, chlorella are preferred. He likes the Yerba Prima Bentonite and may start with 1/4 teaspoon.
With chlorella, glass-grown may be best; as others may have arsenic and aluminum contamination.
Once the environment has been addressed and binders are put in place, he then moves on to address any potential colonization in the sinuses and GI tract.
Biofilms in the sinuses may be addressed with BEG or EDTA nasal sprays along with an antifungal such as Amphotericin B, Ketoconazole, or Nystatin (strongest to weakest). He may also use colloidal silver nasal sprays to help penetrate biofilms. Recently, a colloidal silver/EDTA spray has been introduced by Hopkinton Drug.
Then for GI biofilms, he may use Interfase Plus or Beyond Balance MC-BFM along with an antifungal such as Itraconazole, Ketoconazole, and/or Argentyn 23.
Other materials he may consider include Beyond Balance MYCOREGEN, ozone, limiting carbs and sugars, and considering Candida (which may also produce mycotoxins).
Gliotoxin is produced by Aspergillus and possibly Candida.
Mold makes toxins as a protective mechanism to keep threats away.
There is good evidence that gliotoxin is made by Candida.
For gliotoxin, he may use Saccharomyces, Bentonite, and/or NAC.
Nystatin is added as a standard treatment for gliotoxin.
For sensitive or toxic patients, he may use Beyond Balance TOX-EASE GL, Pekana ITIRES and RENELIX, IV PC, and Annie Hopper's DNRS.
He cannot emphasize enough how much he loves DNRS - it will often right the ship and allow him to start working with other tools.
In some cases, he may use Pekana MUCAN or SanPharma Roqueforti or Candida suppositories and nasal spray.
For probiotics, Lactobacillus rhamnosus and Lactobacillus casei may help with aflatoxin and increase catalase and glutathione peroxidase.
Lactobacillus plantarum may help with removing aflatoxin, and Brevibacillus laterosporus can help protect against exposure to aflatoxin.
In terms of ozone, it is not strongly antifungal when used rectally but does go to the liver and help with detox. It is gentle and helpful.
IV ozone has not been particularly helpful in those with mold issues. He likes to use nasal and ear insufflation with a specific protocol.
LDI can reboot the immune system; might use a Candida antigen or a nasal wash LDI to speed up mold treatment.
Researched Nutritionals Transfer Factor ENVIRO may support those dealing with Penicillium, Fusarium, Aspergillus, and Candida.
Lufenuron is another tool he likes a lot for fungus and parasites; it impacts chitin. Can help with Candida, parasites, and mold. It may be done 3 days in a row per month in some patients.
Lyme coinfections include Bartonella, Babesia, Ehrlichia, Rickettsia, Mycoplasma, Chlamydia, viruses, and Candida.
Bartonella and mold are both very similar and trigger inflammatory cytokines that are similar.
There are 27 species of Bartonella, and we generally test for only 2 of them.
On the west coast, Babesia looks different than the east coast; symptoms he calls Bartonella are similar to what some call Babesia on the east coast. His experience is based on west coast observations.
Specific symptoms for Bartonella include burning pain on the soles of the feet, parasthesias, occipital headaches, migrating joint pains, depression, anxiety, internal vibrations, skin rashes / striae.
Babesia may be sweating, chills, fever, disconnection of the nervous system, headache, not feeling like yourself, joint pain and swelling, anemia, nausea, vomiting.
There is a "Babonella" dance between Babesia and Bartonella.
Bartonella can be odd neurological symptoms, pseudo-seizures, dyskinesias, paresthesias in non-neurological areas, tics, spasms, fasciculations, or "atypical" MS/PD/AZD/ALS.
Bartonella increases sensitivity to light, sound, noise, food chemicals, EMFs, and touch.
May benefit from challenge/provocation testing with A-BART or BAR-1 to see if the patient has a response.
Bartonella treatment may be with Septra and Rifampin.
Supplements may include Resveratrol, Houttuynia, Banderol, Cryptolepis, Deseret Biologicals nosodes.
May use with Beyond Balance TOX-EASE GL or capsules, Pekana ITIRES/RENELIX.
If both mold and Bartonella are factors, start with mold.
Antifungals do not negatively impact the biome, but antibiotics do.
It is far easier to treat the patients when mold is off the table and inflammation has been reduced.
If you treat the big issues, the immune system can often handle viruses, Mycoplasma, and Chlamydia.
Other things to consider in patients may include PANS/PANDAS, Cipro toxicity, metals, oxalates, cervical trauma fibromyalgia, viruses, parasites, and other toxicities.
Mast Cell Activation Syndrome - a bridge between the immune system and nervous system.
Lyme, coinfections, and mold are the primary sensitizers.
Mediators include histamine, serotonin, proteases (tryptase), and proteoglycans.
Mast cells coordinate the immune response to infectious agents and to toxins.
MCAS occurs in at least 10% of the population and 50% or more of his patients.
It is curable if you fix the mold and the Lyme.
Mast cells can even react to water.
Dr. Afrin admits that triggers for MCAS do exist, but thinks of MCAS as something that you need to treat for the rest of your life.
POTS is often triggered by mold, Bartonella, and MCAS.
Chronic prostatitis is often mold, Bartonella, or MCAS.
Diagnosis of MCAS is primarily clinical. Testing is highly inaccurate and requires a refrigerated centrifuge.
He often starts treatment with Quercetin 30 minutes before each meal, Loratadine (Claritin), and Famotidine (Pepcid).
He has his patients try a low-histamine diet for 2 weeks. 50% benefit. Those that do not need not continue.
Quercetin (also in lower doses in NeuroProtek LP), DAO may be used 30 minutes before each meal.
AllQlear is a tryptase inhibitor that can help those with MCAS; quail egg.
Claritin (H1 blocker) and Allegra (H2 blocker) often are a good combination.
Pepcid or Zantac are H2 blockers.
Ketotifen and Cromolyn Sodium can be helpful. Ketotifen is his favorite RX tool for MCAS; it is an H1 blocker, leukotriene inhibitor, and mast cell stabilizer.
Lactobacillus rhamnosus can help to stabilize mast cells. Bifidobacterium longum and infantis can help degrade histamine. Lactobacillus plantarum and Bifidobacterium breve and lactis may be helpful.
Many probiotics make histamine and make the problem worse.
"Type A" approaches do not work when recovering from these illnesses.
A small dose often goes a long way.
The last part of his talk was on Porphyria, and the treatment for this condition is in contrast to most of the other treatment he uses.
Porphyria is a build-up of unstable heme molecules; heme is a byproduct of RBC metabolism.
The most common way to trigger it is with antibiotics to treat Bartonella that also treat Chlamydia Pneumoniae (CPn).
Killing CPn can release porphyrins into the system.
A herx lasts 2-3 days; when longer, consider porphyria.
May include anxiety, OCD, restlessness, nausea, and vomiting.
Explore CPnHelp.org web site; Dr. Charles Stratton.
Porphyria is more common than many realize.
Out of 25 urine tests in his patients, 15-17 were positive from his patient population.
Collect the urine when feeling horrible to optimize the test results.
A high carb diet is the treatment, need high fluids, avoid red meats, milk products, and alcohol.
Glucose or dextrose is the treatment; IV D10 often works well.
Prevention of the condition is with folic acid and hydroxy-B12. charcoal, GABA, and Plaquenil may be helpful.
Rebooting various systems in the body is often needed after treatment. He often uses FSM or LENS to support rebooting the various systems in the body in sensitive patients.
Mitochondrial issues are something universally observed in his patient population.
Body work can play a big role in his stuck patients.

In the Q&A session, the following were shared:

40% of cats have Bartonella.
You can have Bartonella without Borrelia.
Mold in the home can also be found externally on pets.
Mold treatment with binders only fixes about 10% of his patients; others need to deal with the colonization with antifungals.
Sauna is helpful, as are ionic foot baths, but many cannot do it for very long.
Parasites are under the mold and Lyme layer in his world.
He likes BodyBio Chlorella.

Julie McIntyre spoke on "Understanding and Applying Herbal Medicines in the Treatment of Lyme Disease and Co-infections" and shared:

Note: I was unable to attend portions of her lecture, and thus only captured subsets of the broader information she shared.
Chronic illness opens the doors to change.
Plant medicines open many doors.
She does not use intake forms but asks her clients to send a document of their diagnosis, travel, symptoms, allergies, pets, and more to gain insights. She also likes a full body photo.
Liquid chlorophyll is concentrated alfalfa; the mint flavor with 1 TBSP in a quart of water can be helpful.
She uses whole dandelion plant; the root for the liver and the rest of the plant for the kidneys.
Shilajit gives nutrition and energy. It is full of minerals, amino acids, serves as a detoxifier and adaptogen. It is "the destroyer of weakness".
The kidneys hate ice water; don't drink ice water.
Red clover can be a mover of swollen glands or for sinus infections that are recalcitrant.
Strong blood carries medicines to deeper tissues.
In Babesia, look for spleen inflammation.
Red root is helpful for moving fluids and reducing inflammation in the spleen and liver and stimulates the bile.
May also use Salvia miltiorrhiza for spleen support.
Calendula may be helpful for the lymphatics and spleen.
Eclipta alba in green drinks; eyes, hair, liver, reducing inflammation. The liver holds anger which this herb supports.
Artichokes and beets can help support the gallbladder.
The strongest cholagogue is Greater Celandine or Chelidonium. She likes to use it homeopathically as well.
People that are chronically ill walk with fear all the time.
The root bark of Wahoo was used for malarial liver in the 1800s.
Ailanthus may be helpful for Giardia; grows around water. Woodland Essence carries. Also can be used homeopathically.
Tablets are hard to digest and have binders in them.
Alcohol is a tremendous transportation system that goes right through the stomach lining.
Generally, in her world, 1-5 drops is a "homeopathic" dose, 5-10 drops is a tonifying dose, and 10 drops up to 1 tablespoon is a therapeutic or medicinal dose.
Ramping up on Sida often leads to a flare; it is then best to reduce to 1/2 the dose but not to stop entirely. Stay for 1 week on the lower dose and then go back to just below the dose that caused the original flare response.
Ashwaganda and Baical Skullcap are often best with loser doses in the AM and higher doses in the evening as they are relaxing.
Tinctures can be taken with food if they lead to nausea or stomach issues.
Herbals have to be spread throughout the body for a systemic issue.
Japanese Knotweed crosses the GI tract and blood brain barrier. It shuts down so many inflammatory processes from coinfections and tends to help right away.
Cryptolepis may be helpful for MRSA and Babesia and crosses the blood brain barrier.
Andrographis is a cholagogue and is antiviral.
Bacopa may be helpful for short-term memory issues.
Gotu Kola preserves memory and brain function, rebuilds myelin sheath, and nourishes the nervous system.
Salvia miltiorrhiza may help with hypercoagulation.
Cleavers - fresh or dried tea or tincture - may be used at higher amounts as compared to Red Root. 1/2 teaspoon three times a day for cleavers as compared to 1/4 teaspoon three times a day for red root.
Isatis, Bidens, Artemisia, Cat's Claw, Andrographis may be used as antimicrobials.
Nervines include Ashwaganda, Gotu Kola, Bacopa, Pasqueflower (Pulsatilla may be helpful homeopathically for anxiety).
Passion Flower may help circular thoughts.
Motherwort may support the mitochondria and serve as a muscle relaxant, calm tension, and reduce anxiety.
Lemon Balm may help with Shingles, nerve pain, tension, anxiety, irritability.
Cramp Bark may help with muscle spasms.
Binders will not impact the effect of the herbs.
She uses charcoal, diatomaceous earth, chlorella, modified citrus pectin (a favorite), and zeolite.
Chlorella and pectin leave the GI tract and have broader systemic effects.
Homeopathic Kali Phos may help those that are very sensitive; or Nux vomica.
In her experience, Butcher's Broom has not failed for POTS patients. Also may use Hawthorne berry.
She is a big supporter of marijuana and CBD. Sativa is more energizing; Indica is more indicated for infections as it is calming and nutritive.
Cat's Claw: Tomentosa is more anti-inflammatory and increases WBCs. Rhynchophylla may have more neurological action; calming, pain, cognition, inflammation.
In order of power, tinctures are the strongest, then powders, then glycerites.
Dosing of herbs is normally three times daily to keep the system saturated.
Anamu may be a helpful internal insect repellent.
Houttuynia, Isatis, and Lemon Balm are common anti-viral options.
Myrrh essential oil or tincture topically can be helpful for long-standing warts.
There is a Banerji homeopathic treatment protocol for Babesia which she has used with some clients.

In the Q&A session:

Dr. Nathan mentioned that Carafate can help with Bartonella gastritis.
We now live in a world that has never been as toxic in the history of human kind. These toxicities weaken all of us - even if you are not sick and a canary in the coal mine.
Oral PC does not seem to work nearly as well as IV PC.
Some of the things FSM can do are "pretty magical".
Binders do not bind tightly; charcoal adsorbs but doesn't really "bind". It is more like static cling and starts pulling down the GI tract. It might lose the cling and lead to reabsorption and back to systemic toxicity.
Stem cells have been a real mixed bag - most seem to get very little out of it, some got worse, a few got better. Until it is further refined, it may not be worth the cost.
The same antibiotics that work for Bartonella often work for Mycoplasma, and Chlamydia.
Binders once daily are often adequate and you can take several binders at the same time.
Julie mentioned that Mycoplasma is the most difficult to treat and Bartonella potentially the most impacting.
For Mycoplasma, she mentioned Isatis, Houttuynia, Sida, Cryptolepis, and Bidens (ureaplasma).

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.

Was this helpful? If you found this information helpful, I would very much appreciate your support in keeping the site going. If you would like to donate to my work, I thank you in advance and send you my gratitude.

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.