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In this episode, you will learn the latest in the realm of biotoxin illness and mold illness.

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About My Guest

My guest for this episode is Dr. Sandeep Gupta. Sandeep Gupta, MD is a holistic medical doctor, nutritional and environmental medicine specialist, ayurvedic consultant, and wellness coach. Dr. Gupta received his medical degree from the University of Queensland. After graduating medical school, Dr. Gupta worked in a range of public and private hospitals including several years in intensive care. Like many, his own personal journey with chronic illness shifted his focus, and he now works to support those with complex chronic illnesses such as mold illness and Chronic Inflammatory Response Syndrome (or CIRS). Today, he has a private holistic practice on the Sunshine Coast in Australia where he consults with people worldwide.

Key Takeaways

  • What is biotoxin illness, and why is inflammation a central feature?
  • What symptoms are seen in CIRS?
  • How are the innate and adaptive immune system involved in biotoxin illness?
  • What is the difference between mold allergy and mold biotoxin illness?
  • Can CIRS be the result of Lyme disease without mold exposure?
  • What is the soup of materials encountered when exposed to a water-damaged building?
  • Can HLA-DR serve as a predictor for the potential of developing CIRS? As a predictor of treatment outcome?
  • What are the benefits of a mold sabbatical?
  • What self-testing methods might be employed? When should one consider an IEP?
  • How important is removal of the source of the exposure?
  • What air filtration systems might be helpful?
  • Can mold exposure from a water-damaged-building colonize the body?
  • How is the treatment of MARCoNS approached?
  • What is the clinical value of urine mycotoxin testing?
  • Can NeuroQuant be used to explore the potential for limbic system dysfunction or Mast Cell Activation Syndrome?
  • What role does VIP play in recovering from biotoxin illness?
  • What is the basic treatment strategy for biotoxin illness?
  • What is the role of illness?

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Interview Date

January 8, 2021


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

[00:00:14] 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.

[00:00:35] Scott: Hello, everyone, and welcome to episode number 137 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Sandeep Gupta, and the topic of the show is Mold Illness Made Simple.

Dr. Sandeep Gupta is a holistic medical doctor, nutritional and environmental medicine specialist, Ayurvedic consultant and wellness coach. Dr. Gupta received his medical degree from the University of Queensland. After graduating medical school, Dr. Gupta worked in a range of public and private hospitals, including several years in intensive care.

Like many, his own personal journey with chronic illness shifted his focus, and he now works to support those with complex chronic illnesses such as mold illness and Chronic Inflammatory Response Syndrome or CIRS. Today, he has a private holistic practice on the Sunshine Coast in Australia, where he consults with people worldwide. And now, my interview with Dr. Sandeep Gupta.

This is the second time that Dr. Sandeep Gupta has been on the show. He joined us first way back in Episode 17 to talk about CIRS Down Under. Today, he's back to talk with us about the latest in the diagnosis and treatment of CIRS or Chronic Inflammatory Response Syndrome and his recently updated course Mold Illness Made Simple. Thanks for being here today, Dr. Gupta.

[00:01:58] Dr. Gupta: Thanks for having me, Scott.

[00:01:55] Scott: Talk to us about your personal journey with your own health and how that journey led you to making your work in holistic and environmental medicine such a focus and passion for you today.

[00:02:10] Dr. Gupta: Yeah, so in 2005, I was working in the intensive care of a hospital and working largely with... with post cardiac surgery patients and so on, and really just in the normal conventional world of medicine. That same year, I traveled to America and got a gut flu called Shigella. And I had a very strong antibiotic to treat that, according to the sensitivities and according to the usual medical protocols. And according to the normal expectations in medicine, I should have just totally recovered and been able to get on with my life. But instead of that happening, I had a massive health breakdown. And I had extremely severe headaches, extremely severe fatigue, and very disabling gut symptoms.

I went and saw some of the specialists at the hospital where I was working, and one of them suggested a very, very high dose of Prednisone. And I really just kept exploring, what could have caused this? Because even though I realized, okay, we can use Prednisone and lower this inflammation, but there was still the question what had actually changed me from being a relatively healthy human being to being someone who could barely function all of a sudden? And the obvious thing was that antibiotic and that illness.

And interestingly, most of the specialists didn't particularly seem interested in that connection or exploring that at all. And that led me to looking at the role of the microbiome and looking at what can happen when you get an imbalanced microbiome and an overgrowth of Candida albicans, or other dysbiotic organisms, and how that can lead one to have intestinal hyperpermeability, which can lead to quite severe headaches.

And amazingly, some... I discovered some things. Like, for instance, if I was to have the supplement glutamine, all of a sudden, my headache would go away. And it was like, “How does that make any sense whatsoever in the medical paradigm?” And... and there was various other gut treatments that that very instantly affected my headaches. Now, according to the standard medical understanding, that shouldn't have been the case. And really, the gut and headaches are just 2 separate systems which don't have anything to do with each other. But in fact, it became very clear that the cause of my headaches was to do with the gut, and to do with the fact that I had a massively altered microbiome. And by bringing balance back into my microbiome, by changing my diet, by using quite strong probiotics, and using various herbal formulas to lower dysbiotic organisms, I was able to regain my health almost fully. And really, that led me on a whole journey of exploring further integrative medicine and understanding how the body works at a more basic level.

[00:04:58] Scott: For those people that may be newer to the world of mold and mycotoxins, or more broadly biotoxin illnesses, what we call CIRS, can you give us an overview of that condition? And why is inflammation the hallmark or the centerpiece of these conditions?

[00:05:13] Dr. Gupta: Yeah, I think it's a great question. And really, this condition of CIRS, which was described by Dr. Ritchie Shoemaker and his research team, was based on the condition known as SIRS or sepsis syndrome, which was actually something that people generally encounter in intensive care medicine, which is also something I used to treat when I was working in that domain.

And really, this whole area of research has come from the idea that, when someone becomes really, really unwell from a urinary tract infection or a pneumonia, or any other type of fairly minor infection, and when that turns into a life-threatening sepsis situation, the problem is not really just the organism, the original organism that caused that infection. So, let's say someone who had a urinary tract infection, then all of a sudden, is... is in this life-threatening situation where they've got very low blood pressure and need ionotropic medication just to maintain their circulation, even having treated their original infection with antibiotics doesn't necessarily get them free of that state that they're in.

And what we had been clear is that there's a whole separate mechanism called a cytokine storm, which is responsible for most of those symptoms. So, what happens as a result of these compounds called cytokines, is that one develops leaky circulation, and that... that leads them to have very low blood pressure, and leaky lungs, and... and... and various other organs, which develop really a lot of inflammation in them and get very badly affected.

And so, really, it became quite clear through the research that, in sepsis, the organism was only part of the problem, but the other huge part of the problem was the inflammatory storm. And... and so, Dr. Shoemaker and his team started looking at that in chronic illness patients. And they found that, in some patients who had been exposed to a relatively small amount of a biotoxin that, for instance, the rest of their family was also exposed to but were not particularly sick, they became very, very inflamed as a result of those exposures, and... and would basically continue to have a chronic illness, even... even sometimes when that exposure had been taken away. And so, that's why he referred to it as Chronic Inflammatory Response Syndrome. It's like a chronic form of sepsis syndrome.

And really, what he described was that it was a chaotic, inflammatory response to a biotoxin that occurred in genetically predisposed individuals. And... and yeah, the original research really looked at that, this idea that people with this syndrome were genetically predisposed. And we can talk a little bit more about that and how... how the more recent experience is... is kind of evolving in terms of whether it's really a purely genetic condition. But that was the original description.

And the description was that people with a genetic predisposition were unable to process biotoxins from sources such as water-damaged buildings, or tick bites, or contaminated bodies of water due to something called defective antigen presentation. So, instead of being able to create antibodies to those biotoxins, they created this... this inflammatory storm, which then became the illness.

[00:08:44] Scott: It's interesting, because it sounds like there's a lot of correlation there between CIRS, C I R S, S I R S, and the current situation happening in the world with COVID, and those people that go on to develop this long-haul COVID sounds a lot like Chronic Inflammatory Response Syndrome.

[00:09:02] Dr. Gupta: Yes, absolutely. There's a very great correlation there. And I think there could be much more research done in this whole area as to what sort of predispositions are setting people up to get long-haul COVID. And what sort of interventions may help in actually helping to switch off this overloaded or over... overactivated inflammatory response that occurs in these patients.

[00:09:29] Scott: Talk to us about the scope of symptoms that you see in someone that has this multisystem, multi-symptom illness. And then are there any unique signs or symptoms that serve as clues for you to think, “Ah, I need to explore the potential for mold illness, water-damaged buildings in a particular patient,”?

[00:09:48] Dr. Gupta: Okay, so the first thing about CIRS is that it's going to be a multi-symptom, multisystem illness. So, if someone comes to you as a practitioner and they say they have symptoms from one body system, so for instance, they just have headaches and insomnia, well, that's not CIRS. In the same way if they only have symptoms from two body systems, so for instance, they have headache and insomnia and abdominal pain, that's also not CIRS. However, if they have symptoms from a range of different body systems, then you... that's much more suggestive.

So, in CIRS, often patients will have fatigue, they'll have skin rashes, they'll have abdominal pain, they'll have headaches, they'll have insomnia, they'll also have sinus congestion. So, that's one of the first things it's that... it's that... it's the range of different symptoms that tends to make you think that someone has CIRS, rather than something more localized like a microbiome imbalance.

Now, there are some specific symptoms which have been described, and that includes a vibratory sensation, or static electricity shocks. Those two, I think, in particular have been described from mold as being very specific. The other thing is any symptoms that appear to change when a person is exposed to certain building environments is likely to be more specific for mold-related illness.

[00:11:15] Scott: So, we know that the inflammation is associated to the immune system and how it's responding. Let's dig a little bit into the innate versus adaptive immune response, and how that could be different under normal circumstances as compared to someone that's dealing with Chronic Inflammatory Response Syndrome. 

[00:11:33] Dr. Gupta: Right. So, my understanding is the innate system is... or the innate immune system, rather, is... is a more... much more nonspecific response that really starts almost immediately when any type of foreign invader is introduced into the body. And it really, you know, goes on, in general sense only for 4 or 5 days. And so, for instance, an example would be, and you mentioned in, in COVID-19, when someone gets exposed to the virus, and then initially becomes very acutely unwell very quickly, it means they've only had an innate immune system response. And that response has become ramped up very... to a very high level very quickly.

So, the innate immune system response includes cytokines. And as we mentioned before, cytokines are certain compounds. It can include things like C4A and TGF beta 1. There's also, you know, a number of different interleukins. One that's looked at very commonly is our interleukin 6. Interleukin 13 has been looked at very closely with regard to asthma and... and related syndromes. And so... and then there's another one called tumor necrosis factor. And so, these are all cytokines. And what they do is they're signaling molecules that signal organs and cells to perform certain responses. And generally speaking, they cause the cells to go into like a danger response.

Generally speaking, that's supposed to be only quite a small response, or a small part of the immune response to any foreign invader. But the... the more coordinated and specific response is the acquired immune response. And that usually starts on around day 3, and that involves the formation of antibodies. And that's the most important part of it. There are also some other elements of it like the complement system and so on. But the formation of antibodies is considered to be a very specific and coordinated part of the immune response. And generally speaking, if one has a proper acquired response to any foreign invader, then generally one is able to rid that invader from the system. And the problem is, when one is not able to have that acquired immune response, then one tends to have a chronically overactivated innate immune response. And that is essentially what CIRS is.

[00:14:00] Scott: So, that's where you were talking that if we have this genetic predisposition to biotoxin illness, that then translates into having an ongoing innate immune response that's driving inflammation and having an under-functioning or absent adaptive immune response, or that antibody side of the immune system.

[00:14:19] Dr. Gupta: Exactly. That was the original description in a T.

[00:14:22] Scott: You know, sometimes people think about mold exposure, and they say, “Oh, I get sneezy, runny nose, you know, my eyes burn,” that type of thing, which is really more mold allergy. And I want to talk about the distinction between mold allergy and mold biotoxin illness. Can someone have both of those? Is the treatment the same or different? And is it important in someone dealing with CIRS to also consider the possibility that some of their symptoms could be from mold allergy and not entirely from mold biotoxin illness?

[00:14:56] Dr. Gupta: Okay, yeah. So, I think this is a great question. And firstly, yes, I totally agree that that they are totally separate and distinct. And they should be understood as being such. So, if... if someone, as you say, just has a response to mold where they get, for instance, a runny nose or a little bit of a skin rash, what that is, is a response from their immune system. And it probably is related to the acquired immune system where they get an antibody response, but it's a... it's an immunoglobulin E response. And that is... that’s still a... it's still a little bit of a dysfunctional immune response. But what I'm going to say is, it's not as dysfunctional CIRS by any stretch of the imagination. It's really just where you're getting... you're getting too much IgE response, and you're getting... getting histamine being released. And histamine is the mediator, which causes many of those symptoms, including skin rash, and runny nose, and so on.

So, in contrast to that, CIRS involves a whole group of different cytokines and mediators. We're not just talking about histamine. There’s... there’s a number of proteins such as C4A and TGF beta 1, and... and MMP-9 that all become elevated and cause inflammation throughout the body as a whole. So, they're... they're very distinct. There's a lot more bodily chaos going on in CIRS as a general rule. So, people with CIRS will generally be a lot more unwell than those with allergy.

Now, there is a little bit of a crossover in the area of what's called mast cell activation syndrome, in that mast cells are involved in allergy to a certain degree, but they can also be involved in CIRS as well. So, you can see there is a little bit of a... a crossover there. And those who have mast cell activation syndrome may share some of the symptoms of allergy. They may get itchy skin rashes and so on. But their problem is still multi-symptom and multisystem. So, it's much more like CIRS overall.

So, the two are definitely distinct. And yes, I would agree that, for someone with CIRS, it's worth exploring whether part of their symptoms could be due to mold allergy, because the treatments for mold allergy are much, much simpler. And in many cases, one can do a type of desensitization, and that may be quite an effective for that component to their illness.

[00:17:27] Scott: And my understanding is that's where the LDA, low-dose allergen therapy, LDI low-dose immunotherapy, that those really are targeted more on the mold allergy side and are not really doing anything. While they can be very, very helpful, they're not doing anything specific to the biotoxin illness side, but they are addressing that mold allergy response.

[00:17:46] Dr. Gupta: Yes, that's also my understanding.

[00:17:49] Scott: Beautiful. Traditionally, we think of CIRS as originating from water-damaged building exposure, however, we do know that Lyme and coinfections can lead to CIRS, to elevations of those same markers that you mentioned, C4A, TGF beta 1, MMP-9 and so on. Can Chronic Inflammatory Response Syndrome occur in someone with Lyme alone? Does mold need to be part of the picture? And in those people with chronic Lyme, would you say that it's common that there is, generally speaking, a mold component that's part of their puzzle or picture as well?

[00:18:24] Dr. Gupta: Yeah, it's a great question. And I think the answer is it is possible theoretically for someone to just have CIRS due to tick-borne infections such as Borrelia and coinfections. However, the experience has been that the more long-term or persistent it becomes, the more likely it is that mold becomes involved. And I think one reason for this is that they... they develop a level of sensitivity, the whole system, the... the certain gene pathways become activated once they've had borrelia and coinfections. And therefore, they become sensitive.

And then mold is extremely ubiquitous, and it's very common. Probably, at this point, my impression is more buildings are water damaged than are not in Australia and the United States and... and most other countries. And therefore, the odds are that if you've had a tick-borne infection, that you're also likely going to be exposed to water-damaged buildings somewhere along the line. And therefore, it's likely that mold is going to get in on the act because there's a weakness in the system that gets developed through having that infection. So, it's very, very common to see them both coexist, although it would be theoretically possible for just Lyme to be the cause.

[00:19:43] Scott: Yeah, and that's what I've commonly seen as well is maybe somebody had a, you know, tick bite many years ago, but they never had symptoms, they move into a moldy home and suddenly they have, you know, chronic Lyme disease. But that's probably associated to the immune dysregulation from the water-damaged building it exposure. Or maybe the... the opposite scenario, where maybe they had mold exposure that already dysregulated the immune response. So, when they later came into contact with Borrelia, Bartonella, Babesia, all of those vector-borne pathogens, they could not mount a healthy immune response, and instead shifted into that more chronic Lyme, Chronic Inflammatory Response Syndrome.

[00:20:24] Dr. Gupta: Yeah, exactly. And it definitely seems that the more triggers that one has, the more likely one is to develop a chronic illness. And in some cases, you know, one can have borrelia or another infection in the body and be totally well. So, it's not... it's not quite as simple as have biotoxin equals illness. It's a little bit more of a complex equation there. And I don't know that we've really teased out all of the subtle pieces of that puzzle as yet.

[00:20:53] Scott: I think that, over time, we've heard Ritchie Shoemaker suggests that mold and mycotoxins are a smaller piece of the CIRS puzzle and that there is a soup of toxins, inflammagens, microbes that we encounter in water-damaged buildings, a lot of them that we're still learning about, what are they? How do you treat them and so on? Talk to us about the range of things that we might encounter in a water-damaged building beyond mold and mycotoxins that can contribute to a CIRS condition.

[00:21:22] Dr. Gupta: Yeah, I think this is a great area too for people to be aware of. And there's really been a whole host of different compounds that have been associated with water-damaged buildings in addition to just the mold and mycotoxins. And that includes what we call Volatile Organic Compounds or VOCs. And those VOCs are broken into normal VOCs and mVOCs, which means Volatile Organic Compounds which are of microbial origin. So, those are really important as well. You can get... basically, you can get off-gassing of different microbes which are creating gases that can make people unwell.

Now, the next category is bacteria, which seems to be a really important one. And, you know, there's one researcher and... and remediator in Australia, Vince Neil, who really has emphasized the importance of bacteria in... in making people unwell in different water-damaged buildings. And... and it does appear to be a major player. It's not just mold. And sometimes we refer to the word mold more as shorthand to the whole microbial soup that occurs in a water-damaged building. So, bacteria are very, very important. Also, parasites have been described in a water-damaged building, that they can be part of the... the problem there as well.

There have also been other rarer organisms, such as Mycoplasma and Chlamydia have been associated with water-damaged buildings. And it's quite possible in some cases when... when patients have Chronic Fatigue Syndrome which was associated with Mycoplasma that they could have actually picked that up through a water-damaged building. You know, although that classically was associated with... with having episodes of pneumonia, and being in the air, it's quite possible that it's coming from water damage in various buildings.

So, there's a whole host of different organism. Actinomyces is the other really important one that gets discussed by Dr. Shoemaker and his research team. And I believe has transcriptomic testing has suggested that... that the... the Actinomyces is very significant in terms of the... the gene expression changes that occur. I mean, sometimes, on a practical level and on an individual patient, it's very difficult to know which specific component of a water-damaged building has made them unwell. But you can generally tease out the fact that they're unwell due to water-damaged building. And really, the treatment is not so different in many cases.

[00:23:46] Scott: Let's come back to talking a little bit about that genetic predisposition, the HLA-DR genes, those had been discussed for many, many years as predisposing one to the potential development of CIRS. What's the latest on the HLA-DR genetics in terms of not only being a predictor of the potential to develop illness, but also as a predictor of treatment response? 

[00:24:10] Dr. Gupta: Yeah. So, the HLA theory, I think, is very interesting. And I think it's an area that warrants further research. But probably the biggest thing that's come into question through the different physicians around the world who have been treating mold-related illness is the idea that it's only... these genes only occur in around 24% of the population. And what we generally see with... with patients that are seen in a chronic illness clinic is almost all of them appear to have HLA genes, susceptibility genes. And there is a very, very high crossover with the celiac disease genes. And those celiac disease genes are known to exist in around about 80% of the Caucasian population. And... and my sense is that the same HLA genes which have been discussed by Dr. Shoemaker are probably closer to that.

And so, I think we need more... more research, and we need it to be done in more of an American population or Australian population. The original research, I think, wasn't... was not... was not peer reviewed, and really needed to be fleshed out more, in my opinion. So, generally speaking, what most of the ISEAI physicians have found, and they're... they’re physicians who are part of the group, which is fully known as the International Society for Environmentally Acquired Illness, is that, on a practical level, in terms of differentiating whether... whether any chronically-ill patient is unwell due to biotoxins, the HLA genes don't seem to really be a specific-enough test to help us to differentiate, and they generally haven't been found to be useful.

I'm not saying that they... they're of no relevance whatsoever, but at this point, it doesn't appear that they... they need to be checked in someone who has part of their workup for biotoxin illness. But, you know, there's certainly... there's certainly room for further research. We do know that there's many differences in HLA gene types in those with autoimmune disease versus not autoimmune disease.

And so, you know, it is... it is something that could be developed further in future, and it may be... you know, there was some confusion, I think. So, originally, in the original work from... from Dr. Shoemaker’s research team, it was suggested that there was some mold-susceptible genotypes, and some Lyme-susceptible genotypes, and some multi-susceptible. And in practice, that turned out to be somewhat confusing. In that, for instance, you'd find someone who had a... a mold-susceptible genotype, but their problem clearly appeared to be related to a tick bite, and they clearly appeared to be unwell due to that. But with that old way of looking at things, the tendency was to then just put them purely in the water-damaged building basket. And I... and really, that... that whole approach didn't turn out to be useful and successful.

And so, really, what I'm saying is we... I think this whole HLA theory needs an overhaul with regard to mold illness. I suspect there is some considerations there. So, for instance, if someone has what's called the 15-6-51 gene type, it does appear that they're more likely to get a severe neurological complication of Lyme disease. However, that doesn't mean that if they don't have that gene type, they're not going to get unwell due to Lyme. You're with me?

[00:27:24] Scott: Yeah.

[00:27:25] Dr. Gupta: It's more... it more be that... it's more that they... those people may be more likely to get a very severe cytokine storm that then leads to something like multiple sclerosis or some other autoimmune disease. So, maybe it could be considered that they’re accelerators of disease rather than determining who is or isn't suffering from a particular biotoxin-related illness. I hope this makes sense.

[00:27:50] Scott: Yeah, that makes a lot of sense. And for listeners, the ISEAI group is a fantastic resource, particularly practitioners that want to get more into this realm Their website iseai.org. And I definitely encourage people to look at that as a resource in this conversation as well.

We know that the source of ongoing exposure has to be addressed, either removing the toxin from the patient, or removing the patient from the toxic environment. Talk to us about the benefit of a mold sabbatical in both exploring the potential impact of the external environment on our health, but then also as a longer-term treatment option. And then extending on that, is the mold sabbatical required to recover from mold illness?

[00:28:34] Dr. Gupta: Right, yeah. So, I think this is... this is another really important area that I believe is very worth exploring for anyone who's trying to tease out whether water-damaged buildings are part of their illness. And so, let's take a hypothetical situation. Let's say you have a chronic fatigue syndrome or fibromyalgia patient who has, for years, been trying to get improvement and hasn't been getting it. Let's say they then come in and see someone like myself, who’s very interested in biotoxins, and we're trying to tease out, have water-damaged buildings been a major causative or triggering factor in their illness?

Now, the first thing is we would go through the history. And let's say the person says, “Well, yeah, you know, I've had some houses which have had leaks in them. And, you know, but... but, you know, none of them had visible mold, for instance.” And that's another really classic area where, you know, there's a level of education that people need to be given, that it's not all about visible mold. It can be that... that... that buildings are very severely water-damaged without there being any visible signs. And so, if you've had a building that have had... had a leak, or had flooding occur, even if there was no visible mold, there is going to be very significant amount of contamination that's occurring to the structure of the building, and that will be off-gassing. And so, in many of those cases, let's say in that case, I would be starting to become very suspicious that biotoxins are playing a great part in that person's illness.

Now, that person may not believe me, because of their... you know, their... what they've been led to understand about their illness and so on. Now, the role of a mold sabbatical at that point is that what happens is there's an ability for that person to then correlate differences in their environment to their symptoms. So... and I first heard this concept when it related to gluten and other food allergens is that, if your button is always pressed for something, then small deviations in that button being pressed or not are unlikely to be... you know, there's no difference that's likely to be noticed with your symptoms.

So, what I mean by that is, if you're... let's say you're gluten-sensitive, and you're eating... you're eating wheat bread every day, then going and just having 1 extra bun is probably unlikely to cause much of a difference in symptoms, because that button is already on. What you need to do is turn that button totally... totally off by having zero gluten for at least 3 or 4 weeks. And I did that myself, actually, as part of my illness that, you know, in around... in 2005 when I had that majorly debilitated thing, nurses at the... at the unit where I was talking about, one said to me, “Sandeep, you've got really blocked sinuses. Have you considered removing gluten from the diet?” And my response, like any good conventional doctors, “That's rubbish. It's got nothing to do with that,” right? But I humored them anyway, because I really didn't want to be suffering from... from sinus. And so, I stopped gluten completely for 4 weeks. And then when I actually had some bread straight after that, I actually, all of a sudden, felt like I was suffocating. I couldn't believe it. It was so dramatic.

And so, you can see how this same principle applies to the mold sabbatical. If someone's always being exposed to mold, then just, you know, going outside the house and going to the shops and coming back, you're not going to notice any difference, because your... your inflammatory pathway is already activated. What you need to do is get away from the building from a good period of time. And by a good period... a period of time, we usually say at least 2 weeks. And I know that's very significant for most people, and that is a significant investment of... of... of, you know, time and also, you know, a significant reorganization of their daily routine in order to do that. However, I believe it's very, very worthwhile.

And generally speaking, the best option is to go tent camping, if you don't live in Alaska, or somewhere like that where it's just not possible. If you can... if you live in an area where that... that's... that's possible in terms of the weather, then that's the best option. You need to make sure that the tent hasn't been water-damaged, but that's actually fairly rare. But it actually can happen sometimes if you've put a tent back after it's been raining back in the container or whatever, actually, you can get... sometimes get it tend to becoming water-damaged. But generally speaking, it's pretty rare.

Now, the... the next thing is that you don't want to take your entire house and wardrobe with you. Because if you do that, you will be... you'll be taking a lot of the mold with you. You've got to just take some freshly cleaned clothes. And then let's say you take one electronic item like an iPad or whatever, you're going to make sure that that's... that's been really thoroughly disinfected with a damp cloth and a HEPA vacuum. And so, what you want to make sure is that you're not taking a bunch of contaminated items with you.

Also, the suitcase or the... or the backpack that you take with you, you're going to make sure that's not contaminated as well. You need to give that a really good smell, and make sure that... because if that's been sitting in your water-damaged building, then most likely that will be contaminated. So, that's actually something I just recently started thinking about that that's probably it needs to be part of the instructions as well for a mold sabbatical is you need to make sure, most cases, you probably need to take a new suitcase or backpack with you. You need to wash your clothes, and you need to decontaminate any electronic or other items with you.

I mean, having said that, it's actually a really good time to start getting away a little bit from electronic items and just to get connected with the earth in general, and just to start tuning into your own body in... and just getting much more connected to your own body in general, and noticing what subtle things do make you feel better and not feel better. Some people find that starting a little bit of limbic retraining exercises during that time is also useful.

And then... then when you return to your home, you then you need to... you need to be there for a good period of time. You don't just walk in for 5 minutes and then leave again. You need to make sure that you're there for at least several hours. And then what you need to do is just really tune in and pay attention to your body and your symptoms. Just ask yourself, “Okay, what am I noticing in my body right now? Is there any... any subtle changes are that going on.”

And so, it's not a guarantee, that's the thing that everyone will... will notice a huge difference. But generally speaking, my experience is that... that the majority of people will notice a difference with getting away from their home, if they're in a water-damaged building, and then going back to their water-damaged building. And the difference then is it becomes your own personal experience. It's no longer... you know, it's no longer your integrative doctor who's interested in biotoxins trying to ram down the idea that mold may be affecting you. All of a sudden, it's your own body's feedback. And therefore, it then becomes your own motivation to start addressing that. Because ultimately, someone else trying to convince a patient only has limited effectiveness, you know? It just ultimately... ultimately, something has to come from the person's own motivation. And so, that's the reason that I really like that.

And even if... and even in that case of some... that patient with Chronic Fatigue Syndrome or Fibromyalgia, you can also do tests, which we haven't talked about yet. I mean, and that also is helpful. That can also help someone feeling more convinced that their illness is related to... to biotoxins. I mean, and... and there's a range of different tests which can help to establish that. However, I still think that one's own personal experience with a mold sabbatical is perhaps the most powerful thing in one becoming convinced that biotoxins are a major factor in their illness.

As a long-term treatment option, generally speaking, it's been described in the original literature and so on that... that one just needs a clean home in general in the majority of cases in order to recover. And the original research suggested an ERMI less than 2, or an ERMI less than - 1, if one had a particularly high C4A level. Now, the... that was then replaced with the reg... with the HERTSMI-2 test in... when the subsequent research came out. And the recommendation was that one needed to live in a building with a HERTSMI-2 of less than 11.

Now, the... I think the experience of many... many integrative doctors around the world, particularly from the ISEAI group, is that the... those scores, although helpful, they can't be the total, the full sum total of the... of the assessment of a building. And really, what I'm saying is that your body in many cases will be the best judge of whether a building is affecting you or not. And so, if you are in a building and you go on a mild sabbatical and you feel much better, then that building’s still affecting you, whether or not the HERTSMI is... is lower or greater than 11, because those... those tests are just not perfect.

And so... so, basically, in many cases, people are able to find a home or remediate their own home to a level which is satisfactory for them to be able to recover. However, in a smaller group of patients, they may need to consider what's called extreme mold avoidance. And in... in those groups, doing basically a mold sabbatical or equivalent to that, and... and so that can be tent camping, that can be living in a converted RV, and all these various other variations on that, may be needed for at least some time, or even some people may be long-term in order to recover. So, the key thing is I'm not saying that that needs to be the case in all people, but I'm also not saying that there's no one that needs it.

And I think it comes down to the fact that it's all individual. And you need to... basically, you need to listen to your body. And that's where the mode sabbatical is really, really important in basically establishing whether you have ongoing responses to whichever building you're in, and whether you need to be totally away from... from... from even low levels of... of contamination, or whether you can do okay and recover, even despite low levels of contamination in a home.

[00:39:10] Scott: Yeah, I mean, I think it's very clear that the less exposure we get to mold and toxins from this soup of water-damaged building items, the better we will be from a health perspective. One question that I had was, when you do the mold sabbatical, do you find that in some people, they may not notice enough of an improvement if they're not also considering the enterohepatic recirculation potential and incorporating some type of binding agent during the sabbatical?

[00:39:42] Dr. Gupta: Yes, I think... I think there was a small group that... that don't notice enough benefit. And, yeah, I guess one possibility is that they're not binding mycotoxins at all to get them out of the system. I mean, the other thing is there's just a subgroup of people who... who just are struggling to get in touch with their body is what else I've noticed. And for whatever reason, they're just... they're just not really able to tune into their symptoms very effectively and into what their body feels. And... and often this is related to where they're at in terms of their own journey of trauma and so on.

You know, then... and that would... I mean, this isn't something I've talked a lot about, but there's different stages when you're dealing with emotional trauma. And emotional trauma is often a component of CIRS. And that can be due to the illness itself or it can actually be a predisposing factor. And it's often... it's often a bit of both. And it's, firstly, emotional trauma is very, very common.

Now, there's a whole stage of emotional trauma where one basically is disengaging from that trauma totally and almost acting as if it doesn't exist. And during that stage, one is not very well connected to one's body at all. And so, if you're in that stage and you go on a mold sabbatical, you may not be able to just tune into your body well enough. And... and often people who are in that other ones who, during that whole time in the mold sabbatical, they'll generally be complaining and finding things to, you know, that... that are annoying them and so on. And they... you know, that's... that's basically you're... you're not really getting into the proper rhythm of the mode sabbatical in that case. You know, you're, you're still in your head. And what you really got to do is try and ground yourself into your body and really feel into your body. But also, you know, as Scott says, yeah, making sure that you're on at least some basic treatment is... is probably quite important.

[00:41:30] Scott: Let's talk about testing of the environment. What are some of the initial self-testing methods or strategies that could be a starting point for people? And then when should you consider that an indoor environmental professional or IEP is really necessary?

[00:41:45] Dr. Gupta: Okay. So, this is... this is also very, very important. And the first thing is simply just to use your senses, okay? So, the first thing is just to look around your home, and look very carefully. I'm not just talking about having a very cursory glance at the walls, you need to really look at the skirting boards around your building and look at the font... the windows sills. And have a look, is there any signs of black mold or other different colors of mold there?

Now, the second thing is then smelling. Do you notice any type of odors in your home at all? Now, this is often a difficult one, because most people with CIRS and related disorders will have a degree of nasal congestion. And if you've got significant nasal congestion, which can be due to fungal colonization in some cases or other dysbiotic organisms, that can mean you don't have much of a sense of smell. And so, in fact, sometimes, you may have to work backwards and do a degree of treatment for your... your nasal congestion before you'll be able to notice any subtle smells.

So, that's the first thing is just to look around and notice, and then also to look is there any signs that your roof is leaking, or if it's totally full of leaves when congested? Are there any signs like that that... that make you suspicious of the fact that your... you know, your roof may be letting water in, or any other area of the house maybe not properly with standing water from the outside and letting water into the interior. So, that's the first thing. And I do think that's really important. Again, this idea of just totally tuning into your senses, that's really important.

The second thing is you can do some basic testing. Now, a simple one is what we call mold plate testing. And although that's not considered to be, you know, very, very accurate, it is very motivating, in the sense that, if you put a mold plate in various rooms and you see mold in there, well, that's... you know that... again, that's... that... that's almost at the same level of power as doing a mold sabbatical and realizing you feel totally different. It's just it's an aha moment for anyone to realize that their mold is... their home rather is... is got mold growing in it, even though it's not visible. So, that can be very, very useful.

The next thing you can do on your own is to do the ERMI or HERTSMI or EMMA test. And... and... and so, they are basically what we call PCR tests or DNA test, which is similar to the test that's being used for COVID. But they're on the home, they're not on a person. So, you get... you use a Swiffer cloth. And so, the ERMI test goes and looks for a very large number of molds, around 30 or so, while the HERTSMI-2 only looks at 5. So, you can derive a HERTSMI-2 from the ERMI test, by the way. So, if you do... if you do the ERMI, you actually get both.

And then the third one is called the EMMA, which also includes mycotoxin testing. And that can be quite useful in the sense that sometimes, Stachybotrys particularly, which is one particularly nasty species of mold won't be able to ever be discovered through just testing for the mold, but you will able... you will be able to find the mycotoxins from it, the trichothecenes more readily by using the EMMA test. And that's offered by RealTime Laboratories. And... and I think what you know, from the recent discussions we had with them, they're trying to adapt this test so that it includes all the... the mold species from the HERTSMI-2, in which case, I think it may become the preferred test.

[00:45:18] Scott: Absolutely, that'll be fantastic. So, when we're looking for an IEP, how important is it that we really make sure that that person understands Chronic Inflammatory Response Syndrome versus they just come out, do an air test give their stamp of approval? And then how do we go about finding someone who, from a CIRS perspective, is really qualified to play that role?

[00:45:20] Dr. Gupta: It's of utmost importance is the answer. And really, you know, I think there's many different facets of life where the... the qualifications and skill of a practitioner in a certain area are very variable. Now, I would say, in this area of indoor environmental professionals, it's probably more so than any other area. And so, basically, the... you know, one of the issues is there's no real standardization within the field. So, really, one could be going around calling oneself a mold Inspector, but really only having a very superficial level of knowledge. So, for instance, one could be calling oneself a mold inspector, and really be only just dealing with visible mold. And so, one could then... one scope of work could be just simply spraying and... and bleaching visible mold, that's... that they're in a building.

Now, obviously, if you've got a subtle mold problem and you get someone with that scope of... of work, they're just not going to do anything for you. They're just going to walk into your home, and they're just going to say, “Your home is totally fine.” And that's because they're just not looking with enough of a microscope. It's the same thing if you let's say you have a plate of bacteria, that... that's not visible, and you take it to someone who doesn't actually look in the microscope, and they'll just say, “Oh, yeah, that... that's just a totally normal plate.” It’s because you haven't looked in the microscope.

So, you know, then you get someone who actually knows how to look in the microscope, well, they'll... they'll look at that and say, “Well, hang on, there's actually thousands or millions of bacteria in this plate you've given me. Who said it was normal?” And so, it's all... it's very much dependent at what level of focus is the person willing to look at. And... and... and... and so, someone who understands CIRS, or let's say they don't even use the word CIRS, but understands chronic illness related to water-damaged buildings, whether that be mast cell activation, or chronic fatigue syndrome, I don't think it's so much matters that... that they're specifically tuned into that word or that particular body of research, but they need to understand the idea that, even very low levels of mold can be very deleterious in people with chronic illness who are very sensitive to mold.

Then that's a key understanding, then those people are much more likely to then look with a much finer microscope. And the sort of things that those practitioners will do is look for very subtle signs, firstly, like I've mentioned. Then they'll do what's called moisture mapping. So, they'll... they'll use a moisture meter, and the look for areas of... of increased moisture and map that out and try, and then think about why there could be an increased-moisture reading in that area. That's a very, very important part of an IEP review. Because it’s... it’s not just a matter of working out, “Is there mold in a home or not?” it's also working out where it is, and why it is there.

And so, let's say they... they find it in a particular bathroom, they also need to identify, “Okay, is that the shower that's leaking? Is it the... the waterproofing around the shower that’s... that’s not doing its job properly? Then we need to get a contractor in to firstly make sure that that waterproofing is fixed?” Because that's the second thing is going and fixing mold without getting rid of the source of the problem is not going to be of any use whatsoever. So... so, that's one of the first things they'll do.

And then the next thing they'll... they’ll generally do is do sampling. And it can be a sampling. I'm not saying air sampling is totally useless. But air sampling won't pick up certain species of mold. So, Wallemia is one example, for instance, and I think Stachybotrys and so on is very rare that they'll pick that up in the air. And so, generally speaking, they can do air testing, they can do surface sampling. And in many cases, it is useful then for them to consider doing the PCR testing like ERMI or HERTSMI-2. Although that's somewhat rare amongst IEPs to do that, it is generally... it will be more sensitive to picking up low levels of mold and the other things.

But I'm not saying that that always has to be the case. And I think if... if a IEP or building biologist is really doing their job properly, they should be able to pick up the problem, even without doing ERMI testing. So, it's very, very important that they understand that low levels of mold can cause problems for chronically ill people. And it's very important that they've got the tools and knowledge to be able to go to a quite a subtle degree to try and find out the source of mold and the presence of mold in a building.

And so, there's a number of different certifications as well, which you can look at which are all covered in my course. That... that can give you an indication that an IEP is more well trained in this area.

[00:50:39] Scott: Beautiful. If somebody cannot get an IEP to physically come to their location, these virtual consultations are becoming more well known, is that something that potentially could help guide you in the right direction? How does a virtual consultation work?

[00:50:54] Dr. Gupta: Yeah. So, a virtual consultation would generally work over Skype or Zoom or other similar video conferencing program. And ideally, you want to have a good-quality laptop or iPad or something like that, which is able to, you know, give that person a reasonable tour of your home, and to be able to give them an idea of the building, and... and help them to understand the appearance of the building. You then need to give them the history of the building verbally. And they probably would have to rely on that to a greater degree than they would if they were doing a physical inspection. So, it's not going to be exactly the same, but I think it can be quite satisfactory.

And in some cases, if you have a local IEP who's not as expertly trained, but are willing to work with a remote IEP, that could also be a methodology which could be quite useful, in that let's say you had yourself and the local IEP sitting at... on one side of the computer, and then you had the... the distant IEP who was more expert. And there’s a... there’s a list of those experts at the ISEAI website who you could call on. There’s... there’s a... there’s a range of different individuals who have been working in this area for a long time. And I think that's not just the United States, I think they're also listed there for Australia and other countries.

And so, if you can then have one of them on the other end of the line, and maybe in some cases, they may even be in a different country, that... they can then take you through the process, even though they themselves are not able to get into the building and do the sampling themselves, they can guide the local IEP through the process of what sort of moisture mapping they need to do, and what sort of sampling they need to do, and then what sort of further steps they may need to take. So, I think that's quite an acceptable kind of methodology for working, especially in this world in which travel is no longer as easy as it was a year ago.

[00:52:55] Scott: Right, absolutely. Once we get to the point of understanding there's a problem, need to do some remediation, how important is that the inspector and remediator are different people?

[00:53:08] Dr. Gupta: Well, that's the gold standard, absolutely, is that they... the inspector and the remediator are separate, and so they don't have a conflict of interest. And therefore, basically, an inspector will do what's called a scope of work. And they will then pose it to the remediator. I guess you could say the... the other idea is that you've then got two eyes looking over the one job, rather than just one set of eyes. And generally speaking, the remediators do have different... a different skill set to a inspector. The remediate is really, really focused on how to deal with a problem, while the inspector is really... their skill set is how to identify and... and to... to create a scope of work around that problem that they've identified.

Well, the remediator he needs to know, in a very expert way, how to firstly deal with the source of moisture in grass. Now, in some cases, there's no actual specific source, it's more just to do with what we call condensation, and... and so there's nothing to do. But first, one has to consider whether there's an actual source that needs to be dealt with. So, another really common one is one has rising damp coming from the bottom of the building. And one may... may need to install something such as perimeter drainage or another strategy to deal with that before one actually deals with the... with the contamination.

So, then the second thing is... is dealing with the building contamination. And the general mantra is that all contaminated building materials need to be removed. And... and so, that... that's something that often doesn't occur in... in many cases.

[00:54:48] Scott: It seems to me that people often are looking for solutions where they don't have to do what you just talked about, which is removing the source material where they're getting that exposure from. And we're looking towards things like fogging or ozone or diffusion of essential oils to bypass that need for more invasive mitigation. And so, I'm wondering, you know, do those strategies work in that manner? And are there also nonliving particles that are part of CIRS that have to be removed with strategies that go beyond just killing something?

[00:55:23] Dr. Gupta: Yeah, I think it's a great question. I think the answer is embedded in the question pretty much, in which it's basically, yeah, you know, the... you'll never be able to have a totally satisfactory solution if you don't get rid of the source problem and get rid of all contaminated building materials. And also, the other thing is also getting rid of any contaminated or dealing with any contaminated furniture and possessions. So, that's that... that's the gold standard.

Now, the thing about fogging a building is you... that will make a difference. So, for instance, if you use something like hydrogen peroxide or ozone, what they do is they’re oxidizing agents. So, they will kill mold that's in the air. I'm not denying that at all. But the problem is, as Scott mentioned, that the particles will still be... will still be there, and they can still... you know, they can still off gas to a certain degree, that you're still getting particles of mold in the air, which can keep your inflammatory system triggered, so to speak.

Now, then the next thing is, you've still got something which is... which is off-gassing the microbes that's still in the background there. So, even if you deal with it once, it's going to just keep coming back. Because it's like you've got a fact... I mean, the classic analogy is, if you've got a boat that's leaking, and you've got... you know, you've got a... you've got a bucket paling water out of there, you haven't dealt with the hole in the boat. It's just going to keep leaking. You're not going to do... you're not going to do a lot. I'm not... so, I'm not going to say don't get a bucket and... and don't start paling some of it out. I mean, yeah, sure, of course, do that as well. But you've got to deal with the source problem. You’re just never going to get a satisfactory solution without that.

Now, you can... you can get a temporary solution, especially in cases where it's going to take a little while to gather your resources or work out, you know, how you're going to move out of your building for a certain period of time. I'm not saying that it's easy. And maybe... maybe that might take a couple of months. And maybe during that time, looking at a temporary strategy might be reasonable.

And, you know, a more... more satisfactory solution rather than fogging is to use a very high-power air filter, like what we call an air scrubber, like a commercial-grade air scrubber. That often can be done in... you know, in the interim while you're working out the logistics of moving out of your home. Because generally, when your home is remediated, you can't be in that building. You're going to need to move out during that time. And I know that's tricky in certain parts of the world, especially if you're in lockdown, or whatever it might be. So, it may be that you need to have a temporary solution. But I think it's important to realize that those temporary solutions are... they're just not a replacement for proper remediation.

[00:58:08] Scott: Yeah, I love the analogy that Raj Patel talks about, which is that you're trying to towel yourself off in the shower, but you haven't turned off the water yet, right? And so, you just never quite get anywhere. You mentioned the air scrubbers. And so, let's talk a little about air filtration devices. Some of them are filtration, some of them that have PCO purification and sanitization technologies built in. What are you finding clinically most helpful for your patients? And then can a good air filter minimize the need to do the remediation?

[00:58:42] Dr. Gupta: Yeah, right. So, the main two categories of air filters are, as you said, PCO and HEPA. There is also some slightly different modifications of PCO, which is called PECO. But PCO stands for photocatalytic oxidation. And what it... that technology generally relates to the use of UV light that basically is present in that filter, and the air comes in, and it becomes oxidized through that UV light, and you get a breakdown of particles that has occurred. And one of the advantages of that technology is there's no limit to the... the size of the particle that that can break down.

But the downside to that... that technology is, in some cases, you can get harmful... harmful substances being formed. One of those is ozone. Ozone, I mean, ozone is a wonderful healing substance, actually. I mean, you can use it internally and so on. But some people are very, very sensitive, especially if they're multiple-chemical sensitive or mast cell... mass cell activation syndrome patients. So... so, there are certain units which are PCO that don't create ozone, and that may be better, particularly if you're in that very sensitive category.

There are other compounds that appear to be created by PCO filters in some cases, and there's been reports that formaldehyde and some other similar compounds can sometimes be generated. That hasn't been 100% confirmed yet. But if you then use a HEPA filter with that, you should be able to then deal with any harmful compounds. Well, maybe not the ozone, but maybe any other... any other compounds should be able to be dealt with by the HEPA filter.

So, HEPA filter stands for high-efficiency particulate air. And that's really much more of a physical filtration device, where it's able to physically filter particles down to a certain size, which from memory is 0.3 microns. And then basically, anything smaller than that won't be dealt with. So, the downside is very small particles, which some CIRS patients can be sensitive to, may not be able to be filtered out by that technology. So, generally speaking, we recommend if you can find a technology which has both, that appears to be very, very, very, very useful.

And... and I believe Air Oasis is one brand that has certain devices that have a combination. There's one that's called the iAdaptAir. However, that's still a fairly small device. They also have larger ones, which are the... like the air scrubbers I was referring to. I believe they still have those on the market, which still have a combination of PCO and HEPA. Do you know if that's the case, Scott?

[01:01:26] Scott: Yeah, I know with the iAdaptAir that it's kind of a modular unit where you can have 1, 2, or I believe 4 of them kind of connected together. So, you can actually get a pretty sizable iAdaptAir as well. And then here in the States, we also... I think Molekule is another one that has a similar mix of filtration and purification.

There is some debate about the potential for mold colonization in the body after exposure to water-damaged buildings. So, I'm wondering if you could talk to us about the difference between colonization and infection. What is the potential for internal colonization? And then thus, the possibility of mycotoxins being produced within us, even if our external environment now is remediated is pristine? And are there any ways that we can test for the potential of internal fungal colonization?

[01:02:19] Dr. Gupta: Yeah, so this has been actually a huge area of controversy. And there's actually been a couple of different research groups who have totally different schools of thought on this particular issue. And in the original description of CIRS, basically, it was described that particles or actual mold gets in the body and triggers the inflammatory pathway. But it wasn't described, that fungus itself gets in and colonizes the body, and itself causes mycotoxin production. That wasn't part of the original description.

However, there have been other... I mean, there's definitely been reports in the medical literature of fungal colonization. There's no doubt about it. I mean, so fungal rhinosinusitis is known to be a certain proportion of patients who have sinus problems have fungal rhinosinusitis. Now, the ENT surgery literature suggests that it's only a minority. However, I would suggest that it isn't a minority. I would suggest that it's actually very common. It's just very difficult to be able to culture fungus. And one report did show that around that 90% or more of chronic sinusitis cases are actually include fungal colonization. So... and then a report from India showed that there's a certain incidence of cerebral abscesses, which can then develop if one develops bad enough fungal colonization in the sinuses.

So, it's not a mild problem actually, it can become very severe, in that the nose and sinuses are actually very close to the brain. There's only a very small plate that separates them. So, if you develop a serious fungal infection there, in some cases, that can travel to the brain. So, we have to consider this as a possibility in CIRS, and that by not treating it, there's a risk of someone actually becoming very, very unwell.

Now, the other area that's been discussed is in the lung. And the literature discusses pulmonary Aspergillosis in a lot of... in a lot of detail. We also know now that in COVID cases, there's a certain amount of people that get aspergillosis, and they tend to get much more severe illness. So, that is definitely a very... you know, an illness that I've seen in many cases. And there are certain tests for that. And so, my experience through the years, although I initially didn't believe in the presence of fungal colonization, I'm now have the belief that it is present in at least a subset of CIRS patients.

And there is a difficulty in... in being able to identify in exactly which type It is present in which it's not. Now, Dr. Neil Nathan has suggested a couple of methodologies. For instance, if you're using urinary mycotoxin testing and you're finding, despite the use of a thorough binder and detoxification process that the levels are not reducing, that would be one case in which you might consider there is fungal colonization. And I would agree with that. Also, you have to consider the possibility of another source that... that for instance, there might be a hidden source of mold in your home, or you could be consuming food mycotoxins. Although the recent research suggests that's only very... that's not a major factor in... in the presence of urinary mycotoxins. However, I guess it still can't be totally excluded on the other hand. I'm afraid... you know, afraid this is not always totally simple.

So, there are other tests you can do, including the organic acid test, which is offered by Great Plains Laboratory. And there's a number of markers there, I think, including markers 2, 4, and 9, which are related to... which are called friends. And they seem to have been born out in the literature to some degree regarding the presence of fungal colonization.

So, fungal colonization, I guess, is where your... you've got the presence of fungus in a localized area of the body. And then fungal infection is where that's become more widespread, and where you've really developed a degree of inflammatory response to it in some cases as well. So, again, that's probably another academic question that, you know, is it possible you could have fungus in your body that's not then causing an inflammatory response? And I think that's possible as well.

So, the simple answer is, I think it needs to be considered in all CIRS patients. I have seen CIRS patients improve without it. So, therefore, I don't think it's necessarily something that needs to be used in all cases. However, I have seen some patients in which the use of antifungal herbs or medication has been the turning point for their recovery.

So, that... that's really where I've got to in my personal investigation of this area, is that it is definitely something to consider in every patient, and particularly in the patients who are not getting better. As you said, or for someone who's left a water-damaged building, they're no longer in a water-damaged building, but they're not improving, and they're still passing large amounts of mycotoxins either in their urine or they're showing up on their serum mycotoxin test, which is now available. There's a mycotoxin antibody test available in America, which is called MyMycoLabs. And there's also a serum mycotoxin test available out of Germany now. I'm not sure if you've seen that one, Scott. So, that that's come to my attention just over the last few weeks.

So, if you had... if you're doing one of those tests and you're seeing the persistent presence of mycotoxins despite the house being thoroughly investigated for mycotoxins and mold, and it needs to not just be the house, by the way, it needs to also be the motor vehicle, and it also needs to be the workplace if... if one is working away from the home. And if there's no sign there, then one needs to consider that it's possible one could have a fungal colonization or infection in the body that's creating mycotoxins.

[01:08:16] Scott: Let's continue on with the sinus conversation talk for a moment about MARCoNS. That discussion is one that's been part of the CIRS conversation for many, many years. How important are practitioners finding treating MARCoNS to be clinically? And should the focus be on anti-microbials to kill the Staph, to kill the MARCoNS, or longer term, should the focus be on the optimization of the sinubiome?

[01:08:43] Dr. Gupta: Yeah, I think gradually, as time has gone by, there's been a decreased focus on MARCoNS as being a pathogen in the traditional sense, meaning, you know, bug that needs to be killed at all expense. And so, it's now more considered that... that it is a dysbiotic organism that's very common in CIRS cases. And generally speaking of its presence, it needs... you know, it means that certain antimicrobial herbs or substances can be considered. However, it doesn't need to be eradicated at all costs, is what I'm saying. It's basically something that needs to be brought back into balance.

I mean, stuff of that nature to a certain degree is normal in the body. Maybe not multiple antibiotic-resistant coagulase-negative staph, but certainly coagulase-negative staph are pretty normal in the body. So, it's quite possible. In some cases, what you'll see is, by treating it with something fairly mild like silver and EDTA or something like that, sometimes it'll actually just mutate back to a less-severe form of staph. And so, I think that's probably what's happening is that it's more like a mutation of normal bacteria in the body that's occurring in CIRS.

And so, I think we you need to consider that it's... you know, that we've got a sinubiome, as you mentioned, and then we need to consider that as a whole. So, rather than just focusing on one organism and killing it, we're really thinking now about bringing that back into balance and bringing the beneficial species up. And that's where using nasal probiotics is also starting to come onto the radar as part of a treatment program. And I think you yourself are using that. I've been using Lactobacillus sakei mainly, and... and that does appear to have some degree of clinical response, although it's fairly slow and mild.

[01:10:35] Scott: Yeah, I had that experience once of putting the juice from the kimchi into a nasal spray bottle, spraying it up my nose many years ago, and wow, that burned for about 4 days. It's pretty... that was pretty intense.

[01:10:50] Dr. Gupta: Yeah, yeah. So, we don’t recommend doing it that way. We recommend getting a commercial product of Lactobacillus sakei. And I think there's one called LantoSinus, and I think there's another product that you use, is that right? 

[01:11:03] Scott: Yeah, there's a company called Sure Sinus that has a combination, I believe, of 4 different organisms that they shipped to you in a capsule, and then you mix it with some filtered water and use that as a nasal spray, and then also as an oral swish as well. And so, that is one that I have used some and am optimistic about, but it's still relatively new.

Let's talk a little bit more about the urine mycotoxin testing. There has been a lot of debate. You covered some of that relative to the potential for positive mycotoxin tests and to potentially be related to food sources that it doesn't look like that's the case. But how much value do these tests have in your clinical experience? Is it something that you use? Give us a little of your perspective there.

[01:11:46] Dr. Gupta: Yeah, so that's something that really broke on the scene, I guess, around 4 or 5 years ago, and I think it started off with RealTime Laboratories and then following that Great Plains offered a product. And now we also have Vibrant Health which are offering, you know, a very comprehensive product. And basically, the idea is that a certain amount of mycotoxins appear to be excreted in the urine. We also think a lot of mycotoxins are excreted in the stool. So, I would personally be interested if anyone, if any lab started wanting to look at the stool for mycotoxins, I'd be very interested. But urine is probably one excretory source of mycotoxins, and therefore, there are different mycotoxins which show up.

Now, interestingly, the different labs don't necessarily correlate well. So, if you run one with RealTime Laboratories and Great Plains and Vibrant, you won't get exactly the same answers. And one reason is they... they’re using different methodologies. So, the RealTime Labs and... and also Vibrant, I believe, are using a form of ELISA, while Great Plains laboratory using liquid chromatography and mass spec. And so, it’s... it’s quite different. And there are some technical differences, which I won't go into so in a lot of depth. But basically with the ELISA, it is possible that you could pick up a broken-down mycotoxin, one that's not fully there, because it can still latch on to what's called an epitopes part, which could be of a metabolized mycotoxin. So, that's also a consideration.

However, basically, what a urinary mycotoxin testing test shows you first and foremost is what you're excreting in the urine. It doesn't... of course, it's not necessarily representative of the total body store. However, if you're showing a lot of, you know, mycotoxins in your urine, that tends to suggest that you've got a high body load. You can't... you can't exclude the possibility of an incidental exposure. And therefore, I don't think a urinary mycotoxin test should be just done sort of lightly, without doing a proper evaluation on someone. Like, you know, sometimes that's the tendency in the new functional medicine circles is just to order a whole raft of functional tests and, you know, even without doing an extremely thorough history. And I would discourage that.

I think it's very important to do a really thorough history and evaluation, and basically come up with your own evaluation, whether you think the person has a mold problem or not. And then, based on that, if you decide to do a urinary mycotoxin test, and most commonly, you would do that with an organic acid test as well, because the organic acid test answers probably more questions and answers, you know, “Is there a fungal colonization? Is there mitochondrial dysfunction going on? Do you have oxalates present?” which is another extremely important thing. And so, there's a bunch of things that the organic acid test offers, which so I think that's probably a more high-priority test. But then the urinary mycotoxin test tells you which particular mycotoxins are being excluded at the particular time.

Now, the... probably the most obvious thing is I want to see if someone's not excreting any mycotoxins at all but I think they have mold. Then I'm concerned that the excretory pathways are not working well, and I want to really work on those really hard. And that's, you know, basically the recent work that Dr. Neil Nathan and Emily Givler and Beth O'Hara have done where they've basically isolated which detoxification pathways, and which binders and which mold species various mycotoxins are related to. Well, that can then help you then if someone is exceeding a certain amount of mycotoxins by then matching up those mycotoxins to the various binders and detoxification agents like... including Calcium D-Glucarate is probably the most important one actually, now that we see that glucuronidation is the most important detoxification pathway. So, that can help you to then decide on a protocol. But you still have to consider the fact that one has mycotoxins in the body that are not being excreted.

So, one could just as easily decide to use a generic binder protocol and a generic set of detox supplements that catches the vast majority of mycotoxins and rather than doing the urinary mycotoxin test, because it's... I guess, it's... and particularly, you know, if you're only using 1 test, let's say you only decide to do the Great Plains Lab, I think in many cases, you won't pick up the subtle ones like aflatoxin and trichothecenes in many cases, because that... for whatever reason there is, those particular technologies seem to have a little bit of a bias to picking up certain mycotoxins, particularly ochratoxin and mycophenolic acid. And you'll generally... that's what you'll generally pick up with Great Plains Labs, and sometimes a bit of gliotoxin. In the majority of cases, that's what you'll find.

While if you do RealTime’s labs, you're much more likely to find aflatoxin and trichothecenes and so on. So, that's why I think Dr. Nathan, at one point said, “Well, maybe do them both. Well maybe do all three.” But then you're starting to get up into the thousands, you know, of dollars in terms of... of that. And... and what's going to be probably a likely outcome in many cases is you're going to see the person has a little bit of all the different mycotoxins. And therefore, I think in some cases, especially if your budget is limited, you can probably just simply assume that there is going to be a range of different mycotoxins in the system, and use various different binders to try and cover all of those.

So, I think what's definitely gone out of fashion is just using Cholestyramine or just using Welchol without any natural binders. So, I still do use Welchol quite a lot. But generally speaking now, I'll almost always add some bentonite clay to it. If you... if you have a look at those charts, the bentonite clay is probably the one that picks up the most of the other mycotoxins, and maybe a little bit of charcoal as well to pick up trichothecenes. But that would be a very common regime I would use. And I think in many cases, that wouldn't be changed a lot from doing a urinary mycotoxin test. So, anyway, I hope that’s... that’s helpful. I know, it's a slightly different perspective than maybe others. But that's what I found clinically.

[01:18:08] Scott: No, that was fantastic. And I like that you tied in the oxalate piece. And for me, over the last year or two, that idea of oxalates being a secondary mycotoxin from Emily Givler’s work, and we've done a podcast on that that people can refer back to. And that's very interesting as well. I never... I never really understood that high levels of oxalic acid could be another indicator that there is a mold component to an illness. And so, that's a really neat concept.

[01:18:35] Dr. Gupta: Yeah, absolutely. And I think many... many practitioners who are dealing with autism spectrum disorders and so on, who are working from the other side, and more looking at metabolic problems and so on, they then may come to... to mold from the other side where they see someone has a high level of oxalates and having some fungal markers, and then start to actually question whether they may have a contaminated building or have some fungal colonization in their system. And interestingly, there's been quite a lot of data showing that those with autism... autism and autism spectrum disorders often will have a fungal component to their illness. And... and that's one of the... you know, the areas in which the oxalates have... have really come on to the radar. And I think Emily's one of the researchers is really bringing this... this whole field forward. But I think that's the... that oxalates are a really important thing.

So, if you're going to think about fungal colonization, in my view, you need to always also think about oxalates. And if someone has... particularly if they have moderate or severe elevation, so that's on their organic acid test, let's say their levels are above 200. So, if it's above 50, let's say it's between 50 and 200, I'm calling that mild. And so, above 200 to about 500, I'm calling moderate elevation, and then above 500, I'm calling severe. And I've seen some people who have levels of 1000 or more.

And so, some people are absolutely full of oxalates because there can also be a genetic component to it in their case. And there can also be malabsorption and other components to it, not just the mold part. But yeah, if they do show high levels of oxalates, then just removing a little bit of oxalates from their diet. And Emily recommends doing it quite gradually, otherwise people can go into a bit of a healing crisis. And then using various binders such as the magnesium and calcium and zinc citrates, along with B vitamins, such as B1 and B6. In some cases that can be the... that can be the game changer for people recovering from mold. I have found that sometimes. So, it's definitely very worth being aware of in addition to just thinking about the mycotoxins.

[01:20:37] Scott: And the repletion of sulfate from things like Epsom salt baths that can actually help reduce oxalates as well. Yeah. I urge people to go listen to that show. It was super enlightening for me and a great... great conversation with Emily Givler.

The NeuroQuant is another tool that's been used in this realm to explore the potential for mold illness. Some practitioners like Mary Ackerley have made a connection between NeuroQuant results and things like limbic system dysfunction, mast cell activation. From your perspective, what's the role of limbic system dysfunction and mast cell activation in biotoxin illness?

[01:21:15] Dr. Gupta: Yeah. So, this... these whole areas, mast cell activation and limbic system dysfunction have really only come into my radar over the last 2 to 3 years. And what I'm finding, and I think many practices are finding is there's so many more patients who are extremely sensitive now. And... and... and so you have some... some patients who just giving even a tiny amount of... of binder appears to be enough to... you know, to get them reacting in a major way. And so, the further I've gone along with this field, the more I found that just using Cholestyramine and using really strong treatments doesn't work well for a subset of patients. And for a subset of patients, you need an absolutely dramatically different approach. And often, they will be the mast cell activation and... and... and limbic system dysfunction patients.

Although, the ones in which those forms of dysfunction are very prominent, it's possible that they always present to a degree in CIRS, but there is definitely a subset of patients where that's very prominent. And they'll generally be the ones who are... who are sensitive, extremely sensitive patients who say... basically, they come in and say, “Look, I can't tolerate any supplements or anything.” That's a really common... and how many times have you heard that? And so, therefore, those clients, you... you start to think that limbic system activation may be very prominent.

Now one option is to, early on in the assessment, look at doing what's called the NeuroQuant. And so, NeuroQuant is a type of volumetric analysis of brain MRI. So, it's... there's actually a number of different computer programs which do volumetric analysis. But I think NeuroQuant is probably the most advanced and it’s... it’s run by Cortechs Laboratory in San Diego. And basically, what they do is they create... there's certain specifications that an imaging company need to do a brain MRI under. It's called what you call a sagittal T1 scan. And they send the images over the Cortechs Laboratory. And basically, their program is able to then go, “(Sound effect) There's the putamen. There's the thalamus. There's the...” you know? And it basically identifies all of these small areas of the brain. It's quite amazing actually how it does that.

And so, once it does that, it then measures the volumes of all of those areas of the brain. And the original report used to come out just like a graph of around 11 brain areas, which gives you a number. But now, they've even gone a step further. And now, NeuroQuant 3.0 has come out and they've actually brought out what's called the triage brain atrophy report, which then compares the brain areas of various areas with normal controls, which are age and sex matched. Which is amazing. I mean, that's just an amazing level of data that has not been available to us at any time in the past. And so, they now have a very large normative controlled database, Cortechs Laboratories, and we feel that to be very accurate.

And so, the original research on CIRS and NeuroQuant was done on what we call the general report. And it didn't... you know, didn't have the benefit of that more specific reporting in the form of the triage brain atrophy. And therefore, the understanding of NeuroQuant is evolving. And therefore, more and more what we're finding with... with NeuroQuant on patients with water-damaged building exposure is they have a lot of enlargement, and not so much atrophy or shrinkage in their brain. And that the certain areas, particularly the thalamus and amygdala and the cingulate area of the brain, particularly the anterior cingulate which appear to be affected more commonly than other areas.

And those areas tend to be mast cell areas. So, there's... there’s a very high proportion of mast cell in those areas. And many of those are parts of the limbic system, particularly the amygdala. And the hippocampus is also another important one. So, a really important part now is looking at the amygdala when you get a NeuroQuant. Now, if you see a shrunken amygdala, according to Ashok Gupta, that's probably a sign of chronic trauma. While if you see a... a elevated or swollen amygdala, that's more a sign of acute limbic system dysfunction rather than long-term. But either way, there’s a... there’s a high likelihood of limbic system dysfunction.

And... and so, the amygdala is like what you call the brain smoke alarm. Now, just as you know, with a smoke alarm in a building, where there is smoke, there's not always fire. And so, the... so, what... what happens... and the way Ashok Gupta explained it to me (and I think I believe you also interviewed him recently) is that the brain is very much based on survival. And so, let's say you've had a major biotoxin exposure at some point that was, you know, life-threatening, your brain then develops like a fire alarm kind of response, where then even a small amount of exposure, or a small amount of perception of exposure can then trigger the amygdala and other parts of the limbic system to start reacting and to create a... a... you could say a fight or flight response to that potential danger.

And as a result of that, you can develop a very high level of sensitivity to even exposures which are very small and are not life-threatening. I think exactly the same thing could apply to a multiple-chemical sensitive patient who just for instance, you know, smelled a little bit of smoke from someone smoking 100 meters away from them, or whatever it might be, that's not going to be life-threatening, but the brain doesn't differentiate at that point.

And so, the idea here is you've got a dysfunctional smoke alarm at that point. You've got... so, your smoke alarm is going off all the time in... in the sensitive patients. And by looking at doing limbic system retraining, you can bring that down to more normal levels of sensitivity. So, rather than your smoke alarm in your house just going off when you put a piece of toast in the toaster, you want that smoke alarm to go off only when there is a fire.

So, what we're not saying is that, by improving... by reducing the sensitivity of your fire alarm, that you want to then have a fire anytime you want. Of course, that's ridiculous, right? So, we're also... so by that analogy, we're not saying that it's good to go getting exposed to mold or whatever. But what we don't want is for to be hypersensitive to mold. You want to just have... you want to bring that back down to normal levels of sensitivity. And you want... particularly in the sensitive patients, you still want to avoid water-damaged buildings, absolutely. But you don't want to be so hyper responsive that you get one particle of mold somewhere in the air and that you go into a massive, you know, inflammatory response as a result of that.

So... so NeuroQuant can help tip someone off as the practitioner that there's a lot of limbic system dysfunction going on, and that the... the client should consider limbic system retraining. Now, if that's occurring, there al... almost always is a degree of mast cell activation as well. Now, we haven't really teased out which is the chicken and which is the egg. And I suspect that there's actually a bidirectional kind of flow there, that probably if you've got a lot... a lot of mast cell activation going on, that probably causes the limbic system of the brain to... to abnormally function. And I suspect it probably, to a degree, works the other way around as well, that if you've had... you know, for whatever other reason, you've got limbic system activation going on, that probably secondarily causes mast cell activation. So, I suspect both of these things egg each other on.

And therefore, in these clients, generally speaking, you will then have to address their mast cell activation before you're going to be able to do any other treatment. So, their mast cell activation and their limbic system dysfunction. So... and this can be a bit frustrating for clients because they may be wanting to jump right in there and start doing Cholestyramine or whatever other binder they've read about. But in those case... in this case, they're going to have to take a different approach and start thinking about doing limbic system retraining. And the most common forms of that are what we call DNRS, the Dynamic Neural Retraining System by Annie Hopper, or the Gupta Program of Amygdala and Insula Retraining, which is by Ashok Gupta. And there is actually a number of other ones that are out there. I think there's one called ANS Rewire, and... and... and some other forms of limbic system retraining.

But one needs to consider doing... doing one of those of... and that does take a certain amount of time investment, if one's going to do it. Like, there's no point buying it and then not investing the time. You really need to be willing to invest at least a certain... perhaps at least half an hour a day, every day in... in devoting to that if you're really going to get good results out of it. Now, I don't... I mean, this can work the other way around, that if you start feeling so pressured to do a certain amount of time every day, that can activate your limbic system. So, I don't think it needs... it shouldn't be a pressure kind of thing. But on the other hand, you just need to understand that it takes a certain amount of regular work for it to work.

And then along with that, often what one needs to do is start going on a lower histamine diet, and bringing in certain compounds for mast cell activation, whether they be things like quercetin and... and luteolin and rutin and so on. And one of the... the proprietary formulas, which contains those is called NeuroProtek, or medications such as sodium cromoglycate, or ketotifen, or various antihistamines to try and just downgrade that whole histamine response and that whole mast cell response so that the body can come back to normal levels of sensitivity. And at the same time, of course, getting away from any water-damage building exposure is going to be extremely important. But then, after that has occurred, that one's done a certain amount of limbic system retraining, and mast cell activation treatment, then often, one can bring in the binders and detoxification agents and so on, and go on to more of a normal type of CIRS protocol. So, that was a long answer, but I hope that that was helpful.

[01:32:03] Scott: And I saw what you did there with the chicken and the egg, and the egging people on. Nice, nice choice of words.

Let's talk briefly about VIP or vasoactive intestinal polypeptide. That's been discussed as kind of the end goal of the treatment of CIRS. Where does that fit into the discussion today? Is it something people must do to regain their health? And what role does VIP play in healing from CIRS?

[01:32:28] Dr. Gupta: Yeah. So, VIP or vasoactive intestinal polypeptide is one of the... the compounds that has been described becomes lower in CIRS, and it has been described as being a neuroregulatory peptide. Now, what that means is it's a compound that brings regulation into the whole inflammatory pathway. And I believe that's true. And it also has antibacterial and other antimicrobial properties. It also has effects on the smooth muscle of the liver, gallbladder and gut. So, it actually appears to help motility in the gut, and it appears to help dilate the... the liver and gallbladder biliary system to help with detoxification. So, I actually believe it has a lot of different effects that are in addition to just reducing inflammation.

So, as part of the original Shoemaker protocol, it was kind of the cherry on top. And generally speaking, everyone used to... including myself, was very anxious to get onto this. So, I actually developed CIRS myself in... in 2012, 2013. And...

[01:33:33] Scott: When you... when you overflowed your bathtub, as I recall.

[01:33:37] Dr. Gupta: No, actually... no, actually, that was later. That was just... that was just general craziness. In 2012, I had a house flood on the Sunshine Coast here in Australia. There was actually a lot of floods happening at the time. And I was living in a home that was below ground level. And so, that's actually a really common problem. If you... that's actually something to be aware of. If you're ever... ever renting or buying a house that goes significantly lower... the basement is significantly below ground level, that's going to be a huge risk factor for... for mold and water damage, because water can just run into it. And... and there wasn't a proper drainage system in that home. So, when there was floods and it just rained constantly for weeks, and it became basically the water just ran straight into this home. And basically, all the possessions that we had in the garage were... became totally soaked. And... and the bottom layer that has become totally soaked. So, we actually had a very, very water-damaged building there.

And I only developed fairly mild symptoms, but my partner at the time became totally bedridden. And so, that was my... my universe's introduction into mold as a major cause of problems and chronic disease. I actually had no personal interest in this area. And so, I... I just did the tests on myself as part of learning about this whole syndrome and found that I was positive. And so, I went through the whole treatment protocol. I benefited from Cholestyramine and... and also the... I used bed nasal spray at that time, which was antibiotics. That's no longer recommended, by the way. So, it's generally recommended to use something like silver and EDTA, or even a herbal nasal spray to... to address MARCoNS or other dysbiotic organisms in there. And then... then finally went on to VIP when I was away from... from mold. And... and I found myself that it appeared to help with energy. And I also appeared to detox quite a lot on VIP.

So... so, one thing that's talked about with VIP is firstly, there’s... there’s a number of different prerequisites. Now, originally, it was said you need to have an ERMI below 2 or whatever it might be. And then later, it was said that it needs to be a HERTSMI below 11. And then secondly, you need to have a nose...  nasal swab which is free of MARCoNS. And then thirdly, you need to have a normal VCS test, which is indicated that you've had binders for long enough. And then there were some other things that were talked about, a normal lipase level and a normal stress echo. But basically, in other words, the idea there is that one... one doesn't generally just go on to VIP straightaway as part of the healing protocol.

And I have had the experience with someone who was still being exposed to mold and I put them on VIP did have a significant blackout. And so, I do think there's something to that, those criteria that Dr. Shoemaker originally created. However, since then, my thought, and I think various other ISEAI docs have... have mentioned that it probably isn't quite as definitive as that. And in some cases, you may still have... and I have had a number of cases where the patient weren't able to get rid of MARCoNS, and they went on to the VIP, and then the MARCoNS actually went away. So... so, it's actually can... appears that it can work the other way around. It's actually antibacterial in and of itself.

So, if you've given it a good go to try and improve your nasal biome by whichever mechanism, and in some cases, it may need to be antifungals if the problem with the nasal biome is actually fungus, as I alluded to before when I talked about fungal rhinosinusitis Now, if you've done that, and you've... you've had a fairly extensive regime of treatment for the nasal biome, I don't believe you have to be free of MARCoNS to use VIP. So, that's one thing. And I have used it a number of times and people that... that still had it. And... and I believe Dr. Shoe... even Dr. Shoemaker is not... not insisting on that now.

Now, the VCS test is not... that's, again, not an absolute thing. But basically, I do think one needs to have tried to get rid of bi... of mycotoxins out of the system to a certain degree. One should have used binders for at least a good 6 months or so, I think. And generally speaking, that'll mean that the VCS test is normal, unless you have an eye problem. Or there's some cases where people have eye problems and so on and the VCS test is never going to be normal. So, it's not a perfect test. And some cases, the VCS test is never abnormal, so it's not actually really even able to be used. So, mentioning that as well. So, VCS test, I would say is only helpful around 50% of the time. If someone has an abnormal VCS test and they don't have any eye problems, then I think it can be a useful marker of seeing how much someone is improving through the binders.

But the other thing is, we now feel that, even when the VCS test is normal, that doesn't mean all the mycotoxins are gone. Really often, one has to use binders a lot longer than that. But in some cases, what I will do is, if I'm using a pharmaceutical binder, like Cholestyramine or Welchol, I will then switch on to natural binders once the VCS test is normal. This is my kind of blend of the Shoemaker and other protocols. And... and then go on to natural binders, as indicated by the urinary mycotoxin test or as just indicated by a generic... a generic regime, as per the work of Dr. Nathan and others.

So, VIP going back to the... the usefulness, in some people, it appears to be very useful. And in some people, they have virtually no effect. And I think it just goes down to the idea that there's very individual physiology in this whole syndrome. And I think for some people, VIP is a very key compound. In other people, it does... doesn't seem to be that much of a player in their CIRS at all. So, I don't think is, you know, anyone should say something like, “If you don't have VIP, you'll never get better.” That's just not... that's not true at all. But I also wouldn't take the other extreme that VIP is totally useless. And so, I have seen in some... some patients, it is a game changer.

So, again, I would take it down to the idea that it's one option that can be used. If you have a lot of atrophy on the NeuroQuant may assist in some patients, but talking to Dr. Ackerley and Dr. Gazda and so on, they're saying that it's not the only thing that can improve atrophy on the NeuroQuant as well. It’s... it’s really just the whole entire protocol. And VIP is simply one tool in the toolbox.

[01:39:56] Scott: Perfect. That's beautiful. So, as we start wrapping up, maybe you can talk to us about what you recommend for the average mold patient in terms of testing and treatment. Is there a basic approach or strategy that you use that's emerged in your clinical practice?

[01:40:12] Dr. Gupta: Okay. So... so, I think one needs to see a really experienced practitioner in this area. That's the most important thing that... not the tests. And I think if you go and see a very experienced practitioner who's able to take a very thorough history and do some tests in their rooms, including the VCS test, that's the most important part of the evaluation. I find that possibly the most general test that I'm using is the organic acid test by Great Plains these days. I think that just covers a lot of different bases. There are some markers on there now, which are considered to be quite specific for mold toxicity, including the pyroglutamate, and the mandelic acid, and lactic acid. So, I think there's some markers that helped to confirm it. You can look for fungal colonization, can look for oxalates and mitochondrial dysfunction. So, I think for in terms of value for money, I think that's excellent.

And then one could then consider going in the direction of the CIRS blood markers. Now, I generally would say, I'd generally recommend them if your insurance is going to pay for or you have a an insurance case meaning a legal case in which you're you have a problem with a with a building, you know, one of the your landlords or building owners or something like that, where you need to have really good evidence, then I think that's important. And then the tests that I'm talking about there are C4A and TGF beta 1 and MMP-9.

Now, the other thing I mentioned is they're not as specific as they were originally thought to be. So, if you have elevated levels of those, it doesn't mean that... you can't say that you've got mold specifically. But what it means is you're in that realm of biotoxin illness. You're somewhere around that realm. It could simply be mast cell activation. It could be Lyme. It could be something else in that realm. But, you know, basically it gives you... it gives you the information that you've got an overactivated innate immune system, okay? So, it's not specific for mold, but then you then may consider doing a serum or urine mycotoxin test.

And we're only quite... quite new with using the serum mycotoxin antibody test. My colleague, Dr. Rashmi Cabena has... has said that she feels that it's quite useful in terms of differentiating which patients are currently exposed to a water-damaged building and which are not. I have not had enough experience myself to make a comment. The urinary mycotoxin test, as I said, is probably, you know, useful, particularly in terms of working out whether you're treating mycotoxins satisfactorily and getting a rough idea of which mycotoxins are coming out.

Then the other things then would be to consider the nasal swab done by Microbiology DX. And usually, I recommend the bacterial and fungal swabs. And really, what you're looking for then is to... to work out, have you got a dysbiosis in your... in your nasal sinus biome? And, you know, what kind of steps can you take then? And then also considering doing a gut biome test, like GI Map is one of the most useful ones we think these days. And that's... that's another test that's going to be quite useful.

And there's also you should consider, and this really should be right at the start of the evaluation, just having general tests of a broad nature to exclude autoimmune disease. So, sometimes CIRS can become autoimmune. You need to make sure that you haven't got elevated antinuclear antibodies. Celiac disease should always be excluded. And then basic nutrients should always be looked at, including vitamin D, including zinc and copper, and including magnesium levels. So, those are some... some really general things. And you want to have quite a broad... a broad net place. Because sometimes it's possible to go the other way. I mean, CIRS is often missed, which is a big problem. But the other side of it, sometimes people become too focused on mold and CIRS, and they're not thinking of other things that could be part of their syndrome.

So, I also recommend doing the urine testing for pyroluria. I also recommend considering the possibility if you've got SIBO, and also considering doing tests for mast cell activation syndrome. So, having the net just a little bit broader than just CIRS can be very useful in many cases in terms of healing.

[01:44:41] Scott: I know you are a deep thinker. And so, my question to you is, what is the role of illness? And when we go through something like CIRS or mold illness, is there some meaning in our suffering? Does it lead us to personal growth and evolution on some level? And would you change your own illness journey if you could?

[01:45:01] Dr. Gupta: Yeah, excellent question. I think illness is a very great teacher. Illness gets us to reevaluate our lives in many different ways. And I think some of those are much more subtle than we realize. I think some... sometimes, illness makes us reevaluate our whole way that we're interacting with our lives. And they... an illness can be a huge catalyst for personal growth. And so, therefore, my personal experience with... with illness has changed my life so much that I can't even describe it. I mean, firstly, it changed my career from moving from intensive care into integrative medicine. But it's totally changed the way I think about my daily life, and my level of awareness about everything in life.

So, you know, how I mentioned this idea of the mold sabbatical patient who all of a sudden becomes really connected with their body and... and... and their environment. Well, that's huge in terms of personal evolution. You start... if you start to become aware of what's really going on in your body, in your system, there's not many things that will catalyze personal growth more than that.

So, I often say that, even though my experience of going through mold illness, particularly with my ex-partner was very, very difficult, I wouldn't actually rewind and take that away if someone offered it to me. I think it was extremely, extremely beneficial in terms of personal growth. It's given me a totally different perspective on life. And it's been just one of those events that has helped me to reevaluate and become more aware of things on a deeper level. So, illness is a great, great motivator for personal growth. And I think that's important to realize.

[01:46:51] Scott: These conditions can seem so overwhelming, and oftentimes, people feel hopeless. I'm wondering what you can share to provide listeners with hope?

[01:47:00] Dr. Gupta: Yeah, when you're right in the middle of a mold problem, and let's say you're living in a... in a water-damaged building, you're really sick, it's extremely overwhelming. Right at that moment, you know, you feel like that you can't see any end to expenses. You can't see how you can get your financial status back on track in many cases. You can't see how you're going to get well, because, you know, basically what's making you sick is all around you. And so, it's extremely overwhelming. And sometimes, the sort of narratives that are going through people's heads at that time are extremely negative. And that happened to me too.

Sometimes you can be predisposed... you can just be thinking all day long about how unfair life is. And why you? Why did it have to be you? You know, why couldn't it be someone else? And it's... it’s like you're stuck in the mud at that point. You know, you're really in a difficult situation. But what I would offer to people is realizing that that phase of the journey does not go on forever. There is other phases that you go through. So, once you're able to move on from there, no matter how difficult it is at the time. So, if you're able to find a clean building and you're able to finally afford a practitioner who's experienced with CIRS, and I just want to mention that I... I acknowledge that it's not cheap. What I would say is keep your trust in the process. And therefore, just going through all of that, not abandoning the whole process is very important. So, trying to work with one of them, and then trying to work with an IEP, who is well qualified on the other hand, who can help advise you on a satisfactory living situation.

And once you've... you've then gone on to the treatment program, once you've got into a satisfactory place to live, things start shifting. All of a sudden, you start seeing a ray of hope. You start seeing that, all of a sudden that, “Hang on my body can function well again. I can actually get back a little bit of concentration.” I remember that moment for me where, all of a sudden, I started realizing, “Hang on, I do still have a brain here. I still can... I still can't take in some new information. And I still can remember some things.” Because that's another really scary part of CIRS.

[01:49:06] Scott: Absolutely.

[01:49:07] Dr. Gupta: You know, at some point, you feel like you just... your brain has just deserted you. And so, I want to acknowledge how devastating and... and overwhelming it is. But I want to just mention that that phase of the journey will eventually change. And the growth that you will get out of this... this part of the journey, in many cases, will be of value... invaluable. Now, of course, I can't guarantee that, and maybe you don't feel that that's the case right now. But I'm just saying that from someone who has got to the other side of this illness and also helped many other people to do so, that often, there is an amazing life waiting for you on the other side of the illness. And so, hang in there.

[01:49:46] Scott: I know you have worked a lot over the past several years to put together the course Mold Illness Made Simple. It was recently updated. I have taken the course. I found it to be highly informative, fantastic. Even having studied this for many years, I learned new things from the course. So, for people listening, I'm wondering if you could tell us about the course. Is there some type of community that you provide as part of the course for people to have ongoing interaction with you? And I understand that you're offering our listeners a discount as well.

[01:50:16] Dr. Gupta: Yeah, that's right. So, Mold Illness Made Simple was created for the reason that I saw that people had a lot of overwhelm when they're dealing with this illness, and that a lot of the information that's out there in the general domain, in the public domain, is very complicated. We now have some better resources in the public domain. And I think some of the recent books which have come out are a lot simpler. However, I still think one of the really important things to be able to help you to feel less overwhelmed and much more confident is to have clear information. And so, Mold Illness Made Simple course, I think lays out all the information you need to know, and nothing else. It's really just that the key pieces of information.

When you do the course, there’s... there’s 2 main sections. One's on CIRS and the physical body. And that... a lot of that section is devoted to understanding inflammation, and then to understanding the tests that are done, and to understanding the process of recovering through using binders and other treatments.

Now, the second section is on dealing with water-damaged buildings. And really, that's all about the idea of working out whether the building that you're living or working in his water-damaged or not, how to educate yourself on getting a well-qualified IEP and a well-qualified remediator. I've... I’ve also said often that I feel that part of the course is worth it... the whole course is worth it just for that part, that little piece. Because if you... if you get those little bits of information, you're not going to make some of the common mistakes.

The other really important thing is what to do with your possessions. Because if you don't properly manage your possessions, and let's say you move home, then what's going to happen is you're going to cross contaminate your building to the new one. And... and so, I had one talk, I think I published on YouTube around 3 years ago called “The 10 Most Common Mistakes in Mold Illness”, and that was number 1.

So, really what the course does is... is gives you the benefit of... of experience, of not just me, but other mold physicians around the world, in... in... in knowing what... what to do and what not to do, so as not to make this even more difficult than it already is. So, that part is really important around the buildings. We also talk about the mode sabbatical in a lot of detail there,

Then there's a whole bonus module. And one of the most important parts of that is talking about limbic system retraining and other forms of trauma recovery, including somatic... somatic therapy, we call it. And... and I believe that... that little lesson on its own, I think it's an hour and 20 minutes, that's also... that's really a course in itself. If you really take that in and you understand that, I believe that makes the whole course worth it.

There's one section, one lesson there on COVID-19 and CIRS. And really just focusing on this idea that there's no sign that CIRS patients are more susceptible to COVID than anyone else, which, you know, I think is important for people to know. Other... otherwise, that can be a whole extra level of anxiety that's happening at the moment in addition to the whole CIRS experience. I believe if you do it, your level of overwhelm will come down significantly and you'll feel much more confident. That is the feedback that we've had to date.

And there is a community as well on Facebook. So, if you join the course and you get up to module 5, then there's an invitation to join the group and interact there with myself and Caleb Rudd, who is my... my course collaborator who's done a really, really great job in assisting me with creating a lot of those course materials. And I believe Scott is on there as well. And really, there's... there's an opportunity there to just discuss some of the questions. If there's anything you don't understand about the course, you can most certainly post it on that group and... and... and... and... and bring it up for everyone's discussion.

And so, we are offering a discount of 10% to listeners of this podcast. And that’s... that’s really just an ongoing offer. And the... the code for that is BETTERHEALTH. And so, if you put that in when you sign up for the course, that will that... will take you to... to the... you know, that will just bill in the discount while you're checking out. The... the cost of the course is otherwise $299 US. But we... I sincerely believe the course is worth it. It's a... it's a bit of a labor of love. But I really think that... that as part of this whole process, having gone through it myself, I believe it's going to give you a roadmap to recovery, which you can keep referring back to along the way.

Of course, it's not the whole... the whole piece, you know, you still need to find a really good practitioner. You need to find a really good IEP. And you need to get on to all... you know, all of those actions that are going to help you to get better. But it's one important piece in the recovery.

[01:55:08] Scott: Beautiful, and I agree, the course is well worth it. Again, I learned a tremendous amount from it. I actually took the Mold Illness Made Simple version 1 course, and then took version 2 again recently. And there's just so much great information in there.

My last question for you is, what are some of the key things that you do on a daily basis in support of your own health?

[01:55:27] Dr. Gupta: Yeah, that's a great question. And, obviously, there’s... there’s just some basic things that I think everyone needs to just do in order to maintain excellent health. And one thing is just to have a whole food diet. So, I'm personally on a plant-based diet, but there's many other... many other variations of... of a whole food, organic diet that are going to be very useful. And then the other thing I do is take some... some basic supplements. And I think almost everyone can benefit from some... some basic supplements, particularly to support their immune system during this time. And I might just mention what I think are some of the really important ones that can be beneficial at this... right at this point in the world.

I think vitamin D, is really important. Vitamin C, zinc, vitamin A, and quercetin are really important. And then being on some kind of herbal formula. So, there's... there's one... I think astragalus is a really important one, and also andrographis, some important herbs that you can be on on an ongoing basis to... to help support your immune system, just in general. So... so, I think those... that's a very simple thing.

Now, another thing for me personally, which I think is important for almost everyone is getting into the silence within yourself every day. Now, how that may look may differ from person to person. For me, it's a certain type of meditation. And I've also found that it's really important to do this with a lot of intention, you know, that you really trying to tap deeper into yourself and really, really find yourself.  You're not just doing it in a haphazard sort of way, which doesn't really have the same effects. You want to... really want to do it with full attention. And for some people, it's more prayer or communion, particularly if you're coming from a Christian background. I still think that's very, very powerful.

Then the other thing I do is related to emotional health. And I think this is another thing to consider for... for almost everyone is to have some sort of practice in your daily life to look at your emotional health. Now, one of the really important things is finding some joy in every day, and finding the things that you find joyful. So, the things for me that I found to be extremely joyful are going for a walk on the beach, or playing... playing a musical instrument, or reading some poetry. So, something like that would be an example of something I'd do on a daily level to... to find joy.

And then there's something else I really recommend, which is called the Inner-Child meditation, which is connecting to your inner-child part. And really what that does, is that makes sure that you're connected with that really young and wounded part of you. And therefore, in life, you're not going through life as a reactive individual. You're going through life more as a person who's connected with themselves at a deep level, and really knows what's going on with oneself. And so, if you get triggered, it doesn't mean you're not going to get triggered in life. And I still do all the time. But then when that happens, let's say something triggers you. And I must say I was telling Scott at the start of this... this, the news at the moment has been tremendously triggering for me over the last week or so. And when that happens, just being able to connect to that young, wounded part of yourself is a really, really useful way of holding yourself through that and helping yourself from, you know, becoming really limbically active, shall we say.

And I found some... you know, there's some work of some authors such as Jeff Brown who has a book called ‘Soul Shaping’, and he has some courses online can be very, very helpful to help with this element and in the emotional healing realm.

[01:59:05] Scott: So, much good information. I absolutely love it. Thank you, Dr. Sandeep Gupta today for all of this amazing informative information. I really appreciate all that you do. I value you. I honor you. I respect you. You make such a difference in the lives of those of us that are impacted by these complex chronic conditions. And so, thank you so much for sharing generously today of your time and... and really putting information out there that's making a difference for people, for putting this course together, and for everything that you do.

[01:59:34] Dr. Gupta: Thank you, Scott. And... and... and I want to say that I really also appreciate your inquisitive nature and how you keep finding these really, really new questions and new things to look at with regard to chronic illness that are helping this whole field to... to move forward. So, again, my deepest appreciation to you.

[01:59:52] Scott: Thank you so much. Be well.

[01:59:54] To check out the course Mold Illness Made Simple to visit

BetterHealthGuy.link/MoldIllnessMadeSimple. That's BetterHealthGuy.link/MoldIllnessMadeSimple, BetterHealthGuy.link/MoldIllnessMadeSimple, and use the code BETTERHEALTH to get your 10% discount on this informative course. 

[02:00:18] 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, Twitter, or MeWe, you can find me there as Better Health Guy. To support the show, please visit BetterHealthGuy.com/donate. To be added to my newsletter please visit BetterHealthGuy.com/newsletters. This and other shows can be found on YouTube, Apple Podcasts, Google Podcasts, Stitcher, and Spotify.

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