Why You Should Listen
In this episode, you will learn about healing from mold and Lyme disease.
Watch The Show
Listen To The Show
Support The Show
About My Guest
My guest for this episode is Dr. Diane Mueller. Diane Mueller, ND, DAOM, LAc is a survivor of IBS, Lyme disease, and mold illness. Dr. Diane's journey to heal herself led her to complete two doctorate degrees in holistic health care. She has a Doctorate degree in Naturopathic Medicine as well as a Doctorate degree in Acupuncture and Oriental Medicine. She is passionate about bringing research, understanding, and compassion to those with these conditions. She has co-authored the book "Use Your Mind to Heal Your Mold and Lyme: A Survivor's Guide". Her practice, the Medicine with Heart Clinic, treats people from around the country. She co-owns an online functional medicine school, the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine. Her recent book “Use Your Mind to Heal Your Mold and Lyme: A Survivor's Guide” shares many of the strategies that she used to recover her own health and the health of many of her patients.
- Should mold be treated before Lyme disease?
- Is killing the bug important for recovering health?
- How can pulsing antimicrobials be part of a protocol?
- What are persisters, and how are they addressed?
- Can mycotoxins lead to leaky gut?
- Does fungal colonization occur after exposure to water-damaged buildings?
- How does Bartonella impact the lymphatics?
- How do Ehrlichia and Anaplasma negatively impact our mitochondria?
- What is the role of viruses and retroviruses in chronic illness?
- Can medicine mushrooms be used in those with mold illness or fungal overgrowth?
- What is the role of bile transporters in detoxification?
- How might manganese or hyaluronic acid be used as "feeders"?
- How might pulsing be used to avoid sensitization to therapeutic interventions?
- What properties does cistus have that make it a useful tool?
- Why is it important to approach biofilm treatment with caution?
- What is the role of autophagy in cleansing?
- What can negative thoughts do to the physical body?
- Where can patients find support?
Connect With My Guest
April 6, 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.
[00:00:00.29] Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.
[00:00:14.03] 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.
[00:00:35.10] Scott: Hello everyone, and welcome to episode number 143 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Diane Mueller, and the topic of the show is Healing from Mold and Lyme. Dr. Diane Mueller is a survivor of IBS, Lyme disease, and mold illness. Dr. Diane's journey to heal herself led her to complete two Doctorate degrees in holistic health care.
She has a Doctorate degree in Naturopathic Medicine, as well as a Doctorate degree in Acupuncture and Oriental Medicine. She is passionate about bringing research, understanding, and compassion to those with these conditions. She has co-authored the book “Use Your Mind to Heal Your Mold and Lyme: A Survivor's Guide”. Her practice, the Medicine with Heart clinic, treats people from around the country.
She co-owns an online functional medicine school, the Medicine with Heart Institute, where she trains clinicians from around the world in functional medicine. Her recent book “Use Your Mind to Heal Your Mold and Lyme: A Survivor's Guide” shares many of the strategies that she used to recover her own health and the health of many of her patients. And now my interview with Dr. Diane Mueller.
Today, we're talking about healing from mold, and Lyme disease, conditions that I have personally experienced and deeply understand how much they can impact our lives. I'm so excited today to have Dr. Diane Mueller here to share with us; thanks for being here, Dr. Diane.
[00:02:07.16] Dr. Diane M.: Wow, thanks for having me. I'm so thrilled to be on this show with you today, Scott.
[00:02:12.04] Scott: Talk to us about your personal journey through irritable bowel syndrome, Lyme disease, mold illness. What led you to doing the work you're doing today to help others with similar conditions?
[00:02:24.25] Dr. Diane M.: Yes, I mean, you kind of named it right there. It started with IBS as a young child; I had pretty chronic constipation that progressively got worse into my teenage and early 20 years.
And it was at a level where I was doing all the classic things that people with IBS do, going and having the lab work and getting the diagnoses and using laxatives. And I was just basically told there was, of course, nothing that could be really done, and it was just how my body was. That my body really wasn't supposed to have a bowel movement anywhere.
[00:02:58.19] Scott: It's special.
[00:02:59.24] Dr. Diane M.: Right, yes. Some sort of genetic anomaly that makes me only have a bowel movement once every week or two. So I kind of just felt when I was told that; I just kind of felt intuitively like it doesn't feel right to me. So at that point in life, I started reading a lot of books around just nutrition and herbal medicine. I grew up on a pretty standard American diet.
So that was really my first say awareness of different ways of living nutraceutically, nutritionally and that sort of thing. And like that's innately what led me into naturopathic medical school, and it was when I was in medical school then that I started having a lot of other scary symptoms that eventually I found out were Lyme and mold.
But the symptoms that I think are most relatable probably to people with Lyme and mold are the neurological dysfunction and the brain fog. I was having such brain fog, and dissociative type of episodes, where I would basically, the example I give is I was walking for just five minutes, I would go around the block sometimes just take a light stroll because I had such bad chronic fatigue. I couldn't do anything else but just to get outside.
And I would occasionally have these episodes where just a couple blocks from my house, I would completely forget where I lived. I wouldn't know where I was. And it was almost just like everything would just leave my brain, and I remember sitting down; this was when I was in Portland, Oregon where with these beautiful and just foliage everywhere. So my plan usually was like, okay, sit down and just wait.
And it wouldn't take long for this fog to clear; it was really just a few minutes. But then the fog would clear, and all of a sudden, I would remember where I lived, and I could get myself home. But of course, even a few minutes of having like that level of amnesia is incredibly scary. So it was easy at that point in time as I was having other things like numbness, and a lot of pain, a ton of pain.
Sometimes so bad that I'd have a hard time just like getting out of a chair, getting off a toilet. I would sometimes get stuck in these positions. But it was still easy despite all of that to blame it on medical school syndrome because we were studying, we were up late, we were draining our reserves.
And it really was when I got out of school, and a lot of my colleagues were reporting feeling like better than they ever had, and I was feeling worse than I ever had, that then I started doing more investigative research, and that's when I found through lab testing, Lyme and mold illness.
[00:05:47.20] Scott: Wow. I heard a practitioner this week call it “cog fog”, which I kind of like that term, cognitive fog, right? We say brain fog, but cog-fog sounds kind of like a nice new term for it.
[00:05:57.12] Dr. Diane M.: Yes, I love it.
[00:05:57.22] Scott: I've been there too. It's scary when you can't remember why am I in the back seat of the car, when I know I need to drive somewhere, and I know this isn't going to work out, but don't quite know what to do.
You say that your Medicine with Heart method includes three major tenants, so at a high level, talk to us about what makes up this method that you've put together for how you approach recovering from chronic illness.
[00:06:21.11] Dr. Diane M.: Yes, the simplest way of really saying it is really looking at the body, the mind, and how we basically form habits as human beings. So the body really looking at holistically the entire body, so I'm sure we'll get in into it in our time together today. Some of the relationship with the gut, the adrenals, the hormones, even in context of Lyme and mold.
So it's really looking and saying okay, well, in order to treat illness and chronic disease, we really need to think a little more holistically than I think sometimes is natural. Meaning we really need to look and say where are the imbalances beyond just infections, beyond just the toxins, those sorts of things. So that's kind of the body component, and then the mind component is really; I really like to be very careful on how I speak about this, especially when talking to Lyme and mold people.
Because unfortunately, so many people are told that it's in their, it's just in their head. And that is not what I'm saying when I say this at all, the mind component really is looking at research that's actually showing that depending upon the types of thoughts we have to our exterior environment.
So if we have ten people that are all suffering with Lyme and mold, but the internal dialogue on how we're actually processing the challenge that internal dialogue is actually going to impact things like our cortisol levels and our immune function.
And so it's really looking at some of the research that's very supportive to say we need to actually look at the internal dialogue we're having, and we have methods of teaching people how to actually work with the thoughts in our head, that for all of us just seem to spontaneously arise. And so we work with actually teaching, just like learning to ride a bike, learning anything else, on how to actually retrain our thoughts so we can utilize this amazing tool we have, our mind, to actually help our immune system in addition to the body.
And then the third component really is working with habits, and we actually utilize the research from BJ Fogg. BJ Fogg has this amazing research on behavior and how humans actually create change that lasts. So in his model, one of the things he brings up is like if we think about New Year's resolutions, right? So new year's resolutions for a Lyme or mold or gut person could be something like okay, well maybe we're going to take this food out, or maybe we're really going to try to take our supplements three times a day as prescribed.
Whatever it may be, well, what tends to happen with habits is we have that motivation, and then we quickly lose that motivation, usually around month one or two. Which is why New Year's resolutions, so many people fall off the wagon. So the BJ Fogg's behavioral model really looks to say okay, well as humans from a psychological perspective, how do we actually make changes that actually last? That go beyond that motivation.
So in our model, in the medicine with heart method, we really bring in that model. And so that as we work with retraining the mind, as we really give some of the lifestyle changes and the supplements, we're actually looking at the psychology behind how do humans do this in a way that sticks. So that's why we felt like the behavioral model component had to be part of this.
[00:09:56.10] Scott: Yes, it's absolutely beautiful. I mean, I think to us, the holistic approach is very natural, and yet to the majority of more conventional medicine practitioners, it's not natural at all, right? They don't really look at that holistic perspective and also looking at what are the underlying root causes, looking at that body, mind spirit aspect of things that you're talking about here as well.
So that's nice to see that you incorporate all of that into your healing model.
When you start working with someone that's dealing with both Lyme disease and mold illness, have you found that one is more important than the other? Or is there one that's generally done first in your treatment flow?
[00:10:38.10] Dr. Diane M.: I really love this question, and it's something that I really address in my book. Because my personal opinion professionally is that it depends. That it really, truly depends. And there are certain people that I've seen where they have both Lyme and mold, but the mold is only a small portion of their illness, and sometimes it's as simple as maybe the toxic load in their body isn't as bad.
Sometimes people getting out of a moldy house like instantly changes things so drastically. And while the toxins still need to be addressed and detox, Lyme is actually way more important. So I feel like it's something that we do sometimes in medicine; I think to help people understand and to make it simpler is to almost over textbook it.
Of like, oh, this should always be done first. And I really wish human beings were textbooks because it would make medicine so much easier. But in the grand scheme of things, I don't see that there's necessarily one that goes before another. With the caveat of if somebody is in a moldy home, usually, that needs to be addressed prior to anything else is removing them from home, just kind of getting them out.
It's kind of in some ways I would say similar to like if somebody was living on nothing but like I have somebody that I'm working with that does nothing but sweet tea all day long, nothing but sweet tea. Hardly any calories, nothing other than sweet tea.
Like sometimes there's just these things that are so right in our face that yes, they need to be addressed first, like getting somebody out of a moldy house. But then beyond that, as far as do we then start with detoxification and really addressing the mold, or do we really go after the microbes of the Lyme. It really depends clinically and lab test-wise, what seems to be most likely the bigger hitter.
[00:12:40.23] Scott: So when we talk then about the microbial burden, Lyme disease and co-infections. Do we need to kill the bug? Is the germ really the cause of the disease? Or is it more about creating tolerance and integration with our microbiome? What should the treatment focus be? Is it really to unburden the system so that the body then can function according to its original blueprint?
[00:13:03.25] Dr. Diane M.: I really see that it's a both-and, and not an either-or. And it's an area where in medicine, I think we can get into a little bit of trouble when we try to say that we don't need to kill the organisms and just go after the landscape, right? And I've seen that run people into problems just like I've seen only killing the microorganism and not tonifying the landscape, and working with the landscape.
We see mold and Lyme can really affect the hypothalamus and the pituitary and can cause widespread hormonal and endocrine problems. And so it really seems like we need to absolutely go after the microorganisms, absolutely kill the infections. But then really go in and heal the imbalances that have been created in the body.
And oftentimes, if we just go and say kill, kill, kill, kill and do all the antimicrobials, I don't see frequently the body just resetting on its own; it can happen. But most of the time, I see that there's been certain problems, for example, like if the HPA access gets dysregulated, it's usually a problem that's happening with the receptors in the pituitary and the hypothalamus. This term, adrenal fatigue we now know is not really real, it's more of this axis problem, right?
Where the brain and the adrenals aren't seeing each other. So just helping somebody rest and heal from a rest perspective after some way, something like Lyme or mold is not going to necessarily reset the receptors at the hypothalamus and at the pituitary level to really allow the adrenals to come back on board. So that's just one example of why really looking at this from a more whole-body perspective is so important.
[00:14:58.12] Scott: You've talked about a study of 200 patients with Lyme disease that was done to see how commonly things like mold or pesticides or inflammation or heavy metals were present in these people with Lyme disease. What did that study tell us?
[00:15:13.25] Dr. Diane M.: Yes, so that was great work by Dr. Horowitz, and he basically did this like data mining study where he was really looking and saying, okay, well everybody was positive for Lyme, what other symptoms did they have? And that was super interesting because there was like a very large percentage of people that had things like mold, heavy metals, other types of endocrine-disrupting chemicals, environmental toxins.
So basically, what that study really showed us is that when it comes to treatment, and this is why I think that individualization is really important, because for one person, if they have chronic fatigue and headaches and migraines and fibromyalgia, these classic Lyme and mold symptoms.
For one person, it might be Lyme and mold and heavy metals and glyphosates, and for another person, it might be just mold, and maybe there's some Bartonella, and there's no heavy metals, and there's no other environmental toxins. And so that's why I think that study is essentially showing us how as humans, we can have very similar symptoms.
The people in this study had very similar symptoms, but yet how the root causes are mixed together, the whole conglomeration of the different root causes is very differentiated person to person. And we don't tend to know that without testing.
[00:16:43.24] Scott: Yes. And it was interesting; if I remember correctly, it was about 70% of those people with Lyme that also had mold-related issues, about 85% with heavy metals, which is a huge number. I was a little surprised that the number with pesticides was fairly low, and so from my thought process or perspective, I kind of wonder what was used to evaluate those because I actually would, at least as of today, I would expect that pesticides are an issue in a fairly high percentage of people as well. I think we all get exposure to those pesticides.
But it is interesting to see what are all the other co-factors that people uniquely express. Lyme disease can be difficult to eradicate; we know that. Talk to us about persister cells, how are they different from cysts, which is what we used to call things or round body forms that were historically discussed. And what is the role of persister cells in the chronicity of illness? And also in the tolerance to things that we're using like antibiotics or other antimicrobials.
[00:17:45.15] Dr. Diane M.: Yes, I love this question so much. The persister cells, I just think it's just such an interesting topic. So in the Lyme world, we still are talking about the cysts and the round bodies, and Lyme can go into these more dormant type of forms, these morphologies that are the cysts or the round bodies.
And that usually is done based upon the change of the environment or certain antimicrobials; for example, antibiotics can help make Lyme change into those morphologies. So what's interesting is like when we have Borrelia morph into like a sister round body, Borrelia will very quickly move out of the sister round body back into the spiral active form as soon as the environment's right.
So it's a very quick type of transition there, so people can feel sometimes like better for like a day if it's transitioned to like the round body form. But it's going to quickly as soon as the environment changes, they're going to feel bad again most classically. So in order to really talk about the persister cell, we have to go back to a little bit of some basic microbiology and talk a little bit about how bacteria actually have, what their DNA structure is like essentially.
So, humans, we have our double helix type of DNA, and persister cells or bacteria in general, they basically have DNA that is in a plasmid form. So it's circular. And why this is important is how they exchange genetic information. So if we have a spirochete that has genetic information to say be resistant to doxycycline, then that particular spirochete can literally take a tiny little snippet of its plasmid circular DNA and exchange it and basically give it to another spirochete.
And if you look microscopically, if you look under a microscope at the bacteria, what you'll see is that when this exchange, is a genetic exchange occurs, what winds up happening is there's no remnant of the original DNA, it's almost like that DNA is altered in a permanent way. And that's how antibiotic resistance can occur. So what's unique about persister cells is persister cells are thought not to be resistant to antibiotics. But really completely tolerant of antibiotics. And they're tolerant without any genetic change; when you actually look microscopically at a persister cell, the plasmid, this DNA structure is actually completely the same as the original DNA of Borrelia.
Even though it has the ability to avoid these antibiotics, and so that makes it a very difficult thing to treat. So with Lyme, for a long time from a conventional standpoint, things like triple antibiotic therapy have been used as a way of really working with the different morphologies of Borrelia, these different shapes. But that doesn't really get at the persister cells.
And the persister cells do not switch into like the spiral, the active form of Lyme, very quickly; it's a much slower process for these persister cells. So the challenge with this is sometimes people can go through a period, and they think they're better; they think everything's good. Because maybe we've gotten rid of a lot of the spiral forms, we've gotten rid of a lot of the round bodies. But the persister still are present, and stress is one thing that really can actually cause persister cells to say come out of their persistent form, turn into more of this active form.
And then that's usually what we call in the Lyme community relapse. So the question I really have is like, is this really, truly relapsed? Symptomatically it is. Or is it just a sign that when we're relapsing, we're seeing those symptoms really occur. That it really is more of an issue with what we didn't actually get after those persister cells, to begin with.
[00:22:03.10] Scott: So if the persister cells are relatively slow in coming back out from their protected form, might that mean that in certain cases, we don't need to have daily antimicrobial therapies and that we could instead pulse things where we introduce them let's say every other week, or every four days or one week a month or something along those lines. And then if pulsing is a strategy for persister treatment, is that something we can do with pharmaceutical antibiotics. Or is that something better done with herbs, for example.
[00:22:35.10] Dr. Diane M.: Yes, it's a great question. So there is a limited amount of data that is supporting the idea of pulsing for persister cells, so that's one of the strategies we've been using for some time at medicine with heart. And we have very low rates of relapse. So I feel clinically like we've seen some really good results with that. We've basically done pulsing, there's a few different ways we pulse. We've done things like five days on two days off, one week on one week off, we've even done as long as 21 days on one week off.
So from a pharmaceutical perspective, I do think it's always good from a pharmaceutical perspective to use whatever the recommended dose of the length of time, just because we also don't want to have a situation where the spiral forms or these other morphologies are creating or were creating antibiotic resistance.
So I do think we have to be very careful about how we pulse pharmaceuticals. But seeing that there are ways to pulse, where okay we could do a round of say ten days, which is a common course of a lot of antibiotics. We could do a round of whatever the normal course is, depending upon the pharmaceutical, take a break before we did another one.
So that's definitely an option. We in our practice, we tend to primarily use herbs as our number one go-to for Lyme. And we've had great results both with pulsing as well as using the herb Cryptolepis. And Cryptolepis was an herb we've been using for some time, but then just I think it's just over a year ago now, year and a half ago, there was a really great study that would that came out that actually showed and it was looking at persister cells, most of these studies on Lyme are still done in vitro, both pharmaceutically and herbally.
We're really looking at what's happening on a petri dish. But what the in vitro studies showed was that Cryptolepis was actually also killing the persister cells. So that's an herb that we're, in addition to the pulsation therapy, we're using so much in our practice, especially since now there's this really great study showing of efficacy.
[00:24:47.00] Scott: Yes, and it's a great herb because it supports a lot of the co-infections as well, right? So Babesia, some people feel like it's helpful as well for Bartonella. So it's pretty broad in its coverage. We've talked about Borrelia persisters, but when we're speaking about Lyme co-infections like Bartonella, like Babesia. Do we know if these have a persister form as well?
[00:25:08.06] Dr. Diane M.: There is some data showing that Bartonella and Brucella both have persister forms. So we do know about those two microorganisms. I have not been able to when I've scoured studies; I've not been able to find anything that said Babesia or Ehrlichia. Some of these other classic co-infections have persisters. But they could; it could just be that we don't have that data yet. But there's definitely data supporting Bartonella and brucella.
And then other things to consider from a persister standpoint, like E. coli which is so common with small intestinal bacteria overgrowth, and on UTIs. That has its own persister formation, and so when we're talking holistically about really treating the entire body, we do also want to consider microorganisms like e-coli that could be affecting our body, releasing lipopolysaccharides, and other things that are really inflammatory to our system. And that they need to be treated also, likely from a persister cell consideration as well.
[00:26:10.13] Scott: So you mentioned SIBO, let's talk now about mold illness. And I'm wondering what do you think the role is between mycotoxins and their potential contribution to leaky gut syndrome, or even SIBO.
[00:26:25.00] Dr. Diane M.: Yes, it's a really big topic. And a topic we can get into talking about some vicious cycles that happen with disease. So one of the things that we know that can happen with something like E. coli, and with SIBO and the lipopolysaccharides that are really seen and just the gram-negative bacteria associated with small intestinal bacterial overgrowth, is that they can actually block what's called the MRP2 protein.
And so, in order to really explain that and connect it to mold, let me just take a step back and make sure that everybody understands the importance of that protein for detox. So kind of basic Detox 101, we have our phase 1, breaks down toxins, allows them to be slightly more able to be excreted by the body. But then phase 2 comes in, breaks toxins down even more. And so once phase 1 and phase 2 which happen all over the place, but largely in our liver.
Once they happen, then the idea with these toxins that are broken down is we want to get them into, from the liver, into these bile ducts that are essentially called bile canaliculi, into the intestinal tract. And then hopefully, if everything's going out like correct, then we just poop them out. But the problem that we can see is that there is a transportation that needs to happen from the liver to these bile ducts.
And so the toxins are broken down in the liver; they need to make their way to the bile duct and then into the small intestine. So the MRP2 protein, as well as the BSEP protein, are basically these transport proteins that are going to allow the toxins to move out of the liver, into these bile ducts, the bio-canaliculi into the intestinal tract. So it's really important these transport proteins are working.
And one of the things we see with endotoxins and endotoxemia is that we can actually get a shutdown, a down-regulation, a turning down of these transport proteins, and then we can have our liver working great. But all of a sudden, everything that the liver has done is not able to get out. And this is a really important part of detox because so many people are focusing on binding, and binders are huge in the mold world.
And so many people are focused on all these liver things, and the liver is huge, and both of those things are really important. But if we have kind of this block between these two areas, we can give binders all day long. We can give glutathione and dandelion and milk thistle and all the great liver things all day long, and we won't be able to get toxins out.
And that's one of the things that SIBO can actually do, and some of the problems in the gut, and one of the cycles that get to be so crazy too, is okay, so we could try to give somebody Rifaximin, right? So Rifaximin is a common drug to take care of SIBO. But SIBO actually needs these transport proteins to work because bile is being released by the liver to go into the canaliculi, and bile is actually need it for Rifaximin to work.
So we can have a situation sometimes where it's like SIBO's blocking the transport proteins molds backing up, but we give Rifaximin to try to take care of the SIBO. But the Rifaximin's not getting activated because the bile is not being released from the liver in order to actually activate the Rifaximin, and we kind of wind up in this little bit of this vicious cycle that way.
[00:29:57.00] Scott: I think that whole point that you just made is so incredibly important. I first learned about that concept from Dr. Kelly Halderman in a podcast that we did a couple of years ago, the idea that if we don't get these toxins into the bile and into the small intestine to meet up with the binders, we can take binders all day long, but there's nothing that they can really do for us.
And so I love that you brought that up as well, it's such an important point. Kind of coming back to that question about mycotoxins, though, do you think that mycotoxins can play a role in leaky gut? And can they also then be a contributor to SIBO?
[00:30:31.23] Dr. Diane M.: Absolutely, as far as leaky gut. I mean, we absolutely know that there's gut problems that can be affected in a lot of different ways. I mean one just from an inflammatory perspective, but then secondly, these toxins are so, even like from not inflammatory to the gut tissue themselves, they also cause neuroinflammation.
So we know things like we can have vagal nerve being affected, and we can have digestive problems from that. I haven't seen anything like the migrating motor complex, which is so related to small intestinal bacteria overgrowth. I haven't seen anything data-wise to say that mycotoxins are going to affect that. But absolutely, the vagal nerve gets affected.
Absolutely, we turn ourselves easily the neurotoxicity, and the neuroinflammatory result of mycotoxins really puts us into a sympathetic dominant standpoint. And so we can absolutely get like a down the road sequelae, into the gastrointestinal tract from that causing peristalsis, causing problems in a variety of different places.
We can also sometimes see that, at least with Lyme, there can be effects even on like secretory IgA. I'm not sure if that happens with mold too, I don't know that I've seen that. The secretory IgA is our first line defense in our gut, as far as protecting us against infections and of all types. Parasites, bacteria, all these sorts of things. So if we have our first-line defense that is impacted, there's also potential for us to more likely gather and collect gastrointestinal infections. So absolutely, there are links there.
[00:32:15.09] Scott: One of my mentors, Dr. Ann Corson, when we talk about mycotoxins and the effect on the gut. She says that the mycotoxins are like “throwing sparks on a silk scarf”; I always appreciate that analogy to think of the damage that they can actually do to the lining of our gastrointestinal tract.
There is some debate about whether or not environmental exposure to mold can actually lead to colonization of fungal organisms in the body, in the sinuses, in the gut that might then require antifungal therapies as well. What are your thoughts on that possibility?
[00:32:49.06] Dr. Diane M.: My thoughts on that is that that is very likely and probably happening more often than what we actually realize. So I think a little bit of a still an unknown in the field right now is how much of mole toxicity is truly happening because we're just breathing in these mycotoxins that are in our environment versus how much is actually happening because we are actually inhaling spores. And now we have these spore fragments inside of us and is actually the fragments inside of us that are creating the mycotoxins.
So more and more that we are leaning towards really looking at this as there could be some people that really just do have toxins, and I say that because for some people, we absolutely put them on detoxification protocols, and they get better. Really just focusing on the mycotoxins. But other people, we absolutely have antifungals in there, and it seems like they need them to get well too.
So I still think we're at a point right now diagnostically where we have tests, and the tests have improved so much over the past decade, but I still think we're at a point diagnostically where we need some better tests to come out, where we can start to differentiate some of what's happening here. One of the other things I'll say is a benefit of using herbal medicine is that so many times, if we're using herbal medicine for something like a gut infection in combination with mold or Lyme, in combination with mold.
So many herbs that are antimicrobial and antibacterial also have an antifungal component to it too. So it's another advantage of using herbal medicine when we're treating microbes, is there could be some of that happening too, where we are actually in, clinically like everybody that's treating mold, we're actually doing more to treat antifungally then we realize. It just might not be the primary reason that we're say prescribing a certain antimicrobial herb.
[00:34:54.10] Scott: I 100% agree with that; I love my herbs. I think it's a fantastic thing when a lot of times they're actually doing things and addressing things that we're not even really aware of, right? There are so many germs that we don't even have names for. And so, using those complex plant-derived herbs is a beautiful thing in my personal experience.
Let's talk a little more about some of these microbes. So if we're looking at Bartonella, for example, and how it impacts the lymphatic system, and how that itself can lead to a lot of the symptoms we experience. Do you find that it's important to support the lymphatic system, lymphatic drainage when we're dealing with Bartonella?
[00:35:32.23] Dr. Diane M.: Yes, 100%. And not even just Bartonella; I mean Bartonella absolutely goes after the lymph. And so many of these infections will wind up causing lymphatic congestion, and since our lymph is really responsible for cleaning, for moving toxins, for getting the trash out, for carrying our immune cells around.
Moving the lymph is super important. And I imagine some of your listeners know, but probably not everybody knows that the lymph does not move unless we move. And it's like our blood vessels; we have muscles on our blood vessels. So our blood vessels can contract themselves, that's why we can move our blood when we're sleeping.
But it's really our skeletal muscle, the movement of our skeletal muscle when we are walking when we're making motion that is allowing our lymph to move. And that's why when I was going through my treatment, knowing what I know, I was really dedicated to like even if I feel so bad; I have to get five minutes of walking in.
Because it's just knowing that we have to continue to do this. But it doesn't have to be walking; there's lymphatic massage, dry skin brushing, there's a lot of different ways we can effectively move the lymph. But I actually, in the upcoming summit that I'm hosting here, I have several people on it that are actually going to talk about the lymph and all of the links with the lymph, with these microorganisms. Because it's another area that I just feel in the chronic disease world that we are not, we're not taking seriously enough yet as how important it is.
[00:37:12.29] Scott: Absolutely agree, and I think a lot of times too, we don't realize how simple the solution can be. We think we need to go to somebody to do lymphatic drainage massage, which can be fantastic and I've done and benefited from.
But just walking is probably one of the best things we can do, particularly because we can do it consistently. It's free, it's easy, so I absolutely agree with prioritizing walking as a tool for getting that fluid flow really operating better.
If we look at Bartonella and Babesia, the two most common co-infections of Lyme disease, which one do you find impacts your patients? Or is the most symptom-producing, maybe?
[00:37:53.24] Dr. Diane M.: My professional opinion and this would be really interesting to talk to a bunch of other people who do this sort of work, to see if we were kind of in agreement. But I feel like I see Bartonella come up way more than Babesia. And Babesia is there, and it's present, and babesia symptoms I actually think oftentimes look so close to mold that sometimes Babesia may be being missed even by people that are going through mold treatment.
But since we know that cats have it, that dogs even have it. And so if we really know for sure with Bartonella, it's not just vector-borne; it's not just getting a bite by an insect. So I think that might be some of the reasons why we see so much Bartonella. But I sometimes wonder; I feel like Bartonella is so prevalent. Sometimes I question if we should be calling Borrelia the co-infection, and we should be calling Bart the main infection. Like it's that, I feel like it's that predominant in what I see.
[00:38:52.26] Scott: 100% agree with that, as well I love how much we're very much aligned here. Let's talk about the Ehrlichia and Anaplasma co-infections that don't get quite as much conversation. But we know that they can replicate inside the mitochondria. I think in your book, you talk about those two infections being a potential contributor to fatigue.
Oftentimes supporting the mitochondria when someone's still in that kind of stuck cell danger response from an infection or a toxin can potentially backfire if it's done too aggressively. So how do you address fatigue in patients where the mitochondria is being impacted by an infection or a toxin?
[00:39:31.24] Dr. Diane M.: Yes. One of the things to really consider any time we're working with infections and toxins on a cellular level is phosphatidylcholine because phosphatidylcholine really gets that phosphatidyl group really gets into that cell membrane and helps to kind of flush out some of that. So that's a really great tool for how to kind of flush out the cells.
So I really love that nutrient. At this point, I just use it so frequently. It's almost weird when somebody's not on phosphatidylcholine. So that's one way of really working to kind of get somebody flushed out. Magnesium manganese, I find both of those things can sometimes help as well. But phosphatidylcholine, at this point, is one of my big go-to ones there.
And then it's also certainly taking things one step at a time. I really do like alpha lipoic acid; I really like that as a mitochondrial support. There's great research on alpha-lipoic acid supporting the mitochondria. And ALA is great because it can cross the blood-brain barrier, and it does have the ability to almost work like a binder, where it can actually help to flush some of the, grab some of the toxins, get some of the toxins out of the cells even the neurons.
And so when we use something like that for mitochondrial support, that will support the mitochondria and will help with some of the mitochondrial insufficiency. We can use a product like that, that's also doing it in part by binding and pulling out some of those toxins. So those are a couple of my favorite go-tos for that.
[00:41:08.16] Scott: I also am a huge fan of phosphatidylcholine. In fact, that was the topic of my last podcast. I've had two tablespoons in the last 24 hours and a PC IV as well, so we're on the same page with that also.
Some people suggest that Epstein-Barr virus is the kingpin of chronic illness. Others say everyone has it; how important is treating Epstein-Barr virus? And the herpetic viruses in your chronically ill patients?
[00:41:36.21] Dr. Diane M.: I definitely think viruses are a real component of things like absolutely we want to consider them. I have seen people when we put them on viral treatments and EBV-focussed treatments that we do have significant results. I really kind of just to bring it back to how we started this conversation; I just get very nervous anytime we in medicine say like this is the kingpin of all diseases, this is the thing.
And so that's the caution that I give people around saying that okay, well everybody has EBV or other viruses have to be at the absolute roots. I do think it's worth considering; I do often run a test called nagalase on people. Nagalase is an enzyme that viruses produce. We do have to be a little bit careful because nagalase can elevate with cancer.
But typically, we see small elevations with viruses, large elevations with cancer. So we can use the reference ranges to kind of differentiate for that. So using nagalase, I do tests. I would say if I were to pull my charts, my best guesses is probably 25 to 30% of my patients; I wind up running a nagalase on them.
And so it absolutely, I believe, is part of it, but like I said, I just get really cautious about jumping on this bandwagon of everybody has this one thing as the primary thing. I just think we're very complex microorganisms, and we can get into problems when we try to speak like we're; we all have the same problem that way.
[00:43:19.27] Scott: Very few people talk about the endogenous retroviruses, and actually, my mentor Dr. Dietrich Klinghardt is where I learned about this concept. He actually uses nagalase as an indicator of these retroviruses, and so I'm wondering what role do you think retroviruses play in the persistence of conditions like Lyme disease, like mold illness? And how do you approach treatment of retroviruses?
[00:43:41.23] Dr. Diane M.: Yes, I actually first really got a hold of endogenous retroviruses also through Dr. Klinghardt. So I was using nagalase prior to that, but he's the one that really woke me up to this idea that we can have what we are considering the junk DNA. And we can have these retroviruses actually wake up and cause problems.
And when I've looked up, anytime I learn something from a provider; I do my best to research it on my own and see what I can find. And there's definitely not a ton, but there's definitely a couple studies out there that are suggestive of this sort of thing. So I do really feel like it's a real component of things. I don't feel like we have the diagnostic test to really say from a nagalase standpoint like maybe it is hidden EBV or maybe it is herpes or one of these other viruses.
Or maybe it is these endogenous retroviruses. So I don't, unfortunately, feel like we had the scientific data to differentiate, but I think the good thing is, most of our antivirals will treat all of these things anyway. We don't have the level of like with bacteria; even from a pharmaceutical perspective, there's way more antibiotics than antivirals.
And from a naturopathic perspective and a functional perspective, these herbal medicines that oftentimes we use for things like EBV or herpes are going to be many times the same things that we would use for an endogenous retrovirus.
So there's so much overlap there, and mushrooms really are one of my favorite favorites of; there are so many good antivirals. But mushrooms I kind of use most predominantly to treat any of these categories of viruses.
[00:45:31.07] Scott: So let's talk then about medicinal mushrooms. I would say it's fairly commonly believed that if you have a mold illness or a yeast issue, or a fungal issue that you will not tolerate medicinal mushrooms and should not use them. Other people say, hey, that's not true, and that's essentially saying don't take probiotics if you have a bacterial infection, which actually is something you point out in your book, which I love that analogy.
So talk to us about whether or not most people with a mold illness or fungal colonization, or other type of yeast overgrowth will tolerate medicinal mushrooms. And what are some of your favorites?
[00:46:09.01] Dr. Diane M.: Yes. I love this question. I actually was even talking to; I had a great conversation with Dr. Jill Crista yesterday, who has the Break the Mold book, and this, yes. Love her, love her, love her, we had a wonderful time chatting. And this topic came up, this exact topic around mushrooms.
And she and I were on the same page with this around really feeling like, hey, this is an important thing to bring awareness to that, just like you said. If it's a bacteria, we have good bacteria; we have bad bacteria. If it's a fungus, we have good fungus; we have bad fungus. And so I think we need to get away from this whole thing around if you have a fungal issue, that all fungi are bad. Some people don't like mushrooms, and that's fine.
But from a treatment perspective, mushrooms have so many antimicrobial properties. And I use a lot of different mushrooms, but two of my favorites are lion's mane and reishi. And one of the thing to probably most emphasize with mushrooms, though, really comes down to beta-glucans. So beta-glucan, so we talked about nagalase, and nagalase is that enzyme that is secreted by all viruses.
And what nagalase actually does, why these viruses will secrete this enzyme, is because nagalase will actually turn off our macrophages, which is part of our white blood cells. And so when nagalase turns off the macrophages, then all of a sudden, it's like it's basically a self-preservation mechanism by the fungi.
So the fungi will secrete nagalase, then our white blood cells, our macrophages don't work anymore, not as well, and then we have a harder time eradicating the fungi. So this is going to come back to this mushroom thing in the beta-glucan.
So beta-glucans exist in the outer cell wall of the mushroom. And really, all mushrooms. I don't think I've ever seen anything that's saying there's a mushroom without beta-glucans in it. Although that's possible, but I haven't come across that. And so basically, beta-glucans will reactivate those macrophages. And so basically, one of the ways they work is they're actually turning on our white blood cell function again, so then we can fight the fungus.
And the reason this is super important is because depending upon how the mushrooms are grown, will actually impact their beta-glucan content. So if mushrooms are grown as the great decomposers they are, if mushrooms are grown on things like wood, they have a high beta-glucan content. Mushrooms that are grown more just on soil have a much lower beta-glucan content.
So that's one of the things too when we're talking about, like reishi and lion's mane being a couple of my favorite. What is also really important is understanding the sourcing and how these are grown because that's going to really change, especially from an antiviral perspective. The amount of the beta-glucans and the amount of the ability of the mushroom to actually reactivate our white blood cells.
[00:49:20.20] Scott: I heard you talk about chitosan, which is also something that Dr. Ann Corson talks about chitosan as a binder. So talk to us about why you like chitosan as a binder? And then are there some people that need to be cautious when considering the use of chitosan?
[00:49:36.23] Dr. Diane M.: Yes. So chitosan has been shown to basically have about as much binding capacity as the pharmaceutical medicine Welchol. So it's a pretty strong binder for a natural binder. It's not at a level of cholestyramine, but it is a pretty strong binder.
So what's important is that when chitosan is being produced, there is an enzymatic reaction that can be subjected to the chitosan to convert it into chitosan oligosaccharide. And it really is that enzymatic conversion of chitosan two the oligosaccharide form that allows it to have that strong binding capacity. So getting like regular chitosan is not going to work as well as that chitosan oligosaccharide.
chitosan comes from shellfish, so that's really the biggest thing that people need to watch out for. Is if they have any sort of shellfish allergy or reactivity, then chitosan is not going to be an appropriate choice for them. So just make sure if anybody's using this, you absolutely need to ask your client if they have a shellfish allergy.
[00:50:40.23] Scott: And I think Allergy Research Group has a good one called MicroChitosan; if I'm remembering correctly, I think that's one that Dr. Corson likes to use.
Let's talk about Mast Cell Activation Syndrome, that is such a big topic.
What do you see clinically as the primary triggers for mast cell activation in your patients? And what are some of your favorite tools for dealing with mast cell activation while you're also addressing the underlying triggers?
[00:51:04.11] Dr. Diane M.: Yes. Mast Cell Activation Syndrome is such a problem. And oftentimes, I see that a history of a lot of pharmaceutical use can be a big thing. So the most common situation I see in my clinical practice is when somebody has had, due frequently to Lyme, had a PICC line in and was getting a lot of antibiotics for a long period of time.
And that oftentimes can be a trigger for the mast cells to be activated. Alcohol certainly can be a trigger, sometimes even stress or exercise. But it's usually going to be something where it's like the body has just hit its absolute load, and as far as max level of toxins and max level of stress, and the body is reacting by activating those mast cells.
And I do typically find that with Mast Cell Activation Syndrome, we have to address the mast cells prior to actually addressing anything else. Because most people, like one of my mast cell patients, she was at a point at one point where she was reacting to water. And it was like just in her bathtub, so it wasn't filtered water, but come on its water.
And so it's possible there's toxins in there, the minerals she was reacting to, but that's certainly the level of problem that can come. I've been from a treatment perspective; I know a lot of people are using Cromolyn or other mast cell stabilizers or histamine blockers. I have been underwhelmed personally, professionally; I've been so clinically underwhelmed with how effective those are.
I know some of my colleagues have had results with those, and so I'm not saying that those shouldn't be on the market to try because I know other people have had results. But me personally, I've just not been very pleased with what I've seen. And I've even seen people with mast cell activation react to some of the mast cell stabilizers.
And could be some of the fillers and additives in some of these pharmaceuticals. So one of the best things I have actually seen is really coming back to the MRP2 and the BSEP proteins and getting things moving. Because we process a lot of the histamine in our liver. And oftentimes, what's happening? If those proteins are blocked, then toxins aren't getting out.
They're circulating around the body over and over again; they have nowhere to go. And those toxins are part of what's stimulating the mast cell. So this comes back to the things that are going to get the MRP2 and the BSEP proteins working, which is going to come back to choline being like our amazing godsend nutrient. And some of our bitters work really well. Myrrh works really well, so those are some of the top ones to really consider there.
[00:54:01.02] Scott: Yes, my friend Ann Louise Gittleman always says “bitters are better”, and so I think she's been an advocate of that for so long. And when you say choline helps in that realm, too, we're also still incorporating the phosphatidylcholine, right? PC can actually help with this whole bile flow, as we talked about. So it can be regular choline or phosphatidylcholine for purposes of helping to support bile flow, support the liver and thus reduce the mast cell activation.
[00:54:28.04] Dr. Diane M.: 100%.
[00:54:28.29] Scott: Yes. And it's interesting because Dr. Theo Theoharides who's been studying mast cells, for now, I believe, something like 40 years, he actually says that Cromolyn is not a mast cell stabilizer.
And so your observations clinically that it doesn't seem to be that helpful may be supported by some of the research as well.
In your protocols for Lyme, you use manganese; you mentioned that earlier. Some say that manganese feeds Borrelia, so similar to many pathogens being supported by iron-manganese is actually what supports Borrelia.
But you and also Dr. Klinghardt, by the way, have been an advocate of using manganese in people with Borrelia, particularly if they were treating the Borrelia. So talk to us about your rationale for manganese, and can we then also use something like hyaluronic acid in a similar manner?
[00:55:19.07] Dr. Diane M.: The idea with manganese, as well as hyaluronic acid, and I do use them interchangeably, is that they are essentially feeders. And the thought is because Borrelia has that corkscrew type of shape, that as far as the bacteria itself. And it also is very modal; it has the ability to it has these internal flagella.
It can basically move and travel through our body. So the thought as far as one of the reasons why Borrelia is so hard to kill is because it moves, it burrows, it goes intracellularly so easily. So the idea and the concern sometimes with antimicrobials is since bacteria, some of these bacteria can move. We put it in an environment that it is not liking, and it can just move out of that environment.
So the theory on how manganese and hyaluronic acid work really are that they're both used as feeders. We know Lyme likes the joints, for example, because of all the hyaluronic acid there. It's one of the reasons why we can have a lot of joint pain is because it is a food source. And so the idea is by giving the food source, by ingesting it and then the food source, the manganese or the hyaluronic acid make their way into the blood.
And of course, we're taking antimicrobials at the same time, so then the cellular signaling is then going to draw the Borrelia out of hiding because that's a predominant area where the food source is because we just ingested the manganese or hyaluronic acid.
And then there's the antimicrobials there as well to basically kill it. So it's really done in a way to kind of prevent the microorganisms from burrowing deeper. So we have most people on either manganese or hyaluronic acid throughout treatment.
[00:57:11.05] Scott: So it's essentially the lure on the end of the fishing line. Dr. Klinghardt uses hyaluronic acid as well and calls it bug bait, right? So getting those microbes to come out from their hiding places, so the antimicrobials can then work.
You are one of the few practitioners that I've seen that talk about this concept of sensitization or becoming sensitive to specific treatment. So how might a medication that we're taking stop working because we become sensitized or reactive to it? Why do we become sensitized? How do we minimize that potential? And then what do we do if we are sensitized?
[00:57:48.13] Dr. Diane M.: Yes. So I think this might be happening just because of the strong innate ability of Borrelia to learn. And what sensitization is, essentially where something will work for a long time. And all of a sudden, it doesn't work. We can have somebody on this, whether it's a pharmaceutical or an herbal for a Lyme, and it's like they're getting better, they're getting better, they're getting better, and this thing that's work maybe they're 50% better and then nothing.
And that seems to be something that I know there's a couple of us in the community that talks about this, as a clinical observation that we notice. When it's like we get to a point where the efficacy all of a sudden goes down. So kind of the theory behind that is really that there has been almost like a resistance, right? That happens, where the microorganism's not responding in the same sort of way. So we get around it clinically by rotating.
So, in addition to pulsing, we tend to rotate. So my book you'll see, the reader will see that there's like tons of different suggestions on treatments. And the reason that we give so many suggestions, it is more complicated from a clinician perspective to prescribe. It is more complicated from a patient perspective to switch things around.
But we've seen when we rotate things every three weeks, every month, these types of time frames that we can really prevent the sensitization. And if we prevent the sensitization, if we have somebody on a Lyme treatment, and it's working, and then we switch to something else before the Borrelia has been sensitized to it, then we still have that in our arsenal.
But if we wait until the point where somebody is, the Borelli is now sensitized to it, and it's not responding. It's almost like we have to take it out of our toolbox. So by rotating, we allow for things to stay in our toolbox that are working, so we can continue to come back to them later.
[00:59:51.26] Scott: Yes. That's an interesting concept. And so I've seen some practitioners that will also say that the patient can also become sensitive to specific treatment interventions, and the rotation option would work, but they might then use different desensitization energetic systems to help desensitize.
But what you're really talking about here is more the organism becoming resistant to that particular material, rather than the person becoming reactive or sensitized to it, correct?
[01:00:19.24] Dr. Diane M.: Correct, yes.
[01:00:20.29] Scott: Okay. You use cistus in your practice based on Dr. Klinghardt’s work; how is that helpful for your patients, and are you using the tincture or the tea? And why does it need to be used with other herbs as well?
[01:00:32.14] Dr. Diane M.: So what I've seen with cistus from a research perspective is it really doesn't go after those persister cells. And so that's one of the biggest things to use in combination. And that study that I mentioned that Cryptolepis, it did perform so well in persisters. That same study looked at cistus and did not find the same type of result for persisters. So I know Dr. Klinghardt like he talks a lot about tea, and I think that's wonderful.
I love getting people on tea. And I've also found from a compliance perspective that sometimes drinking tea and as much as typically is needed, like six to eight cups a day of cistus, is pretty difficult for people. And it's not a horrible-tasting herb, it's not the best-tasting herb either. We can use some stevia in it, which is also anti-Lyme, to hide the flavor a little bit.
But typically, I have gravitated more and more towards the tincture just purely because of compliance. And so with the tincture, sometimes I will have people take it at three or four times throughout the day; that's most common.
If people can put it in their water and sip it throughout the day, that's wonderful. But then again, we're getting into the taste component of things. So it's super anti-lime, it's a wonderful herb, and I'm so grateful for Dr. Klinghardt for turning me on to it. And I just found increasing value with using it in combination with some of these other persister types of techniques.
[01:02:05.18] Scott: Yes. I like that it has so many different things it can be helpful for. The Lyme piece you mentioned, anti-retroviral, anti-viral, antifungal, so just a beautiful tool that we can implement. However, if listeners are hearing us talking about six to eight cups of cistus tea, please do not go off and do that without your doctor being involved.
Because I literally have seen people have strong die-offs to one teaspoon. And so, as Dr. Mueller pointed out, it can be a very strong tool in many cases.
How do you decide when to incorporate iron? You mentioned that as a mitochondrial support, but then we also know that organisms benefit from iron.
People like Bob Miller talk about the HFE genes and other factors that may lead many people in the Lyme community to becoming iron accumulators. So how do you kind of test for that potential need for iron and then determine when to incorporate that into a program?
[01:03:04.14] Dr. Diane M.: Yes, I mean definitely looking at all the classic markers, ferritin and serum iron and UIBC and TIBC. So iron, I do think, has some level of importance in considering, like you mentioned earlier, that iron doesn't seem to be a feeder for a Lyme, in the same way, that other microorganisms use iron. I test everybody for iron that walks in my door.
I run a standard iron panels on everybody. I don't personally see a ton of people with iron abnormalities. Certainly, if people have high iron, I do consider things like phlebotomy and prescription-based blood donation.
But it really hasn't for me, but a huge part of what I've personally seen in practice is an iron accumulation issue. But it's a really good point, and I think it's because we know there is this tendency for some people. I think it's an important thing to screen for, so it is part of my screening process.
[01:04:08.00] Scott: Biofilms or another big topic that we may need to address in order to uncover the hiding places that we were just talking about for these organisms. How do you like to approach biofilms? And why do we need to be cautious not to overdo it?
[01:04:21.13] Dr. Diane M.: Yes, it's a really important topic. Biofilms are really very real. They're very real, they're a way that microorganisms and evade our immune system, it's a way that microorganisms communicate with each other. So they're absolutely real. But one of the things that I think is not talked about enough that I actually learned from a colleague of mine, Dr. Tom Fabian, who has a degree in the microbiome.
And he educated me on the importance of that our microbiome actually, like the good bacteria, has biofilms. And that's something that until he educated me on this, I didn't have that level of awareness on. So that's one of the reasons why we want to be careful about overuse of some of these biofilm disruptors, and why we want to be careful to say let's just put everybody on biofilm destructors, and we should always be on biofilm disruptors, as we want to be very careful.
We have microbiome throughout our entire body. And we want to be very careful about biofilm disruptors that can cause problems to the good guys. So NAC is one that I do use; NAC definitely we have to be extremely cautious because of this whole thing. So NAC is a mucolytic, there's these disulfide bonds that kind of hold all sorts of mucus molecules together.
NAC will actually break those disulfide bonds, and when we're dealing with situations oftentimes where we have a lot of mucus, and we have microorganisms, not just in biofilms, but also hiding in our mucous excretions.
NAC can help with that. NAC is an amazing thing for the liver, it's a precursor to glutathione. So there's so many different things this nutrient can do. So I like finding things that are kind of high bang for our buck, and so NAC kind of provides that as a option there.
[01:06:15.29] Scott: Some of the unique tools that you use in your practice include PRP or platelet-rich plasma, which I've personally used. And also various photobiomodulation tools or light therapy, which I also love and use. And so talk to us about those two tools and how they're helpful for your patients.
[01:06:34.14] Dr. Diane M.: Yes, happy to. So PRP, the platelet-rich plasma, basically is just another way of bringing the body's awareness to a problem. So a lot of how PRP is working is we are injecting, we're basically spinning, taking the blood, spinning down the platelets that have a lot of growth factors in them, and injecting them to areas that are inflamed.
And so it's a way of kind of waking up the body to say, hey, this area we need immune support here, we need help, we need repair. So it's kind of waking up the body signaling. So this is an area for Lyme and mold. I want to be very clear that I haven't seen any from like a research perspective. I haven't seen any research on this; this is purely clinical and theoretical what I'm sharing here.
But what I have seen in some patients is if there's a lot of joint pain and we're stuck with treatment, it can sometimes really be a supportive adjunct therapy. I've never used it alone for treating Lyme or mold just as a way of getting somebody out of kind of a stuck point. And the same thing with photobiomodulation. And photobiomodulation is such a big topic.
We focus so much, I think, in the functional and health space on far-infrared spectrum of light, and that's great. There's a lot of benefits that can happen with far-infrared. But there's a whole other part of the light spectrum, and that also has medical benefits. So photobiomodulation using more on the near-infrared part of the light spectrum, and there's some research on it when we use a certain frequency and certain pulsations.
So frequency around 8, 10 and then pulse rates around 40 to, either 40 or down to 10, that we can do different things. So like, a 40-hertz pulse rate has actually been shown to really help with mental cognition. So we'll do; we have these devices in the office that are almost like helmets. VieLight is the name of the company we use for this, and they're almost like helmets; they have these little lights that go up the nose, and they just flash at this frequency and rate that is basically sending the light into the brain.
And then and more of an alpha like 10-hertz arena, we can get other things happening such as moving the body more into like a parasympathetic state, which of course is really good for healing. And there's actually a really cool study, and they talk about this on RadioLab, if you know that podcast. This researcher did this study on light and sound, and she's actually the researcher and her team are actually finding in mice that light and sound are activating the microglia in the brain.
So cleaning up the tissue, and they're actually finding that that plaques are disappearing. And not permanently, basically, the study, if I remember the study correctly, it's like an hour a day, they're finding that they have to subject these rats to this frequency in order to keep the microglia going enough to reverse the Alzheimer's.
But she's talking about it, and I believe she may have even brought this to the initial stages of human trials. So we're really starting to see the potential, and especially with Lyme and mold, we know there's so much neural inflammation in the brain, we know there's like some research suggesting that these can be reasons for things like Alzheimer's and dementia.
And we're really seeing that there's more and more support of using some of the light to and sound, according to her research, to actually activate the microglia to clean up the brain, to help with cognitive function, these sorts of things. So again, it's a supportive treatment, though; it's not the whole thing.
[01:10:18.16] Scott: I use light therapy personally every day. I think getting frequency and sound and light and other things that aren't always just more handfuls of pills to take is a beautiful thing. And I would suspect that in that example with the rats, where you said the effects only lasted for so long.
If they looked at the rats more holistically while they were also using the light therapy, they probably would extend the time that had a positive effect. I'm guessing they probably weren't looking at the rats for their infections and toxins and all those other kinds of things. Their mental health potentially, right?
[01:10:50.27] Dr. Diane M.: Oh yes, I have the same theory.
[01:10:53.16] Dr. Diane M.: So you were talking there about cleansing, so let's talk a little about autophagy and how we can use that to our advantage for cleansing. It's not just about binders and just about drainage remedies and things of that nature.
But we can actually take advantage of this built-in process to cleanse our cells. And so talk to us about autophagy, and what are some of the tools that can activate it?
[01:11:15.22] Dr. Diane M.: Yes. So I think we get so into in the Lyme and mold community like I've said around killing, killing, killing, detoxing, detoxing, detoxing. So the reason I like to talk about cellular autophagy is because it's important to also think about repair. And we have the process and the body where we are either in building or we on a cellular level.
We're like building up our organelles, we're building up those cellular components, or we're breaking down to repair, and autophagy is really that process. Where we're saying, we're going to clean the trash out, and it's like an analogy that sometimes I hear people use as building a house. And if we're going to do all of these great home renovation projects, and build up the house, and build up the house, and build up the house.
But we've never remembered to take out the garbage, we're going to have a problem. And that's essentially what autophagy is, it's taking out that garbage, taking out the trash. And we're not talking necessarily on like a detox trash level. We're really talking about, hey, toxins infections have damaged part of our body. Let's get the damaged components out, and let's rebuild on a cellular level more strongly. So that's essentially what's happening with autophagy. And so the best way to get into autophagy, at least with where we are in research at this point, really is fasting.
Fasting is really when we're going to get into autophagy, the deepest, the easiest sort of thing. And autophagy tends to start; click on that process of breaking down and getting rid of the trash about 16-hour mark of fasting. So that's something that doing like intermittent fasting, where we're really doing like time-based feeding and trying to eat within a window can be really helpful.
I really do encourage people, if they are going to do this, to try to push it to hour 18 so you can at least get a couple of hours of being in that, and not just get to the point where you're starting to do this process, and then you're going to turn it off. So even having a couple of days a week if it works for blood sugar and all of that, can really of doing that the 18 hour fast, can really help people a lot.
And you don't have to calorie restrict you can, but you don't have to. You can just you eat what you need two meals in that six-hour window. Another thing to know is that fats do not tend to shut down autophagy. So a way of working with this, in a way if people do have blood sugar problems, is to do something like an MCT oil or coconut oil, and just take a tablespoon or two of one of these oils if you're feeling really hungry.
And that can help keep you in autophagy. We also know that ketones and the development of ketone bodies can help improve autophagy. So I still look, and I still question with what I see if we do like complete fasting versus like, I'm just going to eat a high keto diet. I don't believe with what I'm seeing; you're going to be anywhere near an autophagy because there's also research showing that methionine as the amino acid is really going to shut down autophagy.
So having some of those ketone bodies can help turn on autophagy, and that's great. But methionine as an amino acid which is in so common in all of our muscle meats, and that's generally something people are eating on keto can really turn down that. So we're probably not going to get us deep into autophagy with something like keto, but we can get somewhere.
But really focusing primarily if we're trying to do this autophagy on saying, let's see as much as possible we can have a couple of days a week where we're just eating in a six-hour window, and have that 18 hours so we can really get there. Utilizing things like MCT oil or coconut oil if we really need to sustain our blood sugar.
[01:15:15.08] Scott: Right. So the fat piece that you were talking about is more supportive for autophagy. The alternative there is protein, which is also methionine is in protein as an amino acid. And so what's happening when we have consistent protein, we're really stimulating mTOR, which is that building side of this whole discussion.
And so sometimes we have to really limit the protein, and then when we're fasting, obviously we're doing that too to be able to support autophagy. So yes, I think it's such an interesting area. Things coming up like the fasting-mimicking diets as well with Valter Longo and his research, and so it's exciting to see where that's all going. In our last several minutes together, we want to talk about the mind.
And we left this to the end of the discussion not because it isn't important, because the reality is, it probably is the most important of all the things that we've talked about today. So I wonder if we can start by having you talk about some of the physical manifestations of negative thoughts and what can a negative thought do to our physical body?
[01:16:18.26] Dr. Diane M.: Yes. So it's so interesting from a research perspective how people how researchers tend to induce stress on people. So a common way of inducing stress and research is mental arithmetic. So put people on stage, give them a math problem. Scowl at them while they're trying to find the answer, those types of things.
And so that's a way that stress is frequently induced. So the study that I like to talk about is one where they're doing this classic thing, people are on stage, and there's several different things in this study that people have to do. But this mental arithmetic is one of many different components of inducing stress. And throughout this study, basically, the researchers will ask people what they're thinking, and they'll ask them to categorize like their thought processes as positive, as negative, as neutral.
There's a few different things on the scale. And basically, what the study shows is they're measuring their stress hormones throughout this. And what this study shows is that everybody has the same stressor. And their cortisol is negatively affected in relationship not to the stressor but to the thought that they're having throughout the stressor.
If it's positive, they're not having a negative effect on their cortisol. If it's a negative thought, they are having a negative effect on their cortisol. And this is so important because we see that cortisol regulates our blood sugar; it gives us energy. It plays in with our immune system; we know it affects our hormones or like our sex hormones.
There's so many different areas of our body that we know that cortisol is innately tied to. And when there's probably other things, other biomarkers that are negatively affected by the thoughts that haven't been studied yet, we just don't know yet. But one of the reasons why I think it's super important to talk about is because we can do all the great things.
We can do all of the great herbs, all of the great supplements, pharmaceuticals if they're appropriate, whatever it is. People can be spending thousands of dollars on their health. But internally have this dialogue that is negative, that is basically putting their body into the state of sympathetic overdrive. Sending the body the signal that they don't want to heal, that the body doesn't on a cellular level want to heal.
And the way I like to tell people is like it is one of the hardest things to override our mental dialogue. And to learn how to change it and to learn how to have different thoughts. But once we do it, it's actually one of the most impactful, it's one of the cheapest. We're spending thousands of dollars on these protocols oftentimes, and we can reset our mind and just spend some moments every day doing this work, and it's actually free.
And so we have this amazing tool we're sitting on and not utilizing, not because of any fault of any individual person, but just because, like anything we're learning, nobody has shown us how. And because nobody has shown us how, oftentimes, I think we think as humans like well, I can't do that. I can't do that, it's so common in what I hear.
Well, it's more that we can't do it yet because nobody's actually given us the path and shown us what we can do to start changing things.
01:19:40.01] Scott: I've told this story before, but early on in my own journey, I was using muscle testing to explore different things. And so even self-testing, I'm willing to be well, I would get a yes, I'm able to be well, I would get a yes. I deserve to be well; I would always get a no. And so that was a really important thing for me to work on with lots of different tools, and it's an ongoing process; I don't think we're ever done with the mental, emotional work.
But I found it interesting that even when I was muscle testing myself, that I couldn't manage to get a pass on that, I deserve to get well. So what can you say to those people that are listening, that find it difficult to get the support that they desperately need? Because we look fine on the outside, and people can't begin to understand their struggle.
[01:20:29.12] Dr. Diane M.: Yes. It's a really important question, and sometimes I think it's deciding if it's worth talking to that person if that person's not going to really understand what's going on. Sometimes it can do more damage by starting to fill us with anger, frustration, or self-doubt, or not following our own intuition.
So generally, I tell people, and something I talk in my book about is this concept of support groups. And sometimes support groups can be super useful because it's a way of sharing with people that actually understand. So I do encourage people, if they need to talk, and they don't have somebody to talk to, to actually seek out support groups.
But one thing that I also really encourage people is to seek out support groups that are really finding ways of bringing some of the positive into everything. Because what I've seen, so with some support groups, it's everybody is just like dumping their horror stories and their challenges. And while it can be good to share these things and get them off one's chest.
It actually can fill somebody with fear. So finding a support group where people are sharing, but also really kind of cheering each other on and celebrating their wins, and really building each other up as like we believe you can do this, this sort of thing. And then not sharing, if like friends and family members. Like it's going to be really interesting when my book comes out because my family doesn't even really know about my journey.
This is going to be like the first time they like know how sick I really was because I wasn't going home during that time. I just kind of was avoiding the whole family thing. And it was in part because I just didn't feel like I was going to be understood.
And so I think that's something to really consider, is like choosing the people to talk to that are going to understand, finding support groups that are positive oriented as well as sharing and really, if you really truly feel like somebody is not going to understand, it might be worth not saying much to them because I think sometimes that can cause some sort of damage.
[01:22:41.19] Scott: I like what you said about the positive support groups because one of the challenges oftentimes is when people get better, they tend to move on with their life. And so, a lot of times there's a bit of a negativity bias in the online support groups because the people that are there are still the ones that are struggling.
And then whether or not it's a positive conversation or a negative one is important, but remembering that doesn't necessarily represent the reality of those people that did recover and did get back to living a full and functional life. How important is it to get toxic people out of our lives in order to support our healing process?
[01:23:19.08] Dr. Diane M.: I mean, in general, I think toxic people are good to get out of our life, just to support our well-being. I think it's a really important thing to, it's a complicated thing, right? Because sometimes there's certain things that people are say toxic about, where it's like well as long as I don't bring up this one topic, they're really supportive.
And so I think we have to be very careful about who we're keeping in, and who we're keeping out and having compassion and understanding for other people and their own struggles. But one of the things to really watch out for is if every time you hang out with a certain individual, and you feel drained, you feel upset, you feel sad; you feel anything that's like not positive. Yes, that's going to happen sometimes with humans; none of us are perfect.
But I think it's an important thing to just track that in life in general. And if there's somebody that's like wow, every time over and over and over again, I just feel worse, my symptoms get worse, and you're not feeling that with another person. I definitely think it's important to take a step back and see first before maybe eliminating that person from one's life, to take a step back and say, well, what is this?
Is this person? Is it the way I'm showing up for them? Really looking internally, too, because oftentimes and most times, I think there is a bi-directional level of responsibility. So I think it's worth, especially if the relationship's long term, taking an internal look at oneself. Seeing if there is something that we can change internally to bring to that conversation.
But sometimes, people, through their own process, are just not a positive person in our life, and it doesn't have to be personal to them. It doesn't even have to mean they're a bad person; it doesn't even have to mean they're doing anything wrong.
Sometimes it's just not the right fit, and if you're feeling bad over and over and over again, and you're feeling like sympathetic overdrive, you're in fight or flight, you're probably not hanging out with that person, is probably not helping you from a healing perspective. But also probably not from a wellness perspective.
[01:25:30.06] Scott: A common trap with chronic illness is to feel like a victim. What's the downside of feeling like a victim? And what do you mean when you say forgiveness is for the past, and responsibility is for the future?
[01:25:42.18] Dr. Diane M.: Yes. So victim mentality is powerless. So if I say something has happened to me, this tick bit me, and now I can't get out of bed. I am completely powerless. So in certain ways, and I always exercise caution and talking about this because, in certain ways, we are victims of these illnesses. We can't help our genes; we can't help some of these things that happen to us.
So there is some level of yes, like we are victims to this. But the problem is when we stay in that mentality because we do actually have a choice. And this is where the mind comes in. We do actually have a choice of how we respond to that. And that part we're not victim to. I've seen people that cannot get out of bed and come to me and say like they are having a good day because they are focusing on what they can do.
And they're happy, in a good mood, they're not able to get out of bed, they're not able to do what most of us humans are able to do. But they can still orient to their mind, to I'm going to focus today on what is possible and what can bring be bring me joy in this moment, and that's really where the responsibility can come in. So the idea with the blame versus responsibility.
We really have to be careful when we're looking, and we're bringing up all these, how we can approach our day, and how we can approach our healing process and a way of working with our mind. It's so easy to look as human beings, especially as a perfectionist myself and so many perfectionists in the field; I consider myself a recovering perfectionist.
And there's so many of us in the field that it's like so easy to look at all the ways that we could have when we're going through our illness, done it better, or been more positive. And what we want to be very careful about avoiding in this conversation is feeling bad or guilt or shame, and just realizing like okay, well, that was the past. I can forgive myself for the fact that I didn't make the choices that were maybe the best back then.
But now I have responsibility in the present moment to say how can I basically do the best that I can, and this is where that behavioral model too that we talked about at the beginning really comes in because it's so easy to hear this. And be like, okay, I'm motivated to stop thinking these negative thoughts.
And I'm motivated to take five minutes every day to do gratitude exercises to do mindfulness work to get my mind on track. But that's where really some coaching and some understanding of how to make habits like that stick, because changing the mind and how we think, it is lifelong like you mentioned this.
And it's gotten a lot better for me, I've been doing this since 2004, and my mind works in a very different way than 2004. But I work on this every day still.
[01:28:40.27] Scott: You said you're a recovering perfectionist; I say I'm now a type A- personality.
[01:28:48.03] Dr. Diane M.: That's all, so good.
[01:28:50.10] Scott: You talk about the power of gratitude in the book. Are you at this point in your life grateful for your journey through illness?
[01:28:59.02] Dr. Diane M.: 100%. I would still never wish this on anybody, but it has been one of the hardest and most challenging gifts of my life.
Because one has given me so much compassion for the world, but two and working with some of these things around the mind that my illness basically forced me to work with, I don't know if I would have been as motivated without that.
And this has, this work that I'm doing and have done on myself will carry me until I die. And I think I need it to hit that my version of bottom through my illness in order to see how valuable this is.
[01:29:42.05] Scott: I think we're on the same frequency here for sure. How might the work of Dr. Joe Dispenza be helpful for those with Lyme disease or mold illness? Can we change the expression of our genes in regards to clearing toxins from the body, for example, and then how does that work overlap with the limbic system, retraining, or vagal toning? What are some of your favorite tools?
[01:29:36.00] Dr. Diane M.: Yes. I absolutely love Dr. Joe Dispenza, he's been so influential in my life. And one of the things that I know he's doing in his work is he brings researchers to some of his big conferences to actually measure different biomarkers, to see how things are changing with meditation.
And what he's reporting in some of his research is that we can change genetic expression with our minds, and I've seen that in my own personal life. I've studied a lot of Joe Dispenza; I also have studied a lot of Sheng Zhen, which is a different meditation style taught by Li Junfeng, out of China, although he lives in the states now.
And I did a 36-day meditation with Li Junfeng, and he basically, and I've been studying with him for many years. And at that meditation, I was in a moldy environment. I actually sent a HERTSMI test to the place that I was going to meditate in because I knew it was going to be there for 36 days. And it was, I think it was a 14; I have to go back and look at that number. So it was like, it wasn't 20, but it was not insignificant HERTSMI wise.
And I decided I was going to go, and I had crazy symptoms and crazy headaches, dissociation stuff happening. And it was around day 20, and I just decided I was going to sit in the fire and work on my jeans and reprogram them. And by day 20, I was having dramatically less symptoms. And I still get symptoms, it's not totally healed yet.
But what I've noticed is my symptoms; if I'm around other people that I know are mold sensitive and we're traveling together, I have less symptoms than them. So I really do believe that there is a huge impact on being able to change our genes. I do think meditation is probably fairly useful. I don't think it's the only way.
Gratitude, in general, is interesting because there's research that's really shown that the way we make ourselves unhappy as humans is by comparing ourselves or comparing something in our life to something that we don't have. So a way of making ourselves unhappy is like keeping up with the Joneses that whole saying of like oh, they have a better car, they have a better house, they have a better this.
And then the way that humans make themselves happy is actually by comparing what they have as better than something else. So gratitude is a really good example of that. So if we say wow, I'm so grateful for hot water.
Essentially what we're doing is we're comparing ourselves to a life of without hot water. And that has been shown in research to actually stimulate the happiness. And I saw this in the Philippines when I was in the Philippines, which I was there right before the start of all of our pandemic stuff. I basically was talking to a lot of people. I've never seen poverty quite to that level, where it was eight hours one day of a bus ride throughout the countryside, and I didn't see anything that we would even probably in the states call a shack. Like these semi dwellings were insane, and everybody was so happy, everybody was so happy.
And they were just happy because they had rice that day, and they would say things like, that I have rice today, it's amazing day. And it's really sad that that's how people have to live, and it's also a really good example of how we can be in situations that seem so incredibly horrific. But they were still using gratitude and still incredibly happy. So it's a really good tool in helping the nervous system and bringing out more happiness inside.
[01:33:52.24] Scott: Before I get to my last question for you, I want to talk about the book and the summit. So your new book just coming out, “Use Your Mind to Heal Your Mold and Lyme: A Survivor's Guide”. I will put the link to that in the show notes. And then you also have this exciting summit coming up, The Body, Mind, Mold, and Lyme summit, which I'll also add to the show notes.
Really impressed with the people speaking on that summit, you have Dr. Dan Cameron, Dr. Nicola Ducharme, Dr. Jill Christa, Dr. Jerry Curatola, Ashok Gupta, Dr. Kent Holtorf, Dr. Dan Kinderlehrer who I actually learned about the summit from. Dr. Christine Schaffner, Dr. Chris Shade, Byron White so many amazing people that's coming up in May on the 17th through 21st, so we'll have that link here as well. So very excited about all this great information that you're putting out there. Anything you want to comment in terms of the book or the summit?
[01:34:50.20] Dr. Diane M.: Yes. The concept I'll just comment on real quick, which is really the idea of this is to expose people to a lot of difference with the summit a lot of different treatment methods. So you'll hear people on the summit that are very pharmaceutical-based. You'll hear people on the summit that are very anti-pharmaceutical based.
And I chose people, and I reached out to people specifically for this reason because I really think it's important that we become in medicine more tolerant to different ways of thinking. Not every person responds to the same way of treatment. Not every person, like I have my perspectives, I have my book I help. A lot of people, and I'm not the right person for everybody, nobody is.
And I think this is really important that we do more and more of this in medicine around sharing opposing thoughts, and considering opposing thoughts, and helping people from a client perspective realize that this doesn't mean that one person's right and one person's wrong.
This means that medicine is an art, and there's a lot of different ways of treating people, which is good because everybody is different. So that's really kind of the concept is let's expose people to a lot of different thoughts, and help people understand that there's a lot of different ways of treating this and that there's no one right approach for everybody.
[01:36:07.06] Scott: So creating tolerance within our “people biome” essentially.
[01:36:11.25] Scott: Yes, exactly right.
[01:36:13.14] Dr. Diane M.: My last question is the same for every guest, and that is what are some of the key things you do on a daily basis in support of your own health?
[01:36:20.24] Dr. Diane M.: So I'm really into my morning routine. So I think there's a lot of people in the field that talk about their morning routine. So my morning routine is this, I get up before I even get out of bed, I do a little bit of breathwork. My co-author, my husband, Dr. Miles, has been studying a lot of Buteyko breathing, so I've been incorporating that as the breathing style.
But there's a lot of different types of styles. So I'll do some breathing, I'll do some visualizations. I'll get out of bed; I drink a glass of water, I make my coffee, and once I've done all that, then I go, and I play my guitar. So I really like starting my day with something that is creatively inspiring to me, to get my body in kind of creative thinking mode.
And so I'm not just coming at my day from pure analytic. And after that, I exercise, I go through my day. And then, at night, I'm usually hanging out and doing something that is either oriented to connecting with somebody in my life, my husband, or somebody else.
And then meditate before bed. And of course, I run my lab tests on myself, I run labs on myself about every six months or so, I'll check in on things and alter my diet and my supplements according to the latest. I've been really into peptide therapy this day to these days and some of the anti-aging stuff that we're seeing with peptides.
[01:37:44.01] Scott: Beautiful. This was such a great conversation; I really love the book, use your mind to heal your mold and Lyme, a survivor's guide. I know other people are going to learn a lot from that. I'm excited for people to dig into the book to also participate in the summit.
I am very grateful to have had the opportunity to connect with you and talk with you today. And so grateful for you being so generous with your time and putting all these great resources out there. So thank you so much for being here today, Dr. Diane.
[01:38:13.20] Dr. Diane M.: Well, thank you so much for having me Scott, it's been truly a pleasure talking to you.
[01:38:17.27] Scott: Thank you. To learn more about today's guests, visit MedicineWithHeart.com. That's MedicineWithHeart.com, MedicineWithHeart.com.
[01:38:28.15] 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 podcast, Stitcher, and Spotify.
[01:39:03.00] Thanks for listening to this BetteHealthGuy blogcast with Scott, your better health guy. To check out additional shows and learn more about Scott's personal journey to better health, please visit BetterHealthGuy.com.
BetterHealthGuy.com is an affiliate of Amazon.com and HeySummit.com
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.