Why You Should Listen

In this episode, you will learn about Precision Mycotoxin Detoxification and optimizing mycotoxin detoxification associated with mold illness.

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About My Guest

My guests for this episode are Beth O'Hara, Emily Givler, and Dr. Neil Nathan.  Beth O’Hara, FN is a Functional Naturopath and Functional Genetic Analyst working with clients with Mast Cell Activation Syndrome and other complex conditions.  Emily Givler, DSC is a Functional Genetic Nutrition Consultant, researcher, and lecturer with a thriving clinical practice at Tree of Life Health in Lancaster County, Pennsylvania.  Neil Nathan, MD is the author of several books including "Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities and Chronic Environmental Illness" and works with patients with complex, chronic health challenges.

Key Takeaways

  • Which mycotoxins are most common?
  • What molds produce health-impacting mycotoxins?
  • What is the process through which the body detoxifies itself?
  • How are bowel movements supported?
  • What are the best tools for hydrating the body at the cellular level?
  • How is MCAS supported as part of a detoxification protocol?
  • Which binders are most appropriate for specific mycotoxins?
  • What phase II detoxification pathways are most important for mycotoxin detoxification?
  • What nutrients, herbs, and foods can optimize specific phase II pathways?
  • How is fungal colonization approached in a treatment protocol?
  • What is the role of the parasympathetic nervous system and limbic system in detoxification?

Connect With My Guests

Beth O'Hara, FN: http://MastCell360.com
Emily Givler, DSC: http://TOLHealth.com
Neil Nathan, MD: http://NeilNathanMD.com

Related Resources

Molds and Associated Mycotoxins

Mold / Mycotoxin Aspergillus Bipolaris Candida albicans Chaetomium globosum Fusarium Monascus Penicillium Stachybotrys
Aflatoxin B1 X              
Chaetoglobosin       X        
Citrinin X         X X  
Enniatin B         X      
Gliotoxin X   X          
Mycophenolic Acid             X  
Ochratoxin X           X  
Riordin E         X     X
Sterigmatocystin X X         X  
Trichothecenes         X     X
Verrucarin         X     X
Zearalenone         X      

Binders and Associated Mycotoxins

Binder / Mycotoxin Activated Charcoal Bentonite Clay Chlorella Cholestyramine Diatomaceous Earth Glucomannan NAC Propolmannan Sacc B Welchol Zeolite
Aflatoxin X X X   X X         X
Chaetoglobosin ? ? ? ?     ?   ?    
Enniatin B   X             X    
Gliotoxin   X         X X X    
Ochratoxin X     X X X       X X
Trichothecene X ?       X         X
Zearalenone   X             X    

Phase II Pathways and Associated Mycotoxins

 Phase II Pathway / Mycotoxin Unknown Acetylation Amino Acid Conjugation Glutathione Conjugation Glucuronidation Methylation Conjugation Sulfation
Aflatoxin B1       X      
Aflatoxin B2         ?    
Alternaniol         X X  
Citrinin X            
Chaetoglobosin X            
Doxynivalenol   X          
Diacetoxyscripenol (Type A Trichothecene)         X    
DON (Doxynivalenol)         X   X
Enniatin B X            
Gliotoxin X            
Mycophenolic Acid         X    
Nivalenol   X          
Ochratoxin     X X X    
Riordin E   X     X    
Sterigmatocystin         X    
T-2 Toxin (Trichothecene)         X   X
Verrucarin A (Trichothecene)   X     X    
Zearalenone         X X  

Interview Date

June 30, 2020 

Transcript

Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections.  

[00:00:01.09] Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.

[00:00:14.04] The content of this show is for informational purposes only and is not intended to diagnose treat or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice, or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

[00:00:34.24] Scott: Hello everyone, and welcome to episode number 122 of the BetterHealthGuy Blogcasts series. Today's guests are Beth O'Hara, Emily Givler and Dr. Neil Nathan and the topic of the show is Precision Mycotoxin Detoxification. Today's show is unique in that we have three amazing guests here to talk with us about precision mycotoxin detoxification.

Beth O'Hara is a functional naturopath and functional genetic analyst working with clients with Mast Cell Activation Syndrome and other complex conditions. Emily Givler is a functional genetic nutrition consultant, researcher, and lecturer with a thriving clinical practice at Tree of Life Health in Lancaster County, Pennsylvania. Dr. Neil Nathan is the author of several books including “Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illness” and works with patients with complex chronic health challenges. And now my interview with Beth O'Hara, Emily Givler, and Dr. Neil Nathan.

This is my first ever show with multiple guests. Today we have not one, not two, but three amazing guests on the show to talk with us about Precision Mycotoxin Detoxification. Thank you all for being here today.

We have all had a focus on mold and mycotoxins either personally, professionally or both.  For me personally, I believe that addressing mold illness was a very significant part of the puzzle to my own recovery. I think that our internal environment will only ever be as healthy as our external environment. I'm interested in hearing today from Beth and Emily, their experience with mold toxicity and how critical mold and mycotoxins are as part of many healing journeys. 

[00:02:27.18] Beth O.: So I had mold exposure as a young child. When I was seven, my parents bought this old farmhouse out in the country. And I was so excited, it was like Laura Ingalls Wilder, and the house was over a hundred years old. But I didn't know until years after I moved out was the house was also full of toxic mold. I don't know what kind other than the entire crawlspace was full of black mold.

And I started having health issues at a young age. It took me until, I'm in my 40s now, it took until my mid-30s to learn that what was behind my illness was mold toxicity. And I was severely ill to where is bedridden, and I had to use a cane to walk from the joint pain, and I'm really not functional, severe anxiety, it was a nightmare.

And when I learned about this, I was still kind of limping along with my health, and I was working as a health care practitioner. And as I saw it in myself, I started looking for it more in my clients, and I'm specialized in mast cell activation now and really from the root cause approach and looking at what's underlying this, and what's keeping the immune system dysregulated.

And in this kind of root cause analysis, I look for a number of different things, and my practice is 80% mold toxicity. And so that's out of hundreds and hundreds of people. It's just so common now for a number of reasons that we can talk about, but it's the number one thing that I look at when there's mast cell activation going on now.

[00:04:09.18] Emily G.: I'm always struck by how similar Beth and my own past have been. We've had the good fortune of working together and collaborating with one another for a number of years now. And like Beth, my own journey into being a health practitioner came from my own health challenges. And it took me many years to realize that the mold was part of my own, not the only piece of my own health challenges, but certainly a contributing factor.

And it was multiple points of exposure at home, probably a moldy dorm in college, less than ideal apartments after college. And then a few years ago, I lived in a farmhouse that had flooding in the basement as a result of a hurricane. And we thought that water damage was remediated appropriately, mitigated for, but it wasn't, and we ended up with this invisible poison in our home. Not only negatively impacting my health, but that of my children as well.

My daughter's room she was five at the time, her room was the epicenter of the mold, and she ended up having a series of seizures as a result of it that resolved when we moved out of the home. We didn't realize at the time that the mold and the mycotoxins were the triggering events, but within a month of moving out of the space, her seizures fully resolved and that was seven years ago, and she's never had a repeat seizure.

But it is worth noting that I was pregnant with my youngest child when we moved out.  And at the time, I was not able to find good information about how mycotoxins could potentially be passed either in utero or in breast milk. And so I nursed my son who never lived in the mold for about two and a half years. And when we tested his mycotoxin levels at age three just out of curiosity, they were extraordinarily high. So it is really important for women to note that we excrete this mycotoxin through multiple pathways including through breast milk.

[00:06:27.00] Scott: Yes, that's very interesting. That's something that I had not really given a lot of thought to and certainly can be very important. Today, we're talking about some of your research in terms of what I would call precision mycotoxin detoxification. The three of you have collaborated on this research, tell us a little bit about your collaboration, how it came about, and when will this work be published.

[00:06:48.29] Dr. Nathan: Okay. I can start, and if Emily and Beth have other memories that'd be great. It all happened on the way to a 2019 genomic meeting that Bob Miller hosted in Denver. And all of us were speakers at the meeting, and I did not know Beth or Emily prior to the meeting. And when I heard their lectures, also Lari Young's lecture, they all had big pieces of a puzzle that we've been trying to put together for some time.

I had been working with a number of other folks to try to determine how exactly is each mycotoxin detoxified, because if we know that, then we can enhance detoxification and help our patients get better faster. And I had been really stymied by not finding the information I needed. And lo and behold, these three magnificent women had huge pieces of the puzzle, and I was in seventh heaven, it was like wow, this is just what the doctor ordered.

And so I went up to Beth and Emily after the meeting, and I said, I think we should get ourselves together and put this all together as a table to which clinicians and health care practitioners can refer. So that they can immediately know I've got Ochratoxin, what's the best way both nutritionally and with a supplement to detoxify that. And so over the next several months, everybody worked really hard to put this together. It was just wonderful working with Emily and Beth, and we put together a wonderful table with references so that it isn't that we made it up, every single thing that we talk about on this table, we can document by going to the medical literature.

So what we put together is great. It's not a complete table, one of the biggest questions I get from people who are hearing this information is what about gliotoxin, and the answer is to my knowledge we don't have any research yet telling us the best pathways for detoxifying that. So we'll be looking for that. So it's not a completely comprehensive table, but it's a pretty darn good one. And one that I think we'll be talking about today so that your listeners can jump on board and start using this information immediately.

[00:09:29.19] Scott: And for people listening that table which as Dr. Nathan mentioned is kind of an in-progress effort, and will continue to evolve as more research is available. That table is something you can find in the show notes of the podcast page. So Betterhealthguy.com/episode122 will get you access to that table so you can look at it in a way that might visually be more appealing than the conversation alone. We know that there are hundreds of mold toxins or mycotoxins in the environment.

Talk to us about mycotoxins in terms of which ones are more common, which ones are more likely to cause human disease. And then which organisms produce which mycotoxins, so that we can cover just at a high level because I know there's a very detailed list that people can refer to.

And then does the mycotoxin that a particular mold produces correlate to its pathogenicity in terms of our health? So in other words, should we be most concerned about the molds that produce the highest number of different mycotoxins?

[00:10:34.29] Dr. Nathan: I love your run-on sentence questions, Scott, so much we could say about any aspect of it. So just starting with in terms of what we see on our urine mycotoxin testing, it depends on which lab you used. If you use Great Plains, there is no question that Ochratoxin is far and away the most common toxin you're going to see.

On studies that they are published, 85% of patients with mold illness will have a positive Ochratoxin test from that lab. Okay. From RealTime, we get a bit more different information because they use such different technologies. So, with RealTime yes, we see a lot of Ochratoxin, but we also see an equal amount of gliotoxin, and we'll also see a fair amount of aflatoxin and trichothecene. So those families are the most common ones that we're going to see in clinical practice.

[00:11:38.05] Beth O.: That's definitely what I've been seeing; I do see a fair amount of gliotoxin in my own practice, especially with people who are having nervous system symptoms. 

[00:11:49.29] Emily G.: I also see the same type of mycotoxins popping up. I also see a lot of mycophenolic acid and ZEA showing up. And so some of that may be that we are all in geographically different areas of the country.

And so what our individual clients and patients are being exposed to, and to add to another part of that question, to some degree the most impactful mycotoxin is the one in your body at that time. The point of exposure matters, but our individual genetics for these detox pathways make a difference as far as which are going to impact us more.

So there's not, I don't think that we can point to one particular mycotoxin as being the one that's really dangerous or problematic. That's going to really vary from individual to individual. It's part of the reason that this precision approach is so important.

[00:12:50.20] Dr. Nathan: Right, perfectly said. So in terms of commonness, there are tables out there where you can learn which mold species make which toxins. The simplest version of it would be Aspergillus and Penicillium, which are probably the two most common species of mold toxin that you'll get in a water damage building makes Ochratoxin, no surprise. The other ones trichothecene and aflatoxin are often made by Stachybotrys and Fusarium species.

Again, fairly common in water-damaged buildings. But I do know that that's that helpful, a lot of people want to pinpoint is what I'm growing in my house causing my lab tests to look exactly this way. And I think the danger in that is that you may have picked up exposures in other people's homes, at work, in your car. So I think trying too hard to make that correlation tends to confuse people. The simplest answer is you have it, let's treat it.

[00:14:06.16] Scott: Are you able to correlate the mycotoxins that you see in the urine mycotoxin testing with symptoms? Meaning does a specific mycotoxin lead to more significant health symptom presentation?

[00:14:21.15] Dr. Nathan: You know there's a little bit of talk about that, and I would welcome Emily and Beth's input into this question as well. And in my experience, I have not seen that correlation, certainly not cleanly. I suspect that it doesn't matter which one you have, all mycotoxins have the same physiological effect on the body in terms of how they stimulate the outpouring of inflammatory cytokines.

And it's the outpouring of those cytokines that affect each person differently based on their genetics and their own unique biochemistry. So I don't think we're going to get nice, clean correlations that way. I haven't seen it, but I would welcome other input into that very important question.

[00:15:10.25] Emily G.: I've seen similar things, but I don't there's not a clear one-to-one. Beth, I think in your practice you may see more of those associations. But I see this broad symptom set regardless of general mycotoxin presentation.

[00:15:29.26] Beth O.: I'd agree. The only association I'm noticing is again those nervous system symptoms things like seizures or huge mood swings. I see a correlation with gliotoxin, but I don't think it's necessarily always gliotoxin. And then I have seen cases where people have some of these symptoms, and they don't have the gliotoxin. I do see some correlations with some of the Stachybotrys mycotoxins being a little more significant.

But people are super ill, and they're dealing with Penicillium and Aspergillus. So yes, I don't think we've got any clear associations because I think it's about how these mold toxins are affecting the nervous system and the immune system in general, and just causing all of this dysregulation across the board.

[00:16:18.22] Scott: You have all reviewed a lot of the research on this topic. So what does the research say about detoxifying mycotoxins?

[00:16:27.01] Emily G.: That it's not just one thing. This is a case where we talk a lot about phase 1, 2, 3 detox, and that sounds nice and linear and straightforward. And if you just support all three pathways, everything will be fine. But there is not just one phase 1 cytochrome P450 pathway; there is not just one phase 2 pathway.

There are multiple pathways for phase 3 excretion as well. And these individual mycotoxins utilize different compounds to be conjugated; they utilize different phase 1 enzyme. They utilize different excretion pathways. And so we can take kind of the shotgun approach which people have historically taken.

Kind of lumping mycotoxins under one big umbrella and thinking about them as being all the same thing. But what may be more advantageous is taking this precision routine, taking more of a laser approach than a shotgun. Because each of these mycotoxins follows a different pathway in the body, so I will let my colleagues build on that, but it was quite a journey of discovery.

[00:17:42.10] Beth O.: It was really shocking to me reviewing this research that most of the mold toxins, not all, but majority of them were utilizing a phase 2 pathway called glucuronidation. And a lot of the protocols I was seeing for mold detoxification was mostly targeting glutathione. And the other really interesting thing was that it's a lot of times, not just one pathway.

So some of these mold toxins are going through glucuronidation, and they're passed over to acetylation, and then they go through sulfation. We may see other variations of this, and again this is where really targeting can be much more effective, as well as get people where they need to go faster than doing this broad-spectrum approach. And a lot of people I'm seeing with mold toxicity can't tolerate a lot of supplements, and so we can't give them these hefty protocols, and we've got to be really careful, mindful of what we're choosing to have them try.

[00:18:43.02] Scott: Talk to us about the different phases of detoxification so that we can kind of understand the process to which the body inherently detoxifies. I think sometimes we forget the body is designed for healing, designed for health, designed for wellness and that we may need to support it in that effort. But that it is masterfully designed to support our own health optimization. So talk to us about those phases of detox.

[00:19:08.21] Emily G.: Alright. So we typically think about this as phase 1, 2, 3, but mycotoxins to complicate that a little bit more. But essentially, we're looking at taking these fat-soluble compounds and toxins like mycotoxins and turning them into a water-soluble form, so that we can actually get them out of the body. Our body is smart, even that fat solubility, we sequester these poisons within the fat cells to protect the rest of our body from them.

So in that bio-transformation process, we first utilize generally the cytochrome p450 enzymes of which there are many to start this bio-transformation process. And we turn those toxins into intermediary metabolites, which in some cases are a little bit more toxic, but then they should move ideally seamlessly into phase two detoxification, where those metabolites can be bound up with another compound to make them fully water-soluble.

And generally, that process of taking them from fat-soluble to water-soluble also makes them less toxic. This is not always the case with mycotoxins. So we may be making them water-soluble, but they are still just as dangerous to our kidneys, to our genes, to our liver, to our endocrine system. So we still need to push those newly water-soluble toxins into excretion pathways to get them all the way out of the body, and that's phase 3 detoxification. So just the quick and easy overview of that.

[00:20:52.13] Scott: That was fantastic, that was great. Now we know from Dr. Neil Nathan's book Toxic that some patients are exquisitely sensitive and often cannot tolerate even the smallest attempts to detoxify. The order, the approach is very critical. So walk us through the order in which you find people best tolerate the approaches that are aimed at optimizing their detoxification capacity.

[00:21:17.00] Beth O.: I know we're going to talk about this a little bit more down the road. But really the first place I start with for people is parasympathetic nervous system support and make sure that the vagal nerve is not impinged in some way, where it comes out the base of the skull. So I start there often just as we start with some very basic supplements, and I want to make sure that we talk some more about that.

Because a lot of times, I have people that come in who they're not tolerating anything, they're not tolerating tiny amounts of magnesium oxide. They can't tolerate any kind of mast all supporting supplements. And if we can start there, usually within a few weeks, people start to get more tolerance. And then simultaneously, if they are tolerating some things, then I'll work on if there's any constipation optimizing the bowel movements.

So maybe some things like magnesium oxide, very clean formula, maybe something like ParaSym Plus that can help support from the vagal nerve activation part there. But if there's not any constipation, then also just making sure people are drinking enough water so they can flush those toxins. And I'm actually surprised at how many times I see people, I always asked in my very long intake form that probably drives my clients crazy, how much water they're drinking. And I'm always surprised when people say that they're drinking maybe 20 ounces of water a day. When we really need to be drinking, if we're detoxing, at least half of our body weight in ounces. So if we weigh 150 pounds, we need to drink 75 ounces of water.

And that's quite a bit, that's coming up to almost half a gallon of water a day, sometimes people need more. Then also doing if they're tolerating supplements, some gentle things to support calming the mast cells before we go any further on detoxification. Because if people are dealing with mold toxicity, almost always there is going to be some mast cell activation going on.

And that's part of the reactivity that's happening, which is really important because those mast cells are helping to keep the toxicity or mold colonization at bay as much as they can. And then we move into the targeted binders; we can move into some targeted phase 2 supports and those different pathways that we'll talk about. And then the last steps that we would be doing would be some antifungals, and work on biofilms.

[00:23:57.12] Scott: Beautiful. So let's dig into that, talk to us about how you might approach the bowel movement piece. You mentioned magnesium oxide, but this is such a critical issue to be interested in some of the tools that you think about here.

I think people don't realize that if they're not pooping, that really is the top priority before you start attempting any detoxification, any antifungals, any of those things. And so if the toilet is already clogged, then we need to stop flushing the toilet, right? So talk to us about how you optimize and support bowel movements in support of detoxification.

[00:24:30.20] Beth O.: Mostly, what I've seen work in my practice is the magnesium oxide, usually well-tolerated, not always. If herbs are tolerated, the ParaSym Plus, the herbs that are in there have been fairly effective. Sometimes I have people who aren't tolerating anything like that.

If they have a low blood pressure we can do saturated sea salt; saturated sea salt water will sometimes start to move the bowels where they would really saturate as much salt as water could dissolve, and drink that a few times a day. Got to watch blood pressure and things like that, and make sure that that's not going to make anything worse. What are you noticing working Emily in your practice?

[00:25:15.16] Emily G.: Well, you hit on the hydration which I would echo and re-emphasize. I mean this is really key. There are a lot of people who are not hydrating or who are not hydrating at a cellular level. And so it's not just the water, it's also some mineral balance especially the electrolyte minerals. So as we are increasing the water, especially if people start to ramp it up with, we have this American tendency to do more and more and more.

As you increase that water, you run the risk of flushing some of these electrolytes from your system as well. So we do need to make sure that we are remineralizing. I do occasionally use magnesium oxide. So I do find it tends to be all or nothing for people in terms of its efficacy. There's a threshold where it's not going to do anything, and then if you go too far, it's, and it be a little too aggressive of a push for some people. So I do use that, we can selectively use some fibers.

So it's worth noting that fibers are not going to be universally tolerated, but you can start with the very low and slow. For some people, psyllium husk can increase that fecal-bile clearance and getting rid of some of those lipophillic compounds. There are individuals who do well with a small amount of freshly ground flaxseed.

It is important that it is freshly ground as flax is an extraordinarily delicate oil and oxidizes is really rapidly. You never want to use pre-ground flaxseed; it is already rancid. I don't care if you keep it in your freezer, it is no good. So if we utilize something like flax, it's really critical that we do it the right way. That hull is hard for a reason; you need to grind it and use it immediately.

But I tend to reach for things like the minerals, magnesium, and as Beth noted, the salt. If there is adrenal fatigue resulting from the complexity of these ongoing health concerns that have brought people to us, that can inhibit the bowel motility. So salt is especially doing that. Super salt-saturated water is a wonderful adrenal tonic, in a way to help the body hold on to some of those fluids more readily, nourish the adrenals. And is giving that nervous system a bit of reset at the same time.

[00:27:47.05] Scott: And the supersaturated saltwater that's what is called Sole, correct for people that want to look that up and learn more about it. I do think that the hydration piece is critical, and it's actually one of the areas that I still don't feel that we have tremendously good tools.

I mean we see in people with Lyme disease or mold illness, we see that they have low antidiuretic hormone. That they can drink gallons that they pee out gallons, that they're still dehydrated. So besides electrolytes and minerals, have you found any other tricks to optimize cellular hydration?     

[00:28:25.07] Beth O.: Mostly, I use minerals, but usually in the form of things like concentrates or Quinton water. If people can tolerate it, but we have to keep in mind that also contains sulfates which is going to push sulfation. And I'll let Emily talk about that some more in the role with oxalates that we can have some issues with. But I use those if it's the right time for it, sometimes I'll bring a product called SPM Active onboard to help with the cellular membrane.

That tends to be a little bit lower histamine than other fish oils. I'm not exactly sure why I just see it usually more tolerated, it's not always tolerated. But we have to think again about the timing and all of this because the body will naturally harden the cell membranes to keep when their pathogens keep them from getting into the cell. And so if that's not being tolerated, it may not be the right time to do that, but sometimes that can also help with that cellular hydration. 

[00:29:24.01] Emily G.: There are a lot of moving pieces when it comes to that. The cell membrane integrity is really critical to look at, and there are some common factors between impaired bowel motility and impaired cellular hydration and poor cell membrane integrity. And so for many people, there are low levels of phosphatidylcholine, so the cell membrane integrity is compromised which can have a negative impact on how well you're able to use and retain and compartmentalize fluids in the body.

But then that also is going to have an impact on the nervous system in the vagus nerve, because that phosphatidylcholine is also the precursor for acetylcholine which is the primary neurotransmitter for the vagus nerve. And so we get into this loop, but then because nothing is ever straightforward, if we just add phosphatidylcholine at the wrong time, we can push detoxification a little too aggressively for some people.

So we need to proceed really carefully, that's part of the reason for this precision approach. As wonderful as it would be if there was one just perfect way that oh you need to rehydrate, just do X, Y and Z. It depends on the individual in front of us and where their particular challenges lie. Getting the timing right is really critical.

[00:30:50.15] Scott: Yes. And the constipation piece is so interesting because there are people that maybe just have more normal constipation.

Then there's what you're bringing up as well, which is getting into the realm of the vagus nerve, the migrating motor complex, SIBO that have slower motility and that also essentially leading to this same issue that we need to get things moving through the system in order to optimize detoxification. So that's where the ParaSym Plus that you mentioned, I'm assuming that that's the supplement that Dr. Diana O'Driscoll put together, correct?

[00:31:21.16] Beth O.: That's correct. And sometimes that could be helpful, but also just touching on, I'm glad we circled back to this. Getting the atlas checked and making sure it's not sublaxed is very common, and so that's where the vagal nerve comes out.

If there's pressure on that, it can affect the motility either towards constipation or towards diarrhea. And just sometimes that adjustment is enough to help with constipation. It always comes back to seeing what's underlying causing the issue. 

[00:31:52.14] Emily G.: It's interesting that you bring up that subluxation in the cervical spine because this can actually result from exposure to molds. Many molds especially like Aspergillus and Penicillium are oxalate producing species. And oxalates will displace sulfate, and one of the results that can have is instability in the connective tissue, particularly along the spinal column.

So oxalates will effectively hijack the sulfate transporters to move through the body and will bind with those sulfate receptors, and basically force you to excrete your sulfate and urine. So then it becomes lost for all of the physiological reasons you need sulfate, which is one of the most abundant nutrients in the body. So that can create this exacerbation of health issues. So you get exposed to molds, you get some oxalates, it stabilizes the cervical spine.

You get impingement of the vagus nerve, and now your issues amplify sometimes many folds. So we can eliminate those oxalates, which should really be considered as kind of a secondary mycotoxin. They're a poisonous metabolic byproduct of some of these mold species; we need to eliminate those by replenishing sulfate. But we have to do this like everything else at the right pace.

And so if we utilize things like as mentioned with the Quinton water which is a sulfate source in some of these highly sensitive patients that can be enough to trigger oxalates dumping in mast cell activation. So even something as simple as a little tube of seawater in the wrong person in the wrong time can be too aggressive.

[00:33:41.20] Scott: We know that you both focus on mast cell activation syndrome; it's a huge topic of its own. But your first kind of step includes calming down this mast cell activation, calming down histamine intolerance, calming down that inflammatory cycle. So is that generally through diet or supplements or other tools? What are some of the things you commonly explore early on for mast cell activation syndrome in preparing someone for a detoxification program?

[00:34:09.11] Beth O.: The first place I go to is again this nervous system balancing. And it's interesting when I talk about the effects of stress and even internal stress, people's thoughts they tend to, I don't know we just have this blind spot for this in our culture. And I have a story that I share with a lot of my clients that I've experimented with this and ruminated on something that was really stressful for me.

So one was we got some water, have some water intrusion in her basement in the house that we just bought, bought it because there was no mold. Now we have Aspergillus in the basement that we’re remediating, right? So my worst nightmare. And so when this happened, I would do some experiments of thinking about it, ruminating on it, just to see the effect of that on my body.

And one of my first symptoms of, because I have mast cell activation syndrome myself, is that my knuckles will swell. And so particularly right across here, my knuckles will swell, and when I start thinking like this and ruminating on these stressful thoughts, it'll happen within a couple of minutes. It's just boom; my knuckles will swell, my joints hurt.

And then if I shift myself over and calm myself down and tell myself everything's going to be okay, and use the tools that I've learned to activate the parasympathetic side of my nervous system, that swelling will disappear within about five minutes. It's amazing. So you have to remember the nervous system and the immune system are so intricately woven together. If we can calm the nervous system, we can calm the mast cells. It won't be everything, but it's usually 50% of the healing process.

Is this parasympathetic vagal support. So that's number one that I have people do. And then I have them work on a lower histamine diet. And if they've got some significant mast activation, we'll also do low lectins. And lectins are major muscle trigger for a lot of people, not all people, but a lot. So I have a good cross-reference list on my website that people are welcome to use, it's just up there for free, it's a good resource.

And then there are a few things that I found that generally are well tolerated. So my first starting places will be diamine oxidase supplementation that helps break down histamine in the gut, kind of reduce the overall histamine load. There's a product I love called pH Adjust, and it has sodium and potassium bicarbonate in it and a little magnesium carbonate. And for some reason, sodium and potassium bicarbonate tends to calm a flare down a little bit. I think there's something going on with the balancing action that the carbonates and the body tend to dump sodium during a foyer.

So we can start to replace that sodium. You have to add a little sea salt with that if there's low blood pressure because it's higher in potassium than sodium. And then perilla seed extract and there's a product called Perimine that's got a really good standardized quantity of it tends to work nicely as well as Chinese skullcap extract, baicalin.

[00:37:28.13] Scott: Just to clarify, the Perimine is that the one from Metagenics? 

[00:37:32.29] Beth O.: Correct, yes.

[00:37:34.07] Scott: Okay. And the Chinese skullcap, I mean we're learning more and more about that. But obviously its role in mast cell activation. I know you've talked about its role potentially in cell danger response as well, its role as an antiviral potentially silencing endogenous retroviruses. I mean that's one that to me, seems like it checks a lot of boxes.

[00:37:54.14] Beth O.: It checks a lot of boxes, we have to go slow because though because it can have that antiviral property. It's also going to be in the category of a phenolic compound, of which includes salicylate. So a lot of people with mold toxicity have some salicylate intolerance.

And this has to do with as we get into these pathways; we're going to talk about the glucuronidation pathway that breaks down the majority of mold toxins, also breaks down those phenolic compounds that are in brightly colored herbs vegetables, particularly fruits. So I don't have everyone tolerate that across-the-board, but a lot of people do.

A lot of people do tolerate the Perimine not always. Very rarely have anybody have trouble with the sodium-potassium bicarbonates; that typically goes pretty well. And then that Baicalin extract, people can get as a pure powder online. There's a company called LiftMode that makes that, or you can get it as a tincture and people are super sensitive, that tincture is probably the way to go. So you can dose it one drop and four ounces of water, maybe drink half of the glass see how that goes. So that's how slow I have people get things on board.

[00:39:13.19] Scott: So the baicalin, the tincture is it actually baicalin tincture or is it just a normal Scutellaria baicalensis?

[00:39:22.05] Beth O.: You can find both online, I have people do the baicalin.

[00:39:26.04] Scott: Nice, that's so much good information. And I'm guessing the pH Adjust is probably the reason why people have such a good response when they're having a flare to something like Alka-Seltzer Gold or some people even use baking soda, just because it's also helping to shift the pH to be more alkaline and that can be a really great rescue for detox reactions and Herxheimers and things of that nature.

[00:39:48.28] Beth O.: Exactly. And then something about replacing the sodium and I've tried I have not found the research on it yet. But it's seen as clinically worthwhile.

[00:39:57.11] Scott: So Emily, any wonderful things, what are your go tos for mast cell activation early on and working with clients?

[00:40:04.09] Emily G.: So Beth’s really hit on a lot of key areas for those super sensitive people. What I would add to that is the power of things like breathwork and vagus nerve toning, exercises, cold water immersion and things of that nature. So especially when people are at a state where they're struggling to put anything into their body, sometimes coming back to that basics of the breath can make a really big difference in shifting that nervous system response towards the parasympathetic side. I remind people every day that breath work is powerful enough to carry women through childbirth; it's a really powerful mechanism.

But we would never teach a woman how to breathe when she went into labor; we have to practice these tools. There are practices; it's not like you can lay in bed and do some deep breathing one time, and you're all of a sudden going to feel better. You have to do these on an ongoing fashion. So the breath is really key for a lot of people with calming down this hyperresponsiveness.

[00:41:08.28] Scott: So for people that are interested in learning more about the breathwork, is that coming from the polyvagal theory work? Is there a specific resource or book or practice that you recommend for the breathwork?

[00:41:22.00] Emily G.: I honestly recommend that people find one that resonates with them. Because I think when we look at them in totality, there's no one that I feel that shines heads and tails above the rest. And I work with a really diverse clientele ranging from like old order Amish and Mennonite people to biohackers. And so what works, what one person is going to be able to utilize consistently may not be the same for everyone.

So for some people, the yoga pranayama really resonates, for myself, that is what has been very effective. But that's not something that will resonate with all of my clients. So I do like to give a lot of different resources there. I think if you're just focusing on the breath, focusing primarily on the extended exhalation that we can see a lot of good. I don't think that we have to think about it as there's this one particular piece of breath work that's going to make the difference for you.

[00:42:26.07] Scott: You both mentioned the parasympathetic tone, you mentioned the vagal tone. Is there an aspect of this early on that is also limbic system-oriented or is that not part of what we're talking about when we're talking about the parasympathetic nervous system and vagal tone, I know Beth you've talked about that.

So does the limbic system come into play here as well, particularly when you're talking about your reactions, and then kind of reframing and seeing improvements there? Is some of that overlapping in the limbic area or not?

[00:42:56.06] Beth O.: Yes, for sure. And I see this often with mold toxicity, that emotional regulation, people start to lose. And it was just before we started talking; we're talking with a mom of a young girl who's got significant mold toxicity. And if they just even start to talk about her health, she gets so stressed out she starts yelling.

And she doesn't have any ability to control it, and I see that a lot. So it's like zero to a hundred on the stress chart and no ability to modulate. And so learning to modulate that emotional regulation.

There are a couple of great programs that teach that one is DNRs and there's the Gupta program, there are some other programs that are excellent. And even with those, it's about finding what people resonate with. Some people like one person's voice, some people like another, finding something that's soothing and then they can start to use those tools.

[00:43:57.15] Scott: I want to jump into step two. So step two is targeting binders, so combined with eliminating the source of the exposure, binders are used to help the body excrete mycotoxins, to minimize Antero hepatic recirculation.

Some of the binders like charcoal or bentonite clay or chlorella or zeolite can be fairly broad in their ability to support the body and removing mycotoxins. So my question is, can we just pick one or two or three of these broad-spectrum binders and use kind of a generic protocol? Or do we need to be more specific in aligning the solution with the specific toxin that someone may have in their system?

[00:44:43.11] Dr. Nathan: Let me give you two answers to that question. First, the quick answer is no; if you only use a few binders and you don't know exactly what you're trying to get out of that body, you're only going to get that patient partly well and they're going to stay sick.

And when that happens to patients psychologically is they're doing what you tell them to do, and they're not getting better. They lose faith in your ability to know what you're doing, and that is harmful to the provider-patient relationship and to think that's a biggie. The original work that Shoemaker did which used Cholestyramine exclusively; there were too many patients who didn't get better doing that.

And we later realized that Cholestyramine is a wonderful binder for Ochratoxin, and since Ochratoxin is one of the main toxins, it will work a fair amount of the time. But it's not a very good binder for Aflatoxin or Gliotoxin or Trichothecene. So if you've got that, you might get your patient a little bit better, and they're just not going to get well.

So one of them my teaching litanies is, please use the binders that work for every single toxin that shows up on that test. Logic tells me that is the only way to approach this kind of a problem. Now I said that there were two answers, that's my main answer. The second answer is that if you have someone who is financially strapped and can't afford a urine mycotoxin test.

And you have very good reason to believe that they're sick, we can't just let them hanging in the breeze and not treat them. So I do think that it is reasonable to put those patients on a generic binder program. Say bentonite, clay, charcoal and chlorella and see how they do on that. So I think it's ethically wrong to not treat someone if they're financially compromised, and in that case, I think we have to go to a generic process.

[00:47:01.17] Beth O.: I think you're making some really great points. And when we're bringing these targeted binders on board, we also want to think about which binders are going to bind more things. So, for example, zeolite will also bind lead and mercury in addition to some of the mycotoxins. And so I've seen bringing that one on board early on not often go well.

And when people aren't tolerating it, I really wonder if it's because it's also pulling this lead and mercury too fast for them. So something that I've learned over time is start with some gentler things like charcoal and bentonite that are more selective. And then as they have more tolerance, bring the zeolite on board later, and that's what I'm noticing.

[00:47:46.21] Emily G.: I also take the approach of layering in the binders progressively, so that we can evaluate that tolerance for each. Sometimes when we throw combination binders at someone, there are so many things coming to the table at once.

We can't be sure what is causing any adverse reactions that may occur. So I typically take a one at a time approach with the binders layering them on top of one another. And if we know they're being well-tolerated, then we may think about rolling them into combo product.

[00:48:19.05] Scott: So if we look them at the more common mold toxins, how do we know which ones to consider first in terms of the binder that would be may be most appropriate? Are we basing this off the urine mycotoxin testing and then starting with the highest mycotoxin?

Are we trying to cover all of them? So if there are several mycotoxins, are we using multiple binders from the beginning or doing some type of rotation? Talk to us about the potential binder interventions that you might choose for a specific mycotoxin result.

[00:48:52.08] Dr. Nathan: So yes, I used the urine mycotoxin test as my guide. That is a fairly easy to obtain measurement. It's fairly accurate, and with it, I can proceed by, we're talking precision treatment. We can give precision treatment with that information. Now in terms of the details of that, the Ochratoxin, for example, is best bound by either Cholestyramine or Welchol, which are prescription medications, or activated charcoal. And so on each one, we lay it out.

And in my book toxic, I lay out for those who are interested in the details of what we know about how to bind the various toxins. So yes we can go at it. I base my starting point on the toxin that is in greatest excess based on that test. So my logic has always been if you have a boatload of Trichothecene, that's where I'm going to start.

But one other consideration, and Beth and Emily both referred to this, is that we are all working with very sensitive patients, so I need to proceed slowly, methodically, one at a time with binders and layer them so that we're getting the maximum benefit from it. I usually stay away from the prescription materials until the end of my process.

Meaning, I find Cholestyramine and Welchol so strong as a binder, that they are likely to produce a reaction with someone who is sensitive. So I will usually start and Emily and Beth both kind of alluded to this. I'll typically start with either clay or charcoal based on the actual report.

So for example, if the gliotoxin is in the highest excess, I will typically start with clay and Saccharomyces boulardii, which are the best binders for that. They tend to be pretty gentle, and then I'll move onward to charcoal or chlorella, and then when I've got a feel for the patient sensitivity, then I can add either Welchol or Cholestyramine based on my perception of their constitutional strength. 

[00:51:16.19] Beth O.: So one of the places where this kind of precision approach can be so helpful is looking at which of these binders, like we've been talking about, are going to target which toxins. So for example, we just talked about gliotoxins and the bentonite and the Saccharomyces boulardii which will also work for ZEA. But then when we're looking at Aflatoxins or Ochratoxins, activated charcoal is going to be more effective there.

And this is where if we can look at what these levels are on the urine testing, then really target in. And one of the places that I've seen missing has been when people are on a number of binders, but it's not the exact binders that work for those mycotoxins. And so they're stuck spinning their wheels, even though they're taking this spectrum, it just missed those specific mold toxins that they're working with.

[00:52:15.16] Emily G.: I do think that sometimes people forget about the binding capacity of Saccharomyces boulardii. And so for those very sensitive people or people who are really struggling to move their bowels on a daily basis. Things like clay or charcoal may be too aggressive, and they bind to the bowels a little bit, they could be too drying.

And that's going to significantly inhibit the capacity to actually get these toxins all the way out of the body. So if there are indicators like gliotoxin or ZEA that would be effectively bound by something like S. boulardii, I find that does tend to go well early on more so than some of the other pieces especially if there is that constipation in place.

[00:53:05.09] Scott: One of the items that was on the list that was interesting to me was diatomaceous earth. I remember years ago everyone was excited about it as a parasite tool, as an aluminum detoxifier because of its high silica content. It seemed like it then got a little bit lukewarm, maybe cold, in terms of the diatoms potentially, actually having the sharpness that could negatively impact the lining of the gastrointestinal tract.

And so I'm kind of interested in your thoughts on diatomaceous earth or is that something you clinically use? How do people respond to it? And is that a potential concern?

[00:53:42.16] Dr. Nathan: I can start this. There is one paper in the literature that I was able to find, showing that diatomaceous earth has some specific benefit about binding aflatoxin. So if you had that, there is some rationale for using it.

And then as you're already pointing out, then we get into controversy. How effective is it? How safe is it? Because of that, I have not been using that in my own practice. So if Emily or Beth have, I would love to hear their input.

[00:54:18.00] Beth O.: I haven't used it much for the exact same reasons. I just need more information to feel comfortable and confident with it.

[00:54:26.03] Emily G.: It is something that I used to use a little bit more often than I do now in my clinical practice. I'm here in a very agricultural area in central Pennsylvania. As a result of that, a large portion of my client basis spends time barefoot in fields around chickens and other livestock. And for that reason, diatomaceous earth has often historically proved useful for things like common parasites that would be encountered as a result of exposure to that livestock.

So I'm using it very specifically, but because of that question of is there any type of shredding capacity, I have shied away from it over the years. So I've seen it be beneficial for people, but it is one of those compounds that has these unknown quantities. So there may be times where it's appropriate to pulse it in selectively, but it is certainly not the type of thing that you would want to use as a long-term intervention. I think there you are more likely to see those negative effects start to present.

[00:55:32.08] Scott: Okay. So we're talking about the steps again, just to recap. So step one this parasympathetic nervous system, vagal tone, limbic system, bowel movements, hydration, mast cell activation all of that kind of foundational; step two, the targeted binders that we talked about. Now we're going to get into step three which is the phase 2 detoxification support.

So you've mentioned the pathways here like methylation and sulfation, acetylation, glucuronidation all of those various conjugations. So how do we know which pathway to support? And does that also come back to the mycotoxins that are the highest in a person's urinary mycotoxin test?

If you can maybe talk to us about the phase 2 pathways, the association to common mycotoxins. And are there certain pathways that stand out as more relevant in a mycotoxin detoxification discussion?

[00:56:28.24] Emily G.: First and foremost, I think the most important pathways to support are the ones that are going to detoxify the mycotoxins that are in your body. So this is where we have to test ideally so that we know what's there and we can take the appropriate support. And again we lump these toxins under this one umbrella of mycotoxins.

And both we as clinicians, but even more significantly, our patients and clients who are often not as literate in the language of molds and mycotoxins as we are. We think about these as one thing; molds make mycotoxins, you get them out of the body, and they are very different compounds, and they utilize all six of our phase 2 detoxification pathways. Some of them utilizing multiple pathways for support.

So if we are able to identify which toxins are there, and I'll let best search go through the list that you can certainly refer to the chart that we put together as well. If we identify what's there, we can see which of these pathways are most in need of support if we can then layer on top of that, information about the functional genomics of the person in front of us.

We may be dealing with someone who has a pathway that is genetically inhibited and more vulnerable, to begin with. So if we have an environmental toxin along a genetically vulnerable pathway, what we use for the average person to support that pathway may not be sufficient to clear that toxin. So the more pieces of information we have about each individual, about what's in their system, about their functional genetics, so we know if we need to go above and beyond in terms of that support. We will be better able to effectively clear these toxins successfully and comprehensively.

[00:58:33.17] Beth O.: And that's huge. So Emily and I both do a significant amount of genetic analysis, and that's part of what makes a difference between when you have an entire family who is living in the same environment, with the same old exposures. Beyond age and gender and hormone impacts, you can see very different presentations based on the genetics, and so that can guide us out quite a bit. And you asked where this information comes from, how do we know which pathways.

And we all got so excited about when we came together and started looking at this because we were each presenting on one of these different pathways of the conference and we'd all landed on which mold toxins. And we went through probably over the course of a year; we went through hundreds and hundreds of medical journals.

And looking at okay, this one identified this mold toxin, this pathway. This one, even just making the list and making sure that there were multiple studies looking at it, so we were more confident that that's what really was going on, and really emphasizing the human studies. And so what that's where all of this came from, and we see things like Aflatoxin B1 being detoxified by glutathione.

But then Aflatoxin B2, we don't know for certain, but it looks like it's glucuronidation, and you would think they should be pretty similar molecules; should be the same pathways. And then we have things like gliotoxin still not sure about, mycophenolic acid though is glucuronidation. Ochratoxin very common mold toxin to see goes through three pathways. So it goes through glucuronidation, amino acid conjugation, and glutathione.

So it takes all three of those pathways to clear that. And again this is where we can get really targeted in. But then when we look at Riorin E, this is using acytelation and glucuronidation. So if we give somebody glutathione for Rioridin E, that's not going to clear it. And I think this is where a lot of people trying to heal from mold toxicity are falling through the cracks, but this is where we can really change what we're doing. And I've been using these tables for several months, I know Emily has, and Neil has, and seeing a big difference in how quickly people are recovering.

[01:01:12.25] Emily G.: And how comprehensive that recovery is. Because often people will make some progress and then plateau. They're better than they were, but they're still not where they should be, and it may be because you have mobilized them and eliminated a portion, but not the totality of these mycotoxins. But I think this is also really good information for people who have just been perusing the internet for the past five to ten years and who have learned about things like MTHFR.

I cannot count the number of clients who have come to me saying why have MTHFR, so I can't detoxify. Well good news, methylation detoxification is a relatively minor pathway in terms of mycotoxins. So inhibitions on one of these pathways, and also it's not accurate to say that you have MTHFR, so you can't detox anyway. But the more we know about the individual presentations, the individual mycotoxins, the better we can compensate for any individual vulnerability and create more comprehensive fuel.

[01:02:18.09] Scott: So again for listeners, this table is in the show notes. It is evolving, but thanks to Beth, Emily and Dr. Nathan, we are able to share what we know. So just visit the show notes, and that detail is there. And when I looked at this list, what really stood out for me was that glucuronidation seemed to be the most important place to start.

And Beth and I have done a previous podcast on this topic. A year ago I had heard the word, and that was about it, now I'm realizing how critical it really is. And while you didn't come here to mention your supplement, I will mention it.

So I know Beth you were involved in formulating with Bob Miller and his team and Emily and others, the Glucuronidation Assist product which is one of the ones over the past maybe six to twelve months that I personally have been really excited about. And so I guess the question is if there was a place to start or to optimize in terms of pathways, would we say that glucuronidation is where we might get the biggest bang for the buck?

[01:03:22.21] Beth O.: If they have multiple mold toxins most likely. But again there are some toxins like that Aflatoxin B1 doesn't seem to use glucuronidation. We don't know for sure, though; the research just doesn't point to it. But maybe there'll be a study that does show it will. If I had to and I don't like doing blanket protocols. But let's say I couldn't get testing and I didn't know what the levels were. Or I have on occasion sometimes people are holding on to those toxins so strongly, that even if they can provoke for your mold toxin test, it still doesn't show up. It's just not circulating in their system, but we know there was a major mold exposure. Then some of the glucuronidation supports would be a good place to start when you get to that phase.

So doing some combo binders like we talked about, and then working on the glucuronidation, seeing where you get and then seeing if you need to add some other areas. And I do love that product, but it is a combo product. So it's a little much for some people that are really sensitive. And it's an easy place to start with most people if they don't have a lot of sensitivities to salicylates would be some dandelion root tea is going to support that glucuronidation, that's a super gentle way to start.

And then if they're tolerating that, can build to some dandelion root extract in a capsule and add some calcium d-glucarate if that's well tolerated. A little rosemary, even just adding rosemary to food, will support that pathway. But then we usually have to build from there to really clear these out.

[01:05:08.00] Scott: So that's another piece that you guys are also working on, which is what nutrients and/or herbs can be used to support each of the phase 2 detoxification pathways. So you mentioned for glucuronidation the calcium d-glucarate, dandelion, and so on. Are there any others that really stand out that we want to touch on in this conversation?

[01:05:29.14] Beth O.: The research shows that pterostilbene which comes from bilberries which are a cousin to wild blueberries, that is really good. And so berries, in general, have been shown in the research to be helpful.

And so I think what we're looking for is purple-red berry, pomegranates can support, cruciferous vegetables can definitely support. They actually have calcium d-glucarate in them, so there's a form of that in those cruciferous vegetables, and that's where that is often extracted from. So these are some of the things, quercetin and curcumin if people tolerate those can help and also can be supportive on the mast cell side.

[01:06:13.20] Emily G.: And astaxanthin I would add to that list is also good. And the ellagic acid and astaxanthin also are supportive, I mean so many of these compounds are supporting more than one thing. But astaxanthin and ellagic acid also give a big push to the peroxidase enzymes which are part of our phase 1 detoxification.

So I find that sometimes those two pieces, while they are in fact up-regulating glucuronidation, we need to make sure we get them in at the right time. The rosemary and the cruciferous vegetables also are doing double-duty between supporting the glucuronidase activity, but also supporting the glutathione S-transferases. So when we use pieces like that, we can maximize several of these pathways at one time, which can be a good thing as long as we have the appropriate binders in place to be able to handle that.

[01:07:12.06] Scott: Your final step is the antifungal piece. So first, how do you determine if someone is colonized and has a potential need for antifungals? And then do you look more at the sinuses, at the gut, at systemic antifungals how do you phase those in? And what are some of the interventions here that you find most helpful?

[01:07:33.09] Dr. Nathan: Okay, large subject, and the first part is difficult. It's very hard to know whether someone is truly colonized. There are some tests which give us some clues about colonization. The OAT test from Great Plains, the first panel on the OAT test level. There are some particular materials 2, 3, and 9 which have, but they're not rock solid, but there is an inclination to know that you can have Aspergillus or Fusarium infection of 2, 3, or 9 is involved.

In addition on the same panel, if you have an elevated arabinose, that is a strong implication that Candida is there. So with that information, that helps us. For some patients, it's clinical information such as a chronic sinus infection that doesn't respond to antibiotics. A cat scan of the sinuses shows thickening of the sinus mucosa, and okay, then we have some evidence that that's going on as well. Other tests like a CDSA, a stool analysis, GI MAP can also indicate that the patient has Candida and that that's something we want to be including in our treatment program.

But by and large, I base that determination on how well the patient responds to binders alone. So in my complicated caseload, about 5 or 10% of my patients will respond to binders so quickly and so remarkably that I'm pretty sure that they never colonize. They were just taking the toxins out with binders, and they will literally get well doing just that. So if a patient is 90 percent better after 2 or 3 months on binders alone, I'm less inclined to think that they colonized. Because I'm not chafing at the bit to give them antifungals if I don't have to.

However, the implication is that 90-95 percent of my patients at the end of 2 or 3 months, the urine mycotoxin testing is not better; they're only slightly better clinically. And that's the body's way of saying they've colonized usually sinus and gut, and I need to treat those. I typically will treat the organ system that the patient has most symptoms of. So if they have chronic nasal drip and nasal stuffiness, the sinus infections, I'll usually start with the sinus.

Dr. Brewer, who originally got me going in this area, almost always starts with the sinus first. He believes that is a primary area of infection. However, I see quite a few people who have no sign of symptoms whatsoever, but they have a ton of gut issues. Gas, bloating, distension, diarrhea, constipation, alternating abdominal pain and those are the patients that I'll start with treating the gut. I'd like to add because it's so important that in functional medicine, we talk about treating the microbiome or treating the gut first before we do any other intervention so that the body will be better able to handle this.

This is one area of exception to that because if you have Candida and mold in the gut, you can do anything you want with that gut it's not going to get better until you get it out. So that's how I determine what you do, and then what we give you is solely determined by our perception of your sensitivity.

If you can barely handle small doses of what we've been trying to give you, you won't be able to handle a heavy-duty antifungal. It's going to cause a serious die-off, and it'll set you off for weeks, and I don't want to do that. So with such a patient, I might start with herbals, or I might start with Nystatin as my primary treatment.

Both sinus and gut and I would probably use colloidal silver, sinus and gut. And then I would turn to a biofilm dissolving agent. As my patient gets stronger, I would phase in stronger antifungals based on their ability to tolerate it. 

[01:12:11.10] Scott: When we talk about Nystatin that is not systemically absorbed as I understand. So is there a need for anti-fungal or colonization support that goes beyond the sinuses and the gut, that is more systemic? Or are we not concerned about the colonization of these fungal organisms outside of those two areas the sinuses and the gut?

[01:12:36.29] Dr. Nathan: Well, by and large, those are the two main areas of colonization. I'd also say the vaginal tract; anything exposed to the outside world is a target. It is much rarer for fungal species to get past those barriers and actually infect the body.

So if we're talking about a fungal infection that is systemic, we're talking about a potentially life-threatening infection. This is not minor, and it's not present in the vast majority of our patients. For example, it's rare, but there is Aspergillosis, which is an infection of the lung tissue.

And that requires months of systemic antibiotic treatment to eradicate. So it's very important we distinguish a systemic infection from a colonization because we're really talking about two very different critters.

[01:13:35.20] Scott: It's interesting that we could potentially have Aspergillus colonization in the sinuses and not have it in the lungs. But it sounds like that is what we generally see, right? That it does not affect the lungs, in the same way; it affects the sinuses.

[01:13:49.24] Dr. Nathan: Correct.

[01:13:51.09] Beth O.: Just with working with really sensitive people, what I found is when bringing these antifungals on board to start with micro-dosing, super important for two reasons. One, we don't want to start killing things off faster than the body can address. But also when there's significant mast cell activation, often see when anything new is brought on board, there'll be a large response to that. That can be from both the nervous system dysregulation and the immune system dysregulation.

So bringing on these micro-dosing to begin with helps people deal with the die-off, but also not have as much of a mast cell response to something new being brought into the body. And sometimes even when people are extremely sensitive, having them do it every other day or every few days. I know Neil has some protocols where he has people do things once a week that he could talk with us about. And that is something that I think has been missed quite a bit, is that it's okay to go really slow with people. We don't have to go in with a ball bat.

That's often I think where people end up when our practices is where they're not tolerating these usual protocols, these large amounts. And even we get to the antifungal stage; we have to think about starting super slow again and seeing what's going to be tolerated.

[01:15:18.13] Dr. Nathan: Amen to that.

[01:15:19.25] Emily G.: Well, I would add to that, that when we think about what these mycotoxins are doing to the body and some of the other effects that they are having. We can understand a little bit more deeply why it's so important to work on binding and eliminating the existing mycotoxin burden, before attempting to kill.

When we look at things like Ochratoxin A, in particular, high levels of Ochratoxin A can down-regulate the formation of GCLC, which is a rate-limiting enzyme for glutathione synthesis. And then also decreases Nrf2 expression.

So when we have that Ochratoxin exposure, it essentially inhibits its own detoxification and can slow down some of these other pathways. So if we try to kill that parent organism, we're going to flood these vulnerable pathways and not be able to tolerate them. So it's important to take things one step at a time.

[01:16:21.02] Dr. Nathan: Let me emphasize for a second, it's so important because I get referrals from physicians all over the world literally, and probably the most common mistake that I see being made is putting antifungals into the program before binders go on board. If you're killing toxin, and most antifungals work by punching holes in the cell wall of the mold or Candida species.

Punching a hole in the wall kills it, but it also releases the contents which includes additional mycotoxin, which now moves out into the circulation, and that's what we call a die-off. So if you don't have the binders on board to mop it up, it's really a dangerous strategy to start giving the patient antifungals before the binders are fully up and running.

[01:17:19.27] Scott: Let's talk a little bit more about the biofilm aspect, so you mentioned that after you have these antifungals on board, that you then consider the biofilm piece.

So is that again biofilms primarily in the sinuses or the gut, or are we considering biofilms that might be in the blood or in other places in the body? And then talk to us a little bit about the fact that not all biofilms are necessarily bad, that some biofilms are actually good. So how do we navigate that biofilm aspect of treatment?

[01:17:51.00] Dr. Nathan: I think we all might give you some different answers. It's a very important point you made that biofilm is not all bad. To a certain extent, biofilm protects us against other toxic materials or other bacterial species that are in the gut that could infect the body.

And I believe in what's called body wisdom, which is I may know a fair amount about this stuff, but I am nowhere smart enough to orchestrate all of this perfectly. We don't have enough knowledge, we don't have enough wisdom, but the body has that wisdom, it knows what it's doing.

So in the same way that if we kill off mold or Candida species prematurely without the binders to mop it up. If you start giving biofilm dissolving agents prematurely, it will dissolve biofilm and release extra amounts of those toxins into the system before the body's ready to do it. So again, the timing on using biofilm dissolving agents should be when your binders are up and running as well.

And if you stagger them or layer them by using small amounts of antifungal, and then beginning to add biofilm dissolving agents for both the sinus and gut areas, that I think is an ideal way to approach this. I can't comment on biofilm that is systemic; honestly, I don't really know how much is known about it. A lot of speculation about it, I don't know how much is known about it in terms of hard science. It comes into play primarily in the interfaces in which we are exposed to the outside world.

And that is our sinus, our gut, and the vaginal areas, rectal areas because the entire gut is an open tube on either end. So those are the areas in which organisms can hide in biofilm, and we do need to dissolve it at a pace that our patient can handle. In order to be able to truly get that out of the body, and let that body get back into homeostasis.

[01:20:18.10] Emily G.: I would add that this is another piece where we've got to go progressively and keep checking in, because someone may have an adequate level of binders on board while you're using this antimicrobial and killing agents.

But then when you set that up with the addition of an anti-biofilm protocol, because you are releasing potentially a lot more toxins into that system, you may need to recalibrate the binders that you're doing at that point. So we've got to evaluate and reevaluate at each step along the way, especially in these very sensitive individuals.

[01:20:57.18] Beth O.: And then I think this is a great way to segue to talking about not going too aggressively into this kind of die-off reaction because that is going to set up additional mast cell activation in the body. It means that we have more toxins floating around and the body can excrete and get rid of. That's something that I see frequently when people come into my practice. Usually, they've seen several practitioners before, and they come in, and they tell me well, I can't do detoxification because I get really sick.

Or they've been told to push through it. And then they set off this months-long mast cell flare that can really go on for a long time. And that's something that we need to walk back; so a motto I  tell my clients a lot because sometimes they're like really gung-ho and they just want to get this over with, and take as much as they can take to get done with it. And I tell them that in this kind of work fast is slow, and slow is going to be fast.

So if we try to go too fast, we're going to set people way back. If we try to break down all of that biofilm at once, we try to take a bunch of antimicrobials at once some people can tolerate it, but a lot of people are going to really struggle. And then they could be set back even six months with that kind of approach, and so that's why we're all just kind of coming back to going really slowly.

[01:22:23.07] Scott: One of my mentors have said if some is good, more is not necessarily better.

[01:22:31.14] Emily G.: It's a very anti-American attitude, though. I think we all have this little is good, more must be better. We've got to go to get to that finish line. And we see in clinical practice every day, but if it's not such a thing that that you're deeply embedded in. There's this idea of the healing crisis that so many practitioners will hold on to that.

Oh, we're affecting change, and that's good. But we forget about listening to that body wisdom. A lot of these symptoms our body is screaming at us to please slow down because something is not right. And Beth is totally right that we can do more harm than good in trying to power through that and ignore what our body is screaming at us.

[01:23:16.14] Dr. Nathan: I'm sorry, Scott, that I don't have a little American flag to wave around while we do “if some is good, more is not necessarily better”. Next time, I'll see if I can do that. I simply want to build on some of what Beth has been referring to when she's talking about the importance of mast cell activation, and I want to piggyback on that.

The subjects of limbic dysfunction and vagal nerve dysfunction. Because mold toxicity triggers mast cell activation in the majority of our patients and triggers limbic dysfunction and vagal nerve dysfunction in most of them, and especially when patients are sensitive, it can almost be certain that one, two or three of those entities are at play here and they may need to be addressed first before you can even give your patient anything in terms of more specific mold treatment like a binder or antifungal.

And it's just so important that I want to be sure we're emphasizing that we need to really look at that sensitive patient from that perspective, are you even ready to take anything at this particular point?

[01:24:34.15] Scott: So much good information that's coming out of this discussion. We touched on it a bit, but I want to just highlight this. Because my observation has been that this is something that is often missed and is so critical, and that is the aspect of detoxifying too aggressively, itself being a trigger for mast cell activation, right? So we start in your approach with kind of calming things down with diet, with some interventions that we covered earlier in the conversation.

But as we start unloading the body, and the body then is able to release other toxins metals, mercury all of those kinds of things. We can then have mast cell responses to the toxins that are then kind of moving around in the body. So talk to us a little bit about the importance of balancing that detoxification focus such that we're not then triggering the mast cells to create more inflammation and really kind of shooting ourselves in the foot.

[01:25:29.26] Beth O.: Mast cell activation, this is just absolutely critical. And we have to remember that the estimates are between 9 and 17 percent of the general population are dealing with mast cell activation, so it's not uncommon at all. And in the chronically ill population, my best estimate, this has to be proven and studied, but I think we're looking at 50% or more of our chronically ill clients and patients having mast cell activation.

So when we push things like detoxification too hard, or people try to push through, and I've had people, even when I tell them just do a tiny bit of glutathione see what you tolerate, they push themselves to do 500 milligrams twice a day. And I've seen people be flared up for six months doing that. And this is why we want to be really careful.

And what happens is those mast cells, one they have over a thousand receptors on the outside, they're pretty fascinating cells. And so any kind of toxin can trigger one of the toxin-related receptors, then those mast cells are going to start releasing their different inflammatory compounds. And that can set off a mast cell cascade, where you have a few localized mast cells reacting, setting off this cascade inflammatory compounds, mediators and then that's triggering the surrounding mast cells.

They start to release inflammatory compounds, trigger's the surrounding ones, and that can keep going. Kind of like a forest fire starting with a spark and then eventually burning out of control. These mast cells live over a year, they're very long-lived cells and if they get dysregulated from this excess toxicity being pushed through the body, then they can stay dysregulated for quite some time.

And this is why taking this approach of calming the mast cells initially, and then going very slowly and implementing the protocol is so critical. And you can actually move people so much quicker because if you get them into a six-month flare, you're not going to get anything new onboard until that comes back down.

[01:27:45.03] Scott: Beautiful. So my last question is the same for each guest and Beth, I'll make it optional for you since you've been on the show twice before. And that is what are some of the key things that you do on a daily basis in support of your own health?

[01:28:00.02] Emily G.: I always start with the basics, with myself. The same way I would with anyone else. I make sure I drink enough clean water, not the water that's coming out of my faucet. Good, clean, filtered, living water. I make sure that I have enough electrolytes in my system. And this time of year when it's warm out if I'm outside doing things if I'm perspiring, you need to bring those in at a higher level to put back what I just took out.  Eating clean foods.

Diet is one of the pieces that I come back to, but not putting more toxins in, so I don't have to get as many out. Moving my body, some type of exercise, time out in the sun and time spent either hiking or in my garden. These are my baseline things making sure I'm staying grounded, and I'm getting that sunlight, that fresh air, sunshine, clean food, clean water this is my day-to-day foundation. The other things may vary depending on what's going on in my life, but if those pieces are going to stay consistent throughout.

[01:29:01.12] Scott: Beautiful. I love that you both walk the talk; got anything you wanted to add in terms of things that you're really focused on in support of your own health?

[01:29:10.10] Beth O.: I do have something new I wanted to share in light of the conversation we're having. Which is really working at being diligent and making sure that we're not getting into a mold toxic issue in my home. And so I let my clients tell me about these water alarms that you can get on Amazon, and they'll detect moisture.

And so I'm putting those under every place that could have water. So hot water heater, under each sink. And then I'm mold plate testing every six months now, to make sure that we don't have a new issue develop. Because it's so easy to get mold in your home, and part of the trouble that we were having was from high humidity levels. So just keeping that humidity-controlled is a big one and I've got these little humidity gauges all over the house, which are really inexpensive. So some of these things to stay on top of it, so that if something does develop, we can manage and deal with it immediately.

[01:30:11.02] Scott: Beautiful. This was such a fun conversation, you both have taken your mess and made it your message, your pain and made it your purpose or your passion, you do such good work. And in combination with Dr. Nathan and your other collaborators.

I think the information that you've put together is really going to help a lot of people as we continue to learn more about molds and mycotoxins. And I want to just thank you so much for all the work that you're doing to help minimize the suffering of others; I appreciate and honor both of you.

[01:30:39.23] Beth O.: Thank you so much, Scott. It's wonderful to come together with you as well; I love how we all work together to help people that are struggling with these things.

[01:30:48.06] Emily G.: Yes. This is such important information, and it doesn't do anybody any good if we keep it to ourselves. So thank you for creating this platform to get this out to so many people.

[01:30:58.26] Scott: You bet, thank you both so much and be well.

[01:31:01.05] To learn more about Beth O'Hara, visit MastCell360.com, MastCell360.com. To find Emily Givler, visit TOLHealth.com. That's T-O-L as Tree of Life Health.com, TOLHealth.com. And to connect with Dr. Neil Nathan, visit NeilNathanMD.com. That's NeilNathanMD.com, NeilNathanMD.com.

[01:31:36.10] Thanks for listening to today's episode. If you're enjoying the show, please leave a positive rating or review as doing so will help the show reach a broader audience. To follow me on Facebook, Instagram, or Twitter, you can find me there as BetterHealthGuy. If you'd like to support the show, please visit Betterhealthguy.com/donate. And to be added to my newsletter visit Betterhealthguy.com/newsletters. This and other shows can be found on YouTube, iTunes, Google Play, Stitcher, and Spotify. 

[01:32:11.22] Thanks for listening to this BetterHealthGuy Blogcast, with Scott, your Better Health Guy. To check out additional shows and learn more about Scott's personal journey to better health, please visit BetterHealthGuy.com.

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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.