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In this episode, you will learn how to approach biotoxin illness using a functional medicine model.

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About My Guest

My guest for this episode is Dr. Terri Fox.   Terri Fox, MD, ABIHM is a holistic, integrative, functional medicine doctor in Boulder, Colorado where she founded Boulder Holistic Medicine.  She did her medical training at the University of California San Francisco Medical School.  She has practiced functional medicine for nearly 20 years and is board-certified by the American Board of Integrative Holistic medicine.  In the realm of Lyme disease, she has participated in ILADS events and trained with Dr. Richard Horowitz.  She is also a Founding Member of ISEAI.  She works on her patient’s behalf as a medical detective searching for the underlying dysfunction, instead of just treating the symptoms.   She has expertise in fatigue, bioidentical hormones, sleep disorders, gastrointestinal dysfunction, and Chronic Inflammatory Response Syndrome from mold toxicity and Lyme disease.  She brings a unique blend of western medicine, herbal medicine, nutrition and exercise counseling, supplements and stress reduction techniques to provide her patients with a true holistic approach to healing.  Dr. Fox begins the healing journey with her patients with a two-hour intake to unearth the underlying triggers that contribute to imbalance and dis-ease.  She uses the latest cutting-edge technology and lab testing to help illuminate underlying causes.   She does an extensive work up and tailors a unique individual treatment for you to restore balance and bring you back to wellness.

Key Takeaways

  • What are some of the key functional medicine tests that may help to uncover those factors impacting health in biotoxin illness?
  • What tools can be used to optimize gut health and the microbiome?
  • Why is yeast an important exploration in the biotoxin patient population?
  • How important is implementing EMF hygiene to optimize outcomes?
  • What role do environmental toxicants such as heavy metals, chemicals, pesticides, and plastics play in biotoxin illness?
  • How important is supporting the adrenals?
  • What is the role of the supporting the mitochondria in biotoxin illness?
  • What are some tools for supporting sleep optimization?
  • What tests are used to test the person for the presence of mold illness and Lyme disease?
  • How is testing performed on the external environment in support of health?
  • What approach is used in treating mold illness?
  • How are Lyme and coinfections treated?
  • Do chronic viruses or MARCoNS matter?
  • What is the role of hypercoagulation and biofilm in chronic illness?
  • What is the role of limbic system retraining?
  • How important is it to consider mental and emotional trauma?

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Interview Date

January 4, 2023


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


[00:00:01] ANNOUNCER: Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.

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

[00:00:35] SCOTT: Hello, everyone, and welcome to episode number 178 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Terry Fox, and the topic of the show is A Functional Medicine Approach to Biotoxin Illness.

Dr. Terry Fox is a holistic, integrative, functional medicine doctor in Boulder, Colorado where she founded Boulder Holistic Medicine. She did her medical training at the University of California San Francisco Medical School. She's practiced functional medicine for nearly 20 years and is board certified by the American Board of Integrative Holistic Medicine.

In the realm of Lyme disease, she's participated in the International Lyme and Associated Diseases Society events and trained with Dr. Richard Horowitz. She's also a founding member of the International Society for Environmentally Acquired Illness.

She works on her patients’ behalf as a medical detective searching for the underlying dysfunctions instead of just treating the symptoms. She has expertise in fatigue, bioidentical hormones, sleep disorders, gastrointestinal dysfunction, and Chronic Inflammatory Response Syndrome from mold toxicity and Lyme disease.

She brings a unique blend of Western medicine, herbal medicine, nutrition and exercise counseling, supplements, and stress reduction techniques to provide her patients with a true holistic approach to healing.

Dr. Fox Begins the healing Journey with a two-hour intake to unearth the underlying triggers that contribute to imbalance and disease. She uses the latest, cutting-edge technologies and lab testing to help illuminate underlying causes. She does an extensive workup and tailors a unique individual treatment for you to restore balance and bring you back to wellness.

And now, my interview with Dr. Terry Fox.


[00:02:27] SCOTT: I first met Dr. Terry Fox through the International Society for Environmentally Acquired Illness conference several years ago. I'm excited to have her here today to talk with us about a functional medicine approach to biotoxin illness. Thanks so much for being here, Dr. Fox.

[00:02:44] DR. FOX: Oh, thank you so much for having me. You're one of my biggest heroes. I love your podcast I make all my patients listen to it. All my colleagues listen to it. It's an incredible resource for all of us.

[00:02:55] SCOTT: Thank you so much. That means a lot. It's fun. I get to pick brains for free now. I used to pay people a lot of money to pick their brains. And so, I get do it and have fun doing it.

Like many people in this realm, you had your own personal story that led you to doing the work you do today. Tell us a little about how complex chronic illness and how biotoxin illness impacted you and your family. And how your personal story became the driver for the passion that you have today to help your patients?

[00:03:26] DR. FOX: Yeah. So, my first experience, I was doing functional medicine. Did not know very much about biotoxin illness in the beginning. And I grew up in Virginia, which is Lyme endemic. Almost everybody I know there has had Lyme. And my brother got Lyme, and he got a really bad case a bit, of Neuroborreliosis. And was in the hospital for a long time. And they couldn't quite figure it out.

And so, that's when I first started like learning more from the holistic or functional medicine perspective. And then I just – how it happens, when as soon as you start learning something, they all just start showing up in your practice. All these people with Lyme and mold.

And so, then the big one was my son got really sick. I have this – he's 18 now. But I have this really just active, thrill-seeking maniac. One of those little boys that just tried to jump off of everything and kill himself, and scrappy, and little. And he's just so busy. Like, you couldn't even get him to eat. And then he started limping. And he started like walking down the stairs sideways holding on. And I'd go, "Honey, do your knees hurt?" And he'd go, "No." And then he'd walk sort of normal. But when nobody was looking, he was limping and walking slowly.

And so, I started testing him for things. And of course, I didn't test him for Lyme at first because I really didn't want it to be Lyme. I was like, "Maybe it's a food sensitivity." And so, I tested a bunch of things. And then I tested myself because it is possible to pass that in utero. And I've got this background camping, and ticks, and everything. And so, I had a lab for CDC positive Lyme test. So, then I was like, "All right, I have to test them." And he turned out to be positive.

And we started some treatment. And then there was this musty smell in his room. And I had somebody out and they said that there was a water leak in the attic above his bedroom. And so, at the time, of course, I didn't know enough. And this very sweet family-run business came in to correct the water leak and pull it out. And they didn't know anything about mold. And I didn't know anything about mold. And I had it all done when we were out of town. And then when we came back to town, my son like never got out of bed again for six more months. He was in severe 9 out of 10, 10 out of 10, pain mostly in his head. He had this really bad migraine. And he never had a headache or a migraine before. And nothing would break it.

And eventually I took him to see Dr. Harris in California, who I believe you know, too. And he started them on a couple antibiotics and some other things. But he had us do a mold test back in 2013 on my son. A RealTime mycotoxin, unprovoked. And it was totally through the roof and high.

And so, then we had our home tested, and there was three feet of water under the entire house underneath the vapor barrier. So, we kept opening the crawl space and thinking we were okay because we'd had the floods, the big, huge Boulder hundred-year flood in the fall. And by now it's spring, summer. And so, we realized. And that, literally, the airborne spore traps were all in the red, which you never see that anymore.

And so, we started getting it remediated, and we ended up selling it. And the marriage didn't quite make it through but everybody else got well. And my son, we moved out. And that was probably the biggest turnaround, was getting him out of the exposure and then getting him – he was on binders all summer and then on antifungals. And getting them out of the exposure was kind of the big shift.

And then he got better fairly quickly. I think kids are more resilient. They get better quicker. But for us it felt a lot more that the mold was really the big issue, and the mold is what allowed the Lyme to sort of reactivate and become chronic. Sort of opportunistic.

[00:07:32] SCOTT: Yeah, and I would say in my experience, I mean, people think of me oftentimes in the Lyme arena. But I've been saying for many years that I think even in my experience that the mold piece was probably more significant than the Lyme. The trigger that led to the immune dysregulation, then kind the dominoes then start kind of falling at that point. And it is interesting that we both have – You worked with Dr. Steve Harris. He was my doctor for a decade in my own Lyme journey. And so, that's an interesting connection as well.

We are very much aligned that the terrain is everything in dealing with these complex chronic conditions that we need to look for root causes of dysfunction. That those root causes may or may not always be mold and Lyme with its coinfections or at least not alone. That there's other contributors. What are some of the areas that you first explore from a functional medicine perspective when you're starting down this path working with a new patient? And then let's talk maybe a little bit about what is it in certain people that allows a biotoxin illness to remain active or chronic? Or what is it in certain people that allows you to have Lyme and coinfections but maybe never have Lyme disease versus someone who becomes symptomatic and struggles for weeks, months, years, and decades in many cases?

[00:08:56] DR. FOX: You know, if I'm not necessarily suspecting biotoxin illness when I start down – start with a new patient, I do a really comprehensive two-hour intake. And then I usually start with the basics. A big huge lab draw, and an adrenal panel, a food panel. Often a stool study. Kind of depending. And then from there, we kind of see what we get and then keep digging further until we find all of our answers.

But to answer the second part – So, in biotoxin illness, biotoxin is something that is toxic to humans but comes from a living organism. And what I have found, and I think many of us now, is that there are reasons why – So, there are bugs and toxins. The bugs are the Lyme, the coinfections, yeast, parasites, all that stuff, and then toxins, environmental toxins, heavy metals, and then the toxins that mold secrete, the mycotoxins, and neurotoxins.

And so, what I found is there are certain things that will allow the Lyme to remain chronic, and active, and replicating. And we know a lot of those now. We don't know all of them, I'm sure. I'm sure there are a bunch of genetics that we still haven't discovered.

But one of the examples I use, and I'm making up numbers completely here, is that if we did a good high-end, maybe IGeneX test, and a random sampling of the Northeast, my guess is some 90% have exposure if we're looking at antibodies. And less than 10% of those people are chronically ill.

And so, then I look at the why. Why did it take you down? Versus the other 80% of people that never got chronically ill from it and cleared it on their own. And so, the way that I look at it is it's a balance. And you want your system to be like really strong, and way up here, and optimized. And then the bugs to be like down on the ground, and not replicating, and not active, never to come back. And we know certain things that tip that balance. And so, mold tips it more dramatically than anything else in my experience.

And then environmental toxins. So, heavy metals. High environmental toxin loads. Meaning, pesticides, plastics, glyphosate, that kind of thing. And then gut dysfunction can tip the balance mostly because – well, a bunch of reasons. But 70% of your immune system lives in your gut. If it's not functioning well, if there's chronic, infection of some kind, or dysbiosis, or inflammation, or inflammation from even big food sensitivities, or allergies, then your immune system is busy in there and it can't really fight the infection well.

And then yeast overgrowth is one. I sort of think there's big – there're five biggies. And then like a lot of other small things. I mean, you can see like kind of a system crash just with chronic sleep deprivation, and the adrenals of being in sympathetic overload, and then a trauma happens. And a number of things like that can crash the system and allow the bugs to replicate and become opportunistic again. But I kind of – I generally think of the big five when I start down the road.

[00:12:16] SCOTT: So, summarize those big five for us.

[00:12:18] DR. FOX: Yeah, mold, gut dysfunction, including parasites, heavy metals, environmental toxins. And when I say environmental toxins, everybody has some. But high loads. So, people that grew up near a farm that got sprayed with pesticides or work in an industry that has a lot of environmental toxins. And I think I would say the fifth is yeast overgrowth.

[00:12:42] SCOTT: You mentioned a few of the tests that you might look at, looking at the adrenals and things like that. I know you use a number of different functional medicine labs like Genova, and Great Plains, and Doctor's Data, and so on. Tell us maybe a little more specifics around some of the tests that you're looking at to attempt to uncover the triggers for each individual person.

[00:13:06] DR. FOX: Obviously, it depends on the intake and everything they tell me. But an adrenal panel is – by the time somebody gets to me, their adrenals are usually shut. I think most of those countries adrenals are probably fairly overused and dysfunctional.

I use DiagnosTechs for my adrenal panel. Although I think all the salivary cortisol tests are pretty similar. I don't have any huge preference there. And then I use a lot of Genova often because I like their test, but because it's also contracted with most insurance companies. It tends to be a little more affordable.

I use their antibody assessment, which is a food sensitivity and allergy panel. And I do believe that there're some huge food allergy or sensitivity you don't know about you're going to spin your wheels and not get anywhere because it's pretty primary.

And then I use Genova's GI Effects for a stool study quite often. I like the GI Map a lot, too. It costs a lot more. And I don't find it gives you that much more information. Sometimes I'll use that. And there's some other ones that are out there. But probably most commonly I use the GI Effects.

And then if I'm looking for parasites, I have used the Institute of Parasitology quite a bit. And sometimes you can catch parasites there. But sometimes you can't catch them anywhere when they're still in there.

[00:14:27] SCOTT: And I think another one that is one of your favorites is the NutrEval as well from Genova. Is that one you pretty commonly look at for nutritional deficiencies and things?

[00:14:37] DR. FOX: I do, yeah. I use the NutrEval as a micronutrient test. It's about 12 pages long. It's a wealth of information of your levels of vitamins, minerals, antioxidants, amino acids, oxidative stress markers, all your Omega 3s, 6s, 9s, all that stuff.

If it feels like a simple case and there's no like joint pain, flu-like, achiness, like, Lyme-sounding stuff, then I might do a NutrEval in the beginning and just see if it's any big deficiencies affecting your mitochondria and your ATP production. Otherwise, I end up usually doing NutrEval closer to the end if it's a biotoxin case. Because, for example, mold is depleting to the system. All your antioxidants will get used up trying to pull out the mycotoxins and neurotoxins on their own. And then the treatment is depleting. The binders will bind more nutrients and pull them out. And so, the whole process is fairly depleting to the system. And the same with treating Lyme. I mean, Lyme messes up your mitochondria and so does mold.

And I find, in the end, when they're done with all the protocols and they're starting to feel better, then I do a NutrEval to see, "Okay, where are we deficient now? And what exactly do we need to replace to repair the mitochondria for mitochondrial resuscitation?" Instead of just throwing like the 10 things I kind of assume they might need for mitochondrial help.

[00:16:11] SCOTT: Talking then a little bit more about the gut, you mentioned that the gut drives 70% of our immune system. It also can play a significant role in our inflammatory response, leaky gut, all of those things, intestinal hyperpermeability. Let's talk a little about what are some of the things that you look at to assess the health of the gut? You mentioned the GI Effects. You mentioned the GI Map. You mentioned the Institute of Parasitology. Are there any other things that you look at that give you insight into how healthy or unhealthy is this person's gut? And then what are some of the tools that you might bring in to support restoration of the gut? To support optimizing and diversifying the microbiome?

[00:16:57] DR. FOX: Yeah. I like data. I'm a scientist. I do usually – I mean, some of it has to do with their symptoms. You're not going to see reflux or on a stool study. Some of it depends on the clinical picture. But I usually do – I do a food panel to make sure that's not inflaming everything. And then I do a stool study. And with a comprehensive stool study, there's markers for your upper GI. Whether or not you have enough hydrochloric acid, enough enzymes to break down your food, enough bile acids to emulsify your fats. Some markers for increased intestinal permeability or leaky gut. And then it grows out your microbiome, the aerobic and anaerobic. Doesn't grow out the anaerobic one but it does DNA for them.

And then you get a sense that there's additional bacteria that are just routing the space up and overgrown to a place where your beneficial bacteria can't make a permanent home, or pathogenic bacteria, or disease causing, or parasites, or yeast, or sometimes we catch a little mold.

And then with that, you can sort of get rid of all the bad stuff and replace all the good stuff. And for the microbiome, it's so huge for our health. It's our biggest immunomodulator in the whole body. It increases your good immune signaling and it decreases your immune dysfunction. Decreasing inflammation, autoimmunity, allergy, all that stuff. And each different strain of benefits bacteria has a different benefit and probably more than one. And we're just beginning to learn a tiny bit of like, "Oh this one might have something to do with your weight. And this one might have something to do with your mood."

And so, the take-home message is kind of like we don't really know yet. Which one is which? And we want to have as many as possible different strains in the microbiome. And so, I generally tell people don't use the same probiotic over and over. I like people to alternate two or three different kinds. I like there to be a good spore-based one in there and then the other ones to be kind of more high-dosed and diverse. But I have them replace the bugs, the good bugs, while they're killing off all the bad stuff at the same time.

The idea is like we're doing maybe a dysbiosis protocol with some herbs. And as we're getting rid of all those additional bacteria, we're just pummeling the GI tract with good bacteria in hopes that some of those will stick and stay and make a permanent colonization for us.

[00:19:36] SCOTT: What are some of your favorite probiotic products? And do you think there is a role for FMT or fecal microbiota transplantation?

[00:19:47] DR. FOX: I think that fecal transplants are incredible. And that one day we're going to probably get to use them for all kinds of things. I mean, that just shows you how important the microbiome is. Like, how miraculous the results are with it. And the issue really is that it's not easy to get and it's not terribly legal right now unless you have C. diff and a couple other things. But, I mean, I think it's great. I just think we don't really have good legal access to it yet.

And then some of the probiotics I like, I love Xymogen's Probio 350. It has like 350 billion colony forming units but also like 14 different strains, which is one of the most diverse ones I've seen. Usually, I'll trade off different spore-based one. I like the – it's actually new to me, the ProbioMax IG 26. It's a spore related with IgG in it. I love that one. And I use MegaSpore.  I use Orthomolecular 225. I use lot of different ones. And I just have them – keep switching them out.

There's this – do you know about the set point when you're like two-years-old?

[00:20:54] SCOTT: I do. But tell our listeners.

[00:20:57] DR. FOX: Yeah. It turns out, around two-ish, there's a set point for permanent colonization of your microbiome or lack thereof. And you get your first inoculation of good bacteria going through the vaginal canal. And the second one by breastfeeding. And then the third one is whether or not you've got a lot of antibiotics that killed off the good bugs and they weren't replaced before your set point happens around two-years-old.

And so, it's not easy. But with a good provider and a good stool study, theoretically, we should be able to at least get you back to where you were at two-years-old with permanent colonization of good bugs. And so, yeah. And then some people that were C-section, and bottle-fed, and had antibiotics they were little, you clean up the mess. And then they need high dose, high quality probiotics forever for optimum health. And they might only need them two or three days a week because they do establish a temporary residence for 13 days. So, you don't have to take them every day. But, yeah.

[00:22:00] SCOTT: One of the areas that you focus on more than many is yeast and Candida. And I'm going to say Candida because my understanding from many of my mentors is that is how it's said. But I know many people say Candida. So, tomato, tomato, whatever you want to say.

I know that you also feel that people that have mold exposure will have more issues with yeast. And I completely agree with that. I've seen that so many times over the years. Question is how common is it that you see Candida in your patients? What are some of the symptoms maybe that they may not really consider could be yeast related?

[00:22:40] DR. FOX: Yeah. So, I usually say yeast and not Candida because there's other yeast that can be big players, Geotrichum and all kinds of other ones. But what I found, and this is like my own just clinical experience. I don't know that there's a lot of literature around it or anything. But in a mold case, usually what I found is where there's mold, there's yeast. And that's because they're both fungal. And mold creates all the right environment for yeast to flourish, the right pH, and all that kind of stuff.

And so, I find almost every case of mold that I have, the yeast is a part of the puzzle. Sometimes it's a huge part of the puzzle and sometimes it's a small one. But I always address it in a mold case. And then in Lyme, I always address it as, well, a lot of times people will come to me after they've done all the antibiotics for three different bugs for two years. And they definitely have a yeast overgrowth. And then even not a lot of – I'll still try it with most of my yeast patients just to see if we get anywhere. It's pretty harmless. And then you can look for markers, too. I mean, sometimes you'll catch it on a stool study.

I always tell people that if you don't see it on the stool study, it doesn't mean it's not there. It lives in its biofilm and doesn't necessarily come out in the stool. And if you catch any on a stool study, I assume there's way more than what we're seeing. And then I do like the antibodies yeast to see. That can be a hint. And sometimes you get a hint on the OAT, or the NutrEval, or some of the other tests but I assume it in both of those two scenarios.

[00:24:15] SCOTT: What are some of the symptoms that maybe people wouldn't think about as being yeast that you see, that when you start addressing yeast in your patients, maybe certain symptoms will improve or resolve?

[00:24:28] DR. FOX: Yeah. Well, first, the common symptoms; fatigue, brain fog, headaches. Any and all gut dysfunction, from constipation, diarrhea, gas bloating, all the way up to reflux, to chronic hiccups, and chronic nausea, and all that stuff that we see in Lyme a lot. Any gut dysfunction. All rashes, particularly itchy rashes. But I find all rashes will get worse with yeast and usually with mold, too. I mean, even a true eczema or a true psoriasis will get exacerbated with a yeast overgrowth. And that'll calm down with yeast.

And then I guess some of the things that you wouldn't suspect. I've seen anxiety significantly improve. I've seen acne go away. I've seen people's toenail fungus go away. I've seen – I have a patient who injects the LDI for yeast into her wart and it goes away. And then this one can be explained by kind of what we know about how interconnected they all are.

But I have quite a few patients who they'll tell me that they crave sugar and have had multiple yeast infections I sort of suspect. And then they'll say their joint pain goes away. And I don't really think that the yeast is causing the joint pain but the yeast is allowing the Lyme to remain chronic on some level. And so, you'll see funny things like that, too, that probably aren't directly yeast but has the yeast is what's allowing Lyme and other things to remain chronic. You can get all kinds of great benefits from it.

[00:25:57] SCOTT: Many people are dealing with SIBO. SIFO is small intestinal fungal overgrowth. Can some of these yeast and fungal treatments in your experience help your patients that identify as having SIBO? And then let's talk a little more broadly. Like, where does addressing yeast fit into your broader treatment program? And what are some of your favorite tools for helping to mitigate yeast overgrowth or yeast colonization?

[00:26:25] DR. FOX: As far as the timing goes, usually in the beginning, starting them on a mold, or a Lyme, or a something protocol. Getting all the data. And I use low-dose immunotherapy for yeast. I've found it more effective than years of different protocols, and biofilm busters, and antifungals, and all that stuff. And so, with an LDI, you kind of can't change anything else for a week or two.

I wait until there's a pause in what we're doing. And we're not adding and changing and doing other things when – Time for a pause. And I'll start a yeast LDI. And then that way I can get the first one in and we can kind of move forward when there's pauses in the changing of things in the treatment program. And to prevent. I mean, I think it's wise to use Nystatin if you're doing long-term antibiotics, or fluconazole a couple days a week, that kind of thing.

I find in my practice that what we often think of as SIBO often ends up being SIFO fungal, and that much of it responds to a yeast LDI. I think that we do Rifaximin, we do all these herbs, and we can kind of get rid of SIBO for maybe six months or a year and it kind of tends to come back. And I find with the yeast LDI, often, once you get the right dose, it'll take care of SIFO. And the patient just has to keep taking an LDI every six weeks or so. And then they'll go longer, and they'll forget it, and they realize they don't need it as much, or they don't need it ever again. But, yeah, I think a lot of the SIBO is SIFO.

[00:28:02] SCOTT: It's interesting with the low-dose immunotherapy being such a big piece of how you approach treatment. That also kind of says that it's not so much just about killing the yeast but also about that interaction between the immune system and how the host is responding to the yeast, right? That what we're trying to do with low-dose immunotherapy is create more tolerance, more integration with our microbiome.

[00:28:27] DR. FOX: Yeah. It works on your antigen presentation system. And so, it allows – it sort of does this thing where it picks up the yeast so that your immune system can see it and then your immune system can kind of get rid of it on its own. It's in that like an immunomodulatory world.

[00:28:44] SCOTT: Dr. Dietrich Klinghardt talks about EMFs and the role of EMF exposure in mold, in fungal issues. I'm wondering if you found that reducing EMF exposure moves the needle for your patients? And is EMF hygiene an important part of your treatment approach?

[00:29:03] DR. FOX: I think it's incredibly important. I think it's also terrifying. And in my approach, I feel like there're so many different things that can help. And if I can get a patient with just even the basic hygiene around their phones and their EMFs. And I try to get my patients to put a timer on their Wi-Fi and have it shut off at night.

I had a professional-grade EMF meter. And I went around the house and put it on my computer, put it on my phone. And then the thing that was let off like a thousand times more than anything else was the Wi-Fi router. And so, I figured that's a good way.

I have some EMF blunting things that I put on my kids’ phones, and my phone, and my computer. I don't honestly know how. Well, they work. And then there's Faraday cages and stuff like that. And I try to – I make them put their phones on airplane at night. Ideally, they're not even in their bedroom. But at least put them on airplane. Get the Wi-Fi off.

And then you have certain patients that have electromagnetic hypersensitivity syndrome, and they need a whole other world of protection around EMFs. And I think it's a huge deal. And I think we don't know that many great ways to protect ourselves, avoidance, which is pretty hard.

And then even like the newer phones are letting off more EMFs. And I think it's a huge deal, and I think it's sad, and I think that we don't have much of a fighting chance around not having 5G for all of us in our worlds. And I look forward to having more information about how do we support the body and the system around it? And other ways to help blunt it because I can't really see them going backward in that way.

[00:30:57] SCOTT: No. And I agree with you, that the Wi-Fi router is a significant one. And if you do nothing else, at least turn it off so that you can sleep better because it does impact sleep. And so, I know there is – for people who are more EMF sensitive, there is specific router that's been designed to be better for people who are more sensitive to EMFs. And I've talked to people who have used that that were very sensitive to EMFs, and that allowed them to still have some access to their Wi-Fi but not be as reactive to the Wi-Fi that they had from a prior router. And so, there are some tools like that that are starting to emerge.

[00:31:33] DR. FOX: That's great.

[00:31:35] SCOTT: Yeah.

[00:31:35] DR. FOX: Do you know what it's called?

[00:31:37] SCOTT: I will put the link in the show notes. I believe it's JRS. But, yeah, there's a number of people that I know that have used that and have had some good response to it. I'll put that in the show notes for people as well.

[00:31:49] DR. FOX: And you know, I kind of – Scott, I just wonder, with the EMFs and all the other environmental toxins that we're dealing with today and how they're ten thousand times what they were even a couple years ago, or all those stats are all crazy. I almost wonder, with mold and Lyme, especially mold. I mean, I feel like Lyme's been around longer. Maybe we didn't recognize it or know about it. And I'm sure mold has always been around. But I wonder if we're seeing so much mold toxicity and mold illness because of all these other things. And they all build up. These mycotoxins, neurotoxins, biotoxin from Lyme. And then you throw some glyphosate that's in the grass. And then you throw some plastics. And then you get the EMFs in there. And this is too much. And the system can't tolerate it. And I just wonder if it's like sort of the whole picture or total body burden and the bucket flowing over that even has mold being such a huge issue right now.

[00:32:55] SCOTT: I would totally agree. And Dr. Klinghardt has talked for years about someone who did some research in Europe looking at how mold reacts to EMF exposures, including the levels of mycotoxins that are produced when you take certain molds that are not EMF-exposed and ones that are. And it's a significant difference.

If you were to ask Dietrich Klinghardt, "What's the first thing you do when you have mold in your living environment?" He will say turn off your Wi-Fi." I totally agree with you. There definitely is a connection there. And building practices, and tight buildings, and lack of error ventilation, and antifungals that were put in paints that then caused that whole microbiome imbalance and lead to stronger organisms still kind of being the ones that are around. Yeah, we've created quite a dynamic for being healthy in our modern times.

[00:33:52] DR. FOX: Absolutely.

[00:33:53] SCOTT: Let's come back to the NutrEval just for a minute. I know that you have observed certain commonalities in having done lots of these NutrEvals. And so, I'm wondering, can you see or discern a certain fingerprint in different patient populations that might lead you, just from looking at the NutrEval to think, "Ah, this looks like a Lyme pattern or a mold pattern?" And then how far can addressing these micronutrient deficiencies go in terms of improving patient’s symptoms?

[00:34:25] DR. FOX: Where can they go? Okay. So, fingerprint. For me, I see a clear fingerprint for mold. I don't know that I've found one so much for Lyme. But in mold toxicity, almost always, when I do a NutrEval, all the biggest antioxidants are in the bread. So, glutathione, alpha-lipoic acid, plant-based, antioxidants, vitamin C. B2 is often tanked as well. I don't know if that has something to do with the amount of migraines in mold or headaches and mold. But the B2 is often down.

And then, often, the Bs are not great in general. Because you need them to detox, and methylate, and stuff. And then you can see all the fungal markers as well in a NutrEval. There're three of them. They're sort of more yeast but they can sort of give you some hints about fungal issues in general.

If it's a mold case, it doesn't really shift the presentation in my experience. Like, you have to detox the mold and get rid of the mold and clear the system. And you can be replacing, and the replacing will actually help you pull the mycotoxins out quicker as well. And then it's usually after that you replace and replenish the system. And that's when you can get a big improvement in energy and stuff.

I mean, I use NAD throughout. And I use glutathione throughout. I don't make them do all of them because it's just too many pills for people. The mold protocol is complicated. And so is a Lyme protocol. They're complicated. It's a lot of stuff. And so, I try not to do all 10 things at once.

[00:36:06] SCOTT: So, it sounds like addressing some of these micronutrient deficiencies can then help support the mitochondria. Can help support the immune system. They're not necessarily getting at the boulders or getting at those triggers like mold and mycotoxins that still need to be addressed. But they are kind of supporting the body so that it is better able to participate in the healing process. Is that a reasonable way to say it?

[00:36:31] DR. FOX: Yeah. In the detoxification process, yeah, absolutely.

[00:36:34] SCOTT: Perfect.

[00:36:35] SCOTT: I want to talk about the environmental toxicant exposure a little bit more. You mentioned metals. I personally have been of the opinion for a long time that pesticides and chemicals are probably more important than metals. I'm not saying that metals aren't a piece of the puzzle. But in a Lyme, mold-type person, I have yet to meet someone. I can't think of anyone that I've talked to that said, "Oh, yeah. When I just addressed the heavy metals, my Lyme and mold went away." Right? I mean, it's a piece of the puzzle but it's not the whole pie.

But the chemicals and pesticides, it's kind of amazing how many different things we are exposed to. Talk to us a little about how important those might be. And then I want to get into do you use drainage remedies? What are some of your favorite detox and drainage tools? Do you like coffee enemas or foot baths? Or what's in your arsenal in that realm?

[00:37:30] DR. FOX: Yeah. First, heavy metals. I agree with you. If it's not a Lyme case, heavy metals can be a big thing. If it's fatigue, brain fog, neurologic stuff. But in Lyme, it feels like a layer of the onion. The system is a little bit boosted from clearing the having metals. But, no, I haven't had anybody get rid of their Lyme just from clearing heavy metals, which is different from mold. I've had plenty of patients clear their Lyme just from treating their mold.

But it does feel like a little layer of the onion. And it's pretty easy I think to layer in a chelation protocol if you're already doing a mold or Lyme protocol, because you've got all that detox stuff in place and you can add just a little bit in. And then we just sort of can clear that one thing and not worry about it. I think environmental toxins are massive. And they're getting bigger and bigger. And the amount of even like microplastics that we're exposed to now, and, plus, all the regular plastics, and pesticides, and glyphosate, and all those things. And they're all incredibly toxic to human. Illegal in other parts of the world. And hard to get around. I mean, even our organic food has glyphosate in it. And so, yeah, I think it's probably a huge part.

The one nice thing about, or at least as far as I know about, the environmental toxins is that the protocols to pull them out, the ones that we have thus far, are all pretty similar regardless of which one it is. Maybe minus glyphosate has a little bit of a different protocol.

For patients, I'll often – I'll do an environmental text and screen to see if any few are particularly high. In a Lyme patient, I usually do one. And then, for environmental toxic, toxin exposure, I use a lot of glycine, amino acids, plant-based, antioxidants, glutathione. I'll use some of the humic and fulvic acid for glyphosate and some of those other ones as well.

And then the – Yeah, we didn't speak about drainage remedies. I love drainage remedies. Drainage remedies are kidney, liver, lymphatic detoxification support. It's sort of opening up all three of your own drainage channels. So, you can begin to like – your body can start to detox and drain all these toxins out on its own. We're trying to bind things in the GI tract and get them out and give glutathione so we can metabolize it better. And then we can also open up our own drains to begin just draining things.

And most patients, most of my patients, love the way they feel on drainage remedies. They often ask me, "Can I stay on them?" Yeah. They're like, "I feel brighter. I can think better. I just like them. Can I stay on them?" Of course, you can. It's a toxic world. Stay on them forever.

[00:40:28] SCOTT: Plus, honestly, drainage remedies, if you work with the right ones, it's so easy because you can take many of them and you put them in your big glass of – Your glass jar of water at the beginning of the day. If you're using PEKANA, or using whatever, NutraMedix, Burbur Pinella, whatnot. It's not really that hard. You don't have to put a lot of effort into incorporating drainage remedies. Yeah, I agree. I love them.

[00:40:52] DR. FOX: And it's painless. And it's great detox.

[00:40:57] SCOTT: How about tools like coffee enemas, or ionic foot baths, or castor oil packs, or like –

[00:41:01] DR. FOX: Yeah, yeah. For detoxification of biotoxin, I think that's what you're talking about, I like a bunch of things. I definitely have – I have a few handouts that I use that have all of them on it. And I tell my patients, "You know, don't invest a bunch of money in anything yet." Go and try – try an infrared sauna. Try an ionic foot bath. Do a detox bath at home. Try some lymphatic drainage. Even some acupuncture. Some dry brushing. All that stuff. And see which one you actually feel a little better afterwards. And then that one is the one you maybe want to invest in and get like an infrared mat at home, or even buy an ionic foot bath at home, or whichever ones work for you."

And I try to get them to find – My Lyme patients to find that thing earlier rather than later. Because then as we're moving forward with treatment, if they Herx or they die off, then they know exactly what thing helps them to pull that biotoxin out.

And IVs are great for that as well. I mean, not everybody can afford or can get to. But I think IV phosphatidylcholine and glutathione are miraculous at pulling these toxins out, and especially mycotoxins and biotoxins, and help just kind of almost replenish the central nervous system. And so, that's a great one. But, yeah, have them try a bunch of different ones and then see what works for them.

Oh, and the detox baths I think are amazing. They are six cups of Epsom salts and six cups of baking soda. That one and the ionic foot bath. My son was eight or nine. Those are the two things that I've tried a million things on that poor child. But those are the two things he asked for. He actually asked for an ionic foot bath every day because he felt better afterwards. And we did a detox bath every day because he felt better afterwards. And that's just him. Some people feel better after the IR sauna or different things.

[00:43:02] SCOTT: And how about do your patients generally find coffee enemas helpful in this realm?

[00:43:07] DR. FOX: Yeah, a lot of patients really do. We have a good recipe on our website. I think it's a great way to detox and help your detox 2.5, your gallbladder, secrete a little better and get more bile into the GI tract and help detoxification in that way. I'm not a huge one myself for it. But, yes, I believe in it for some patients.

[00:43:31] SCOTT: I am. One of my biggest favorite tools –

[00:43:33] DR. FOX: I have a lot of patients swear by it.  Yeah. Yeah, that's great.

[00:43:38] SCOTT: No. And I think to your comment about phase 2.5 detox. I did a podcast early on with Dr. Kelly Halderman. And also talked about this on the podcast with Dr. Chris Shade. But if we're thinking about taking binders, and we're taking binders multiple times a day, and the whole scheduling thing, and all of that. If we're not optimizing bile flow, so that the toxins are getting from the liver, to the gallbladder, to the small intestine, then they're not necessarily anything there for the binders to bind to. To optimize the effect of the binders, that optimization of phase 2.5 detox and the bile flow that you just talked about is really critical.

[00:44:16] DR. FOX: It's really critical. It's very important. I have my patients do their binders with fatty food, so they get a little bile acid secretion ideally, so they can get some systemic mycotoxins or whichever toxin into the GI tract for the binder to bind. I'll sometimes use Bitter X. That'll help with some gallbladder secretion. Most of my patients are on some liver support as well, which can help. And so, yeah, I think it's an incredibly important part.

[00:44:45] SCOTT: And for our listeners, the Bitters X that Dr. Fox just mentioned is Quicksilver Scientific, if you're interested in learning more about that.

Let's talk a little bit more about the adrenals, the mitochondria. I think we used to have so much focus on adrenal fatigue, adrenal exhaustion. Now, there are some voices in the functional medicine realm that are saying, "You know, maybe it's not as much adrenal. Maybe it is mitochondria. Maybe it's that we need more ATP. Maybe that also helps then the adrenals. But it's helping every system in the body."

We also know that aggressive mitochondrial support in some cases can be difficult to tolerate early on if someone is still in that Cell Danger Response, that intelligent hypometabolic state, that protective state. How do you work with the adrenals and with the mitochondria in your patients?

[00:45:36] DR. FOX: Yeah. I mean, I think the adrenals are pretty critical for all the rest of your hormones. They're sort of the foundation. And they get survival – they're your survival instincts. They get precedence. And so, if your adrenals are completely out of balance and dysfunctional, then it'll take – a lot of things convert to cortisol for you. If your adrenals are hyper-excreting and you're in an sympathetic overdrive state, your progesterone will convert to cortisol, your testosterone will convert to cortisol, your thyroid and the cortisol are interconnected. Everything's sort of – it gets – all your other hormones can get depleted and balanced in the presence of a lot of adrenal dysfunction.

And so, I think adrenals are big. I mean, the patients that we see now, they're so complicated and complex and have so many things going on that, no, it's not the biggest thing usually. It's like a part of the puzzle. I do usually look at it.

And then for the mitochondria, I agree. I find that doing aggressive mitochondrial repletion and work in the beginning. Often, patients just can't take it. They tank. They don't do so well. And so, you do a little bit in the beginning and then you fill in more later. And mitochondrial dysfunction comes from mold and Lyme, and all of that stuff, as well as nutrient deficiencies. Even without those infections and toxins.

[00:47:07] SCOTT: I would say that fatigue is probably one of the more common symptoms. I'm wondering if you find that's more related to adrenals? More related to the mitochondria? Or could it be factors like viruses or something else that's driving fatigue? And then is there an overlap with the potential causes of fatigue and the potential causes of brain fog? Or do you see those contributors as being very different?

[00:47:33] DR. FOX: Oh, that's tricky, right? I think, I mean, they usually go together but not always. I would say my number one most common patient I have is fatigue. And most of them are foggy as well. And I think – I mean, any of these topics that we're talking about could contribute to fatigue and brain fog. I mean, you can get that from, sure, mitochondrial dysfunction. You can get it from a low thyroid. You get it from sleep deprivation. You get it from mold, Lyme, co-infections. All of those things can contribute to fatigue and brain fog. And so, there are a lot of overlap.

And, yeah. I mean, I think if it seems like more of a simple case, you start at the beginning with the adrenals, and the thyroid, and all that stuff. And if it seems more complicated, you might jump more towards the infections, and toxins, and Lyme, and mold.

[00:48:22] SCOTT: So, we've kind of brought in the concept of the Cell Danger Response just a minute ago. But in some cases, the body is intelligently downregulating the production of certain hormones, like thyroid for example. Maybe even some sex hormones. I know Dr. Klinghardt has suggested that there're some research that talks about how increasing testosterone could benefit the vector-borne infection babesia. I'm wondering, when do you find patients benefit in their overall treatment kind of timeline? When do they benefit from incorporation of hormone replacement? And how important is replacing hormones in optimizing patient outcome?

[00:49:04] DR. FOX: Yeah. I guess I believe a little differently than them downregulating and it being helpful. I can sort of understand why and how that concept would occur. And I listened to your podcast on it. But for me personally and the way that I treat patients is the beginning is a lot of – especially if they're really sick, chronically ill patients, the beginning is a lot of just strengthening the system and optimizing the system in order to tolerate treatment.

And we have a lot of sensitive patients. They do a sprinkle of a binder and they get symptomatic. And so, I can strengthen the system by getting them sleeping, working on their adrenals, and then replacing if their thyroid's low, and if their testosterone is low. I don't know about the Babesia connection for that. But I generally replete most of the hormones in the beginning if they're low. And I find that it gives people 10%, 15% more energy and vitality with which to be able to go through this lengthy detox process.

[00:50:12] SCOTT: Another area that you focus on is improving sleep, which is so key to healing. I'm wondering what you find is kind of driving sleep issues? What are some of the tools that you find most helpful in supporting or improving sleep in your patients? And then I'm curious what your thoughts are on mouth taping.

[00:50:32] DR. FOX: Oh, sure. Okay. Yeah, I think sleep is critical. Personally, I think that if you can't get somebody sleeping, you're going to have a very hard time getting them well. And so, I usually start to work on that in the beginning if it's an issue. And then causes are ways to figure out why. Sometimes it's the adrenals. The adrenals can spike, can get stuck in a pattern where they wake up in the middle of the night, you get a cortisol spike and it's really hard to sleep. And you're supposed to get up and run from the tiger. And those patterns can get stuck from all kinds of things.

Having babies and then waking you up every night. Or going to med school and your beeper going off, code blue. All kinds of different things. And so, that's a common one that I see. And I'll do an adrenal panel for that. And I have them – The middle of the night wake up people. I have them do that for a saliva sample in the middle of the night when they wake up to see if their cortisol is up. And then I have found low thyroid contributes to a middle of the night wake up as well. Often, when you get their thyroid treated just right, that middle of the night wake up will go away.

And then a very common symptom of mold is insomnia. And a very common symptom of Bartonella is insomnia. And even all Lyme patients have, if not insomnia, hypersomnolence or delayed sleep times where they're up all night and then sleep all day. Yeah, there are a lot of different causes.

I love CBD in general. There is a – Quicksilver Scientific makes sleep formula. It's a CBD Synergies SP. And it has the precursors to GABA in it. GABA is your main inhibitory neurotransmitter that you need in order to sleep and not be anxious. It has 5-HTP, the precursor to serotonin. It has a couple sleepy herbs with a little bit of melatonin and a full spectrum CBD. And I love that one for sleep duration. I think it works really nicely. Plus, you get the anti-inflammatory, and the anti-anxiety, and the neuro protective effects of all of it. And if it's a Lyme, patient they usually have a decent amount of pain, and CBD can be really, really great for that as well.

And then I also like – I don't mean to be promoting Quicksilver through this whole thing, but I love their stuff.

[00:52:48] SCOTT: It's fine. They have good products.

[00:52:50] DR. FOX: Yeah. I love their Liposomal Melatonin for sleep induction. And I think it just gets in quicker and gets there faster.

And it works really, really nicely. And then, yeah, I think mouth taping is great. I mean, I personally can't sleep if I can't breathe through my nose. There's a lot to the chronic congestion topic that we can talk about. But I think mouth taping, if you can do it and it works for you, is great. Because I do think it's really important that we're breathing through the nose when we sleep.

And, yeah, like glycine is a nice one because it's detoxing and it can help people with sleep, and RelaxMax. I have a lot of kids do a combination, a little cocktail of – Do you know RelaxMax by Xymogen? It's for anxiety. It's got a lot of inositol in it, which feeds the parasympathetic nervous system. Has some taurine, some mag, and some GABA precursor, too. And it's like a powder, cherry-flavored drink. I actually have a lot of my anxiety patients use that.

And they'll tell me, about 50% of the time they don't have to take their Xanax in a panic attack if they do the RelaxMax, which is great. And so, I'll do RelaxMax with glycine with OptiMag Neuro. Have you ever worked with that one? Yeah, it's just a form of magnesium that crosses the blood-brain barrier and is calming.

So, if it is cortisol spiking, then I'll do quite a bit of cortisol blunting stuff. I find it pretty hard to change a cortisol curve that's been stuck in a particular pattern for a while. It takes a while. And they can't be – if they're still equally stressed, it's not going to change as quickly either. I'll do things like phosphorylated serine, and rhodiola, and taurine, and phosphatidylserine as well to try to blunt overnight cortisol secretion. And that's one of those things that like it's not like the patient can tell that night, the first night that they slept better. But over time if the cortisol is spiking, it begins to smooth that curve out. And there's a lot of other amazing things out there for sleep that are natural. 

[00:54:55] SCOTT: Yeah, I think Integrative Therapeutics has the Cortisol Manager is another one that's similar for that same kind of purpose. Excellent.

Let's talk a bit about testing and treatment for mold and for Lyme disease. First, how do you test for the potential of mold as a contributor to biotoxin illness both in terms of testing the external environment and then also in terms of testing the person?

[00:55:19] DR. FOX: Yeah. Well, I'll start with the person. I do a mycotoxin test. Well, on the first blood draw. I always do a very extensive first blood draw. There're some of the biomarkers I usually put on there just for hints. And I can kind of follow those. I don't take them as a definitive diagnosis. But a C4a, and an MMP-9, and a couple other things to see if it looks suspicious.

And then I do a urinary mycotoxin test. I have several that I like. The one that I like the most is probably – or I use the most is the RealTime Labs. The reason is because I find it to be the most specific. A very, very low false positive rate but less sensitive. So, it doesn't catch all of it. It'll miss some.

And so, I personally think it needs a decent provocation. I used to do them with all kinds of different provocations, get an IR sauna, do liposomal glutathione. And then I started doing it after doing an IV, a phosphatidylcholine and glutathione. And wait about an hour. And then you pee in a cup. And phosphtidylcholine and glutathione will both pull mycotoxins out. And so, you get a better sense of what's in the system if you provoke it like that.

Basically, this also comes if you're sick from mold toxicity, it's likely that you don't detoxify mold well. It's less than a quarter of the population that's sensitive to mold and gets sick from mold. And those are the ones that don't detoxify it well. And so, if they were detoxifying it, and metabolizing it, and getting it out on their own, you could just catch it in the urine. But those are not the people that end up in my office.

And so, I've done. I'm like non-provoked, and then after the IV. I mean, literally, I've seen ochratoxin A of like 17 after an IV. And they had zero before when we did it. It's a pretty night and day provocation. And now, if I'm doing a retest, I have them stop binders for three days before the test so that we're not pulling it out in the GI tract. And then I actually have them stay on antifungals if they're on them. And then that way – So, when you're killing – Let's say that there is colonized mold in the system. If there is colonized mold in the system, it's upper respiratory tract, GI tract. Most commonly here in the sinuses. If you put them on an anti-fungal for the mycotoxin test and there is colonized mold, when it kills the mold, it releases its contents, which are the mycotoxins and neurotoxins. It's even kind of more of a provoked test, which can really give you a sense of what's in the system.

[00:58:00] SCOTT: You don't mess around, do you?

[00:58:02] DR. FOX: I don't. I want to know. Am I on the right track or not? Yeah. I do have a really provoked one. And if people don't want to do an IV or they can't, I like the Vibrant Mycotoxin. And that one you can just do first morning urine. It's good for kids and people who can't get the IV. I mean, to be honest, those are the two I use the most.

[00:58:22] SCOTT: And then how about for looking at their external environment to see if that might provide you some clues?

[00:58:29] DR. FOX: Yeah. There are a couple different things. And it's funny how it's changed over the years, like what we've used to test because it's changed quite a bit. But I now use a lot of qPCR of ERMI. Or you can use the Mycometrics or EnviroBiomics. But it's just a DNA test that's looking at the dust in your house to see if there is DNA of mycotoxins.

And the reason I think that it's become sort of – I feel like it's kind of come full circle. Like, we did it. We used it many years ago and then did that for a while because it doesn't tell you if it's a live mold, or dead mold, or an old mold thing that's no longer there. But now we know that those nanoparticles that mold secrete and the mycotoxins that won't secrete that can live in – Love to live in your drywall, and your wood, and the fabric of your house, those are toxogenic to those people that are mold sensitive. Even if there isn't a current water feeding a mold issue, those can still make people sick that are sensitive. And so, it's relevant, the ERMI regardless of – We just hope that it's not a big issue in the house.

That's the like kind of quick and dirty first thing I often do. And last, they know they had a water incident, or they have a suspicion of mold, or they go, "I knew it like. My basement has always smelled musty. Or we had this one leak five years ago." If that happens, then I just go straight to getting an indoor environmental professional.

And I have some here that I love that I totally trust that are great. And you can also find one if you go to ISEAI, Environmental Society of Environmentally Acquired Illness. They have a whole list of indoor environmental professionals, or IEPs. And I definitely – So, the purpose for that is they can come in and they can figure out where it is. And they'll do a really extensive look at your home, in the attic, in the crawl space, in the gutters, in the slope going towards your house. And they have infrared cameras that can see wetness behind walls and all that suff. And so, if they already know there might be something there, then I just get the ERMI and I send out the people to find it and make recommendations.

And so, what i just mentioned, that there are a lot of mold inspectors out there. Those are not IEPs. They are not legitimate, especially concerned people to test your house for mold. And so, you want to be guided. You want to either look up. And even if there's nobody on that list near you, you can ask some of them and they might know someone. And then there's a couple people that go nationally, like –

[01:01:18] SCOTT: Brian Karr, Corey Levy, Michael Rubino. Yeah, there's a number. I have a list on my site, too, that kind of links to some of those. And some of those can help you find someone in your area as well. Yeah, I totally agree. I mean, if someone shows up and the extent of what they do is air sampling, that's a pretty good indication that you don't have the right person.

[01:01:40] DR. FOX: Exactly. Yeah. And should we speak to that? I think none of us any longer think air samplings are useful. Airborne spore traps are just notoriously negative – Like, low yield. All the conditions have to be just right for the mall to be spool relating, and has to be humid in that moment, and they have to make it into the trap. And we've all now seen so many outrageously moldy houses with negative airborne spore traps.

[01:02:07] SCOTT: Let's talk then a little bit about your approach to treating mold illness. You've talked about binders. But I want to hear from your perspective, how important is removing yourself from the source of the exposure? Moving, remediating, whatever? And then what are some of your favorite binders? And then let's get in a little bit more into the anti-fungal, the colonization conversation. How common is it that you need to incorporate those antifungals? Do you use herbs or pharmaceuticals? Let's just kind of walk through that from removal of exposure, binders, antifungals.

[01:02:43] DR. FOX: Yeah. Unfortunately, I do think that you have to remove yourself from the exposure, whether that means remediation. There's no perfect house out there. There's always going to be a little something. And so, if you got a house that's decent with a little something, then you get it remediated and you get it cleaned up. And by that, I mean not just demoing out that mold and dragging it through the house and letting spores and mycotoxins go everywhere. But demoing it under containment with negative air pressure. And then remediation, for me, that's the small particulate cleanup where you do the HEPA filter, the vacuum on everything, and you wipe everything down, and you fog. You do the whole thing.

Now, some people when the house is really bad, they do have to move. And that's the terrible part of this diagnosis. And so, if I find, if you get a mold case and they're not being currently exposed, it's kind of a fun diagnosis because people get better quickly. It's a complicated protocol. But it's not that long of a turnaround as opposed to Lyme or some other things.

Yeah, if it is a big issue in the house, it's possible you might just need to move. But you're not going to stay in a moldy place with an air filter and binders and get all the way better. It's kind of like you're in a boat, and there's a hole, and you're trying to bucket it out little by little. You're never going to get all the way there until you patch that hole up.

[01:04:18] SCOTT: And I would say the same is true for fogging as well. Fogging in the context of what you mentioned a minute ago is you remove the source material that is water damaged. And then after you've done appropriate remediation, then you're using fogging and small particulate cleaning and some of those things to really do kind of a deep cleaning. But you're not suggesting that fogging is the solution to leaving the actual water damage material in an environment. Correct?

[01:04:48] DR. FOX: No. And actually, fogging is like the icing on the cake at the end. It is not one of the big major parts at all. And fogging alone will do nothing really. I mean, a little something for maybe a day or two.

[01:05:02] SCOTT: Let's get that into your favorite binders.

[01:05:06] DR. FOX: Mm-hmm. Okay. I love bentonite clay. I love activated charcoal. I do use Cholestyramine. I use OptiFiber lean sometimes when somebody can't tolerate cholestyramine. I'll do Welchol sometimes if they can't tolerate Cholestyramine. I will find I can get rid of ochratoxin A in a decent amount of patients without the Cholestyramine. But if it is really high and they can tolerate it, I'll use it.

And then you know there's chlorella, and NAC, and saccharomyces boulardii and some other things that can also help. I tend to use those more in patients who can't really tolerate big doses of the other ones. Then we start more with the gentle ones. That's the binder piece.

[01:05:55] SCOTT: And then let's talk about how common is it that you need to explore or treat the fungal colonization and bring in the antifungals. And can we do herbs? Or do we need to go to the Itraconazoles and those types of things?

[01:06:11] DR. FOX: Okay. Personally, there's no way to know really if they're colonized or not. And so, I assume colonization and everyone. And the one time – Sometimes you know because you know their house is now currently clean. And they know they have this really moldy place that they lived in before and that's when they first got sick. And so, they're still sick. So then, of course, they're colonized.

And there are some patients, that when you remove them from the source, from the moldy home, and you put them on the right binders for their mycotoxins that come up in the test, they'll get better. And glutathione and drainage remedies and all that, if they get 100% better from that, they don't need antifungals. They didn't colonize. But most people will get a chunk better but not all the way better.

And so, I use antifungals on most, the vast majority of my patients. And I always tell my patients there's three places that I see a big clinical turnaround when people get significantly better in a mold case. One is you get them out of the moldy area. Two, on the right binders. A couple weeks in the right binders. You can get a decent turnaround if they're not being exposed. And then the biggest turnaround is usually when you start the antifungals.

And, yeah, I use pharmaceutical antifungals mostly. I use a itraconazole. I do it with Nystatin. And then I do voriconazole as well. I usually start with Itra. And if we don't get all the way where we want to get, then I switch to voriconazole and I see what we can get with that. If patients do not tolerate any or really don't want to do a pharmaceutical, then I'll do herbs. I had as much clinical experience with it, like a dramatic turnaround with the anti-mold herbs. Like, different from the anti-yeast herbs.

[01:08:04] SCOTT: Let's jump in a little bit to Lyme and coinfections. What are the tests that you find? I mean, this is still such a challenging arena. But what are the tests that you find most clinically helpful in trying to ascertain whether or not vector-borne infections are part of someone's clinical picture?

[01:08:20] DR. FOX: Yeah. I mean, a lot of it you can pick up on in your history. But then I've used a lot of different companies over the years. Right now, I'm using mostly IGeneX. I love the newish ImmunoBlot. We're getting way more accurate results. And that's been exciting. And then now they have a FISH for Bart and a FISH for Bab, which supposedly tell us whether or not they're active. As opposed to the ImmunoBlot for Lyme is just showing antibodies. All that means is that you've had exposure to the bacteria. It doesn't say whether it's active currently or not. But these new FISH tests are supposedly telling us whether or not Babesia and Bartonella are active. And then there's an ImmunoBlot blot for them as well.

And, so I've been using that one mostly lately. Oh, there's one. I've used a lot of DNA Connexions before. And I like that one. And then I've used Galaxy a little bit. Vibrant. You know, I'm excited by it. But I haven't used it that much myself yet. I think it sort of it came into my world almost around the same time that the IGeneX started doing the new ones.

One last thing on the diagnosis of Lyme coinfections. So, if the patient can't afford it, the testing, or if I'm suspicious regardless of the test of Bartonella, or Lyme, or whatever it is. Yeah, I'm sure you know this and you've probably done it with people. But you can do a provocation test, which is kind of cool. But it is a lot more affordable.

And so, for example, if I think it's Lyme, I'll give them A-L Complex, a Byron White herbal formula. And I'll have them do 15 drops twice a day for three days. And if they have Lyme, they will be completely angry at me and they will throw it out the window and likely be in significant pain. And if they don't, nothing will happen because they're just herbs. If you don't have Lyme, you won't feel anything. And so, I use those provocation a lot. And for the coinfection, I mean, you can tell by the pattern of their symptoms often what what's at play without needing to spend a fortune on testing.

[01:10:36] SCOTT: Let's talk a little bit then about how you like to approach treatment of Lyme and coinfections. I mean, we could do a whole podcast just on that. But in your mind, what are some of the needle movers in treating vector-borne infections? Do we find here that herbs do work a little bit better than let's say the antifungals, for example, where you're using more pharmaceuticals? Do you find that, to deal with Borrelia, Bartonella, and Babesia, that we do need pharmaceutical antibiotics and antiparasitics? What are your go-tos?

[01:11:06] DR. FOX: Yeah, I have to say – And I already said this before. But the first and most important thing for me with a Lyme patient is to clear the terrain. And I do find that, really, it is that the bucket gets too full and runs over. And that there's all these things that tip the balance that allow Lyme to remain chronic and active.

And so, I'll always do – I test every Lyme patient for mold. And then we'll do the stool study. And we'll do – if we think there's yeast, we'll do yeast treatment. We'll do environmental toxins. And I'll do all that stuff first to clean the terrain and have it be sort of inhospitable to Lyme and Lyme coinfections. And you kind of see where you get.

Usually there's at least a lessening of symptoms when you do all of that work first and get them detoxing. And there's difference between detoxing environmental toxins, like pesticides and things versus biotoxin from Lyme. I'll always start with a little detox even while I'm doing that background stuff. I love TOX-EASE Beyond Balance. I like transfer factors just to help the immune system around the Lyme a little bit. And both those things, people don't tend to Herx. And so, those are kind of feel better things while I try to get at the underlying why is Lyme still chronic in you.

And then once we've done all the homework, then I usually start with herbs. I like a lot of the Beyond Balance ones. They tend to be a little more gentle than the Byron Whites. And they're effective. They're really effective. They're strong. And often, they're so strong, some patients can't tolerate any. That's something you bump up against a little bit with the herbal, which is very different from the mold thing.

But I'll try herbs. I've had great success with herbs especially. And when we've done all the homework, Lyme is just a lot easier to clear with regardless of what you're going to use if there's no mold in the system, and there's no parasites, and all that stuff. The patients will have a more a painless treatment of their Lyme.

And so, if we do all of that, and we've done some herbs, and some immunomodulation, and immune support, and all that stuff and we're not really getting where we want to get. For me, the antibiotics are kind of the last-ditch resort. And I try to do it for the shortest amount of time possible. But I do use – If somebody's gone through all this mold detox and all the rest of this stuff and they still have joint pain, and recurring fevers, and – You know, yeah, I'll do the antibiotics.

I do it with a really intense gut protocol because I really believe the gut is the foundation of the health. And if we kill off the whole microbiome, we're just going to keep slipping backwards. And so, I make them agree to this very intense protocol before I'll start antibiotics.

[01:14:11] SCOTT: Yeah. It's interesting then that for the fungal piece, the antifungals that you're using more the pharmaceuticals. But then in the Lyme arena, the coinfection arena, more herbs, more homeopathy, more transfer factors, more low-dose immunotherapy and then maybe some of the pharmaceuticals.

[01:14:30] DR. FOX: Yeah, well the antifungals don't kill our good bacteria. And I always do liver support with them. They're a little hard on the liver. But I haven't had anybody – I mean, I've had once or twice their liver enzymes have gone up a tiny. And we've just upped the liver support and it's gone away. I mean, I've been doing antifungals with patients for 15 years. 13 years maybe?

[01:14:53] SCOTT: No. And I've also noticed that some people even with the herbs. It's interesting because I think there's been a perception over the years that, "Oh, herbs are not strong enough to treat my Lyme and coinfections. I have to have the pharmaceuticals." And that's not really. When you look at some of these Beyond Balance, and Byron White, and some of those things, I mean, sometimes people have to start topically or transdermally. Sometimes they have to take one quarter of a drop one time per week and then slowly build up. I'm definitely not of the opinion that herbs are lacking in power when it comes to –

[01:15:25] DR. FOX: Strength.

[01:15:26] SCOTT: Yeah, exactly.

[01:15:28] DR. FOX: If anybody thinks that, you just give them three drops of A-L Complex, and they'll know they work. And then there is one caveat to all that. If I have a patient who tells me they went to the hospital for some other infection and they got put on antibiotics and all their pain, and joint pain, and achiness, and every symptom went away, I'm probably going to consider putting them on antibiotics earlier just because there is that percentage of people that just feel a thousand times better instead of having to go through the Herx and the whole thing.

[01:15:59] SCOTT: I want to get a little bit of your perspective about some of the chronic herpetic viruses, the EBV, the Herpes Zoster, the HHV-6, HSV-1 and 2, all of those things. I think EBV and Herpes Zoster do play a significant role in many people's symptoms. I'm wondering if you find that addressing chronic viruses more specifically with antivirals moves the needle. How do you test for whether or not the viruses are becoming less of an impact? Or do you find, that as you address the mole more than Lyme and those kinds of things, that then the immune system comes back to participate in that viral surveillance?

[01:16:40] DR. FOX: Yes. The way I look at the viral reactivation or viral load is that it's sort of because of the mold, and the Lyme, and the co-infections because they're suppressing the immune system. So, these are sort of opportunistic reactivation of dormant viruses. For me, if I can get the underlying dysfunction, the mold, the Lyme, the rest of that stuff treated, usually they go back into being dormant.

Now, like you said, sometimes it is a player. It's in the picture and it's quite active. And you get somebody with a really EBV IgM positive and then a really high IgG titer. And they got chronic sore throats and fatigue is intense. And I will often start some – the Byron White A-EB/H6. And I'll use that one a lot if patients do have high numbers of EBV and see like that's part of the picture. And I just do regular LabCorp testing for most of the stuff that you just mentioned.

And then in the Lyme community we sort of look at if the IgG is five times the high end of the reference range, then maybe it's reactivated and at play. And, yeah, unless it seems like it really is part of the clinical picture causing symptoms, then I just sort of – I don't overly push on the viruses.

Now, viruses, will if I feel stuck. If the patient isn't progressing as I think that they should, and we've cleared the parasites, and the mold, and the da-da-da, I'll do a whole antiviral. I'll add that and layer it in just to see if we get anywhere. And if we do, then we keep it there.

[01:18:19] SCOTT: And it's interesting now because what you're suggesting is that mold and Lyme, that those can dysregulate the immune system. So, these previously latent viruses then can start to reactivate. And it's interesting that we're seeing a lot of the same thing in COVID. That in people with long COVID, that there is a reactivation of Epstein-Barr Virus, and even Mycoplasmas, and Bartonellas, and those kinds of things as well.

Let's talk a little bit about the ongoing debate in the practitioner community around how important or not important parasites are in chronic illness. I'm in the definitely can be important camp. I tend to feel like because there aren't any really good tests that most people just kind of like, "Well, I can't find them. I'm, thus, going to kind of approach this as if though they just don't exist." But I'm wondering, do you find that parasites in your patients are important? You've mentioned the testing that you do earlier with the parasitology institute in Arizona. And when they're present, what are some of the tools that you find most helpful?

[01:19:27] DR. FOX: Well, when they're present, if you catch them, then it's easy. And you do some antiparasitic herbs. Combo it with an antiparasitic medication for that particular – You can catch Blastocystis hominis a lot and treat it with Alinia. And I do that with that herbal combo, which gives me a better long-term outcome.

I mean, I think parasites are a huge part of the picture, and in Lyme, and in other chronic complex illnesses. It's actually part of, when I treat Lyme, I test for the mold first. I do a lot of other stuff. And it's part of my whole protocol. If unless they've gotten better before we get there, I will do a whole parasite protocol. I'll do antiparasitic herbs with – go through like all four classes of the different antiparasitic pharmaceuticals.

And then you sort of rotate through them. You kind of see what happens. Do they react positively or negatively to one? If so, we're going to do that once and more. And I think they're hard to test for. And we're getting better and better but we're still not finding them, you know? They've got all that DNA test now and the GI Effects for parasites. But something – one of the – it might have been the head of the Institute of Parasitology that told me this. He was like, "Someone only shed an egg every like two months, unless you happen to catch it that day. And you're not going to catch it."

[01:20:55] SCOTT: That's probably Omar Amin, I'm guessing.

[01:20:56] DR. FOX: Omar Amin, yes.

[01:20:58] SCOTT: Dr. Amin. Yeah.

[01:20:59] DR. FOX: Yeah. Or it has to be the full moon for this one to replicate. You're not going to catch it otherwise. And especially, if they have a lot of GI stuff, that's kind of a hint. But, yeah, I think parasites are a big deal. And I often just do a presumptive thing because they are hard to find.

[01:21:15] SCOTT: I've had really good results with ParaWellness Research, Dr. Raphael d'Angelo in Aurora, Colorado. He tends to – almost always tends to find parasites in samples and looks both at stool and urine samples. And I've been very –

[01:21:31] DR. FOX: You told me this. And I'm dying to check it out.

[01:21:34] SCOTT: Let's talk a little bit about MARCoNS. I know you use the Microbiology DX to look for MARCoNS. I, over the years, have not been super impressed with treating MARCoNS being a significant game changer for people. And when we do address the sinuses, I tend to wonder what was it? Because we address MARCoNS? Or was it because there was another bacteria? Or maybe more likely because there was a fungal overgrowth there as well? Talk to us about how you explore the sinuses and then some of the treatment approaches that you might use for addressing or mitigating some of the microbial overgrowths we might find there.

[01:22:15] DR. FOX: Yeah. So, I guess I would like to start with how important it is, the sinus health. Because our brain, our central nervous system, detoxes inflammation and neurotoxins through the cribriform plate, which is behind the sinuses. And so, if you're chronically congested, it's very hard for your brain to detox anything.

And so, yes, just like you were saying, you get all these other benefits. And who knows if it was MARCoNS or whatever? But if you've been able to clear this. And so, I agree with you in that I don't think MARCoNS is as big of a part of the picture in mold as we used to think so. Plenty of people get a hundred percent well and still have a positive MARCoNS.

There are two things. One, I do test in the beginning for most of my mold patients. And I do a trial. I still use BEGI initially. I don't ever do BEG without the I, because I always think that there's mold in there, the Itraconazole. I'll do them both. I'll do like you know one round of BEGI. And then you repeat the MARCoNS test. And if it's still positive, I might switch them to the silver with EDTA nasal spray or something, a little – without the Gentamicin. A little less easy on the system or more easy on the system.

And the ones that I find that it matters are the patients who come in with chronic congestion, eustachian tube dysfunction. And they feel like there's a slime in the back of their throat that they can't get rid of. And their throat clearing. And I've had people like their eye look swollen. And that's from MARCoNS. or like people with dental stuff, cavitation stuff.

When it's up in here, sometimes it can be a big player. But now, when people don't have a lot of symptoms up here and they're just a mold case and they still have MARCoNS and they get better, I don't really care about the MARCoNS. But in the ones that do have all this stuff, and I think it's a bigger player, then – I mean, there’re so much different stuff out there now for MARCoNS. I'll have patience – I have all my patients sinus runs because I just think it's really important to be able to breathe out your nose.

And I'll have them put Biocidin into the sinus rinse. Seven to twelve drops. Whatever you can tolerate. Whatever is not too burny. And so, that one's a nice one. And then you can do – There're two probiotic strains in the sinuses. And you can – actually, you can put them in your sinus rinse. I've had patients actually snort them to try to – after they do some of the killing for MARCoNS, or mold, or yeast, or whatever's in there, then they sniff a little bit of the two strains of bacteria to try to replace the good stuff, which I think is fascinating. And one day –

[01:25:11] SCOTT: Is that like the Lactobacillus sakei or something?

[01:25:15] DR. FOX: Sakei and I think it's Casei. And don't you think one day we're going to have a great nasal spray that's a probiotic?

[01:25:22] SCOTT: I wish. Years ago –

[01:25:24] DR. FOX: Why isn’t anyone making that yet?

[01:25:26] SCOTT: Years ago, I put kimchi juice in a nasal spray and I had burning sinuses for four days after I did that.

[01:25:35] DR. FOX: Well, that brings me to another funny one. I have a patient who – this was not her first rodeo. She's had mold and Lyme in the past. And this is my first time seeing her and come back. And her MARCoNS back positive. And she came in and she told me that once she saw the result, she had some old Rifampin from being treated in the past for Lyme. And she opened it up and she put it in the sinus rinse and she sinus rinsed and she said, "All this slimy biofilm, crazy amounts and stuff came out." And she's doing it twice a day and it keeps coming out. And she feels better afterwards. I mean, I don't know.

[01:26:15] SCOTT: It makes you wonder if she had Bartonella in her sinuses.

[01:26:18] DR. FOX: Right. Well, Rifampin gets MARCoNS, too. I don't know if you remember that. But I don't know. It's hard to get an oral agent into the sinuses because there's no blood flow. It's an empty cavity. And so, anyways, that was kind of interesting.

And then, MitoZen makes a MARCoNS nasal spray now, A&B. But like I said, unless it feels like this is a big part of their picture, this whole being congested thing, I don't overly sweat the MARCoNS piece. I do assume fungal colonization in everybody and – well, everybody with mold. And I put them on BEIs at the very beginning. It's a nasal spray with Itraconazole, which is an anti-fungal. And then, EDT for the biofilm. And Bactroban, which is an antibacterial, because it's usually mixed once you open up the biofilm.

And then I've done those. I've added like grapefruit seed extract to it for particular forms of Geotrichum. If I see them on a stool study or that kind of thing. But, yeah, I do the BEI a lot and the BEGI much less often.

[01:27:27] SCOTT: Well, and a whole another conversation that we could have and actually have an upcoming guest where maybe we'll talk a little bit about this. But I think that the sinuses and the oral cavity obviously are contributors to SIBO and SIFO as well, right? I mean, if all day long you're constantly consuming your sinus fluids, and your oral fluids, and whatnot that have these infections in them, then those certainly can be contributors to ongoing SIBO and SIFO.

[01:27:59] DR. FOX: Yeah, absolutely.

[01:27:59] SCOTT: I wanted to get a little bit of your thoughts on the role of mast cell activation syndrome in your patients. What do you feel are the top triggers for mast cell activation, histamine intolerance, and some of your favorite tools?

[01:28:13] DR. FOX: Sure. Mast cell activation syndrome is – Your mast cells house a lot of your histamine. And they also have a lot of other inflammatory mediators. But it it's when a lot of mast cells release all this histamine at once into the system and sort of overwhelms the system with histamine. And the symptoms sort of look like – often, it's after you eat but not always. But it's usually like swelling, flushing, hives, angioedema, that sort of thing is sort of the most common presentations.

And then I find – I mean, it's usually triggered by the same stuff. It's triggered by mold, Lyme, coinfections, other untreated infections. But if the MCAS is really severe, the patient generally won't tolerate treatment. They begin reacting to everything. They're on a low histamine diet. And then they maybe have layered in a low FODMAP diet because now they've got SIBO or SIFO, too. And they're eating five things. And you try to give them a binder and they do not tolerate it.

And so, often you have to treat the MCAS first even though it's not the underlying – It's not the reason. You're not going to heal them with antihistamines. But if you can calm down the histamine levels and the MCAS response in the body, then the patient can tolerate treatment and get better.

And I use a lot of antihistamines. Double up on the daytime ones. Allegra, and Claritin, or Zyrtec, whatever you like. And then one or two before bed as well. And I do Ketotifen sometimes. I usually do it before bed because it tends to make people pretty sleepy. I do some cromolyn sodium. I do some Singulair in some people. I often will do the H2 blocker, although I don't like to do it, but does seem to work.

[01:30:07] SCOTT: Like, famotidine or Pepcid. Yeah.

[01:30:09] DR. FOX: Yeah. And then the natural stuff that I use is – so most of those things kind of stabilize mast cells. And then the other approach is to break down the histamine. You kind of go at it from both sides. And so, I use his DAO or diamine oxidase quite a bit. That's the enzyme that we make that breaks down histamine, which gratefully now you can take in a pill.

And I use Hista-Aid, which is a herbal liposomal combo from Quicksilver. And I know, it sounds like I'm a commercial for them. And I know Beyond Balance has one. I just realized that recently.

[01:30:47] SCOTT: MAST-EASE, yeah.

[01:30:47] DR. FOX: MAST-EASE. We just got it. I haven't played with it much. And then AllQlear. Do you know that one? It's like quail egg.

[01:30:53] SCOTT: Integrative Therapeutics, yeah.

[01:30:54] DR. FOX: Yep, that one I use. Quercetin's great. Just baseline. Take it all the time.

[01:31:00] SCOTT: What role do you think hypercoagulation is playing in these patients? And then kind of layering on that, I tend to think of biofilms and hypercoagulation as kind of being a spectrum, where the hypercoagulation maybe is kind of the early stage of this whole thing? And then biofilms, maybe when it's become a little more significant, I think there is some overlap. I know some of the things like Boluoke, for example, can be helpful for hypercoagulation but also for biofilms. How important is exploring the hypercoagulation component? The biofilm component? And then and how do you approach mitigating those when present?

[01:31:39] DR. FOX: Yes. So interesting. The way you just framed it, I think of it like a slightly different. But, yeah, they're related. Mold makes people more hypercoagulable. It makes the blood more viscous. Lyme also makes the system more hypercoagulable. And what that means is like your blood – think of it as like more viscous and thick. And so, you're trying to get these red blood cells to go through this tiny little capillary bed and oxygenate everything, and it's thick, and doesn't do it as easily and as well. And so, you could sort of relate, too. It can make you sort of sluggish, and foggy, and tired, and all those things. Plus, it's a risk factor for clotting and real clots and other things. Not just micro clots.

But in Lyme and mold, if you do stuff for the hypercoagulability, it's often enzymes on an empty stomach. So, Boluoke or nattokinase, or I use different combination – we use Interfase Plus a lot for mold. And then I often use ProteoXyme in Lyme. Or I'll do the essential oils. But the enzymes that you use on an empty stomach will thin the blood. And so, that leaves some people feeling a lot better because they're oxygenating better.

However, all those enzymes that will thin your blood will also open up biofilm if you do them on an empty stomach. And so, biofilm is tricky. It's important. It's a critical part of the whole thing. I personally do biofilm last. If you – for example, if I have a mold case. And before I've got them up upregulated on binders and other stuff, if I open up biofilm in the beginning, I'm just going to release more mold toxin into the system and they're going to feel worse. You kind of got to wait till they're a little bit further in and they're tolerating it well. And then you go into the biofilm piece.

And the same with Lyme. You do it maybe a little earlier because there's just more discomfort. That's kind of inevitable with Lyme. Then there's a little more like, "Okay, let's just get it done." And in mold, I think it can be pretty painless if you do it all in the right order and stuff.

For biofilm, I do think for both Lyme, mold coinfections, if you don't get through the biofilm eventually, you're not going to completely get rid of it. And so, it is critical. There are a couple agents that don't do both. Are you familiar with essential oils that Horowitz recommends? It's cinnamon clove. Is that oregano? Or is that –

[01:34:27] SCOTT: I think it is oregano. I think, because Hopkinton Drug ended up making a product related to that.

[01:34:32] DR. FOX: Yes, yes.

[01:34:33] SCOTT: Which I think Hopkinton now has closed and it's like PD Labs or something.

[01:34:36] DR. FOX: It is. PD Labs bought Hopkinton. Bye, Dennis. We'll miss you. I'll miss you. I think PD Labs is great because they've actually – Do you know them? They've been around for a while. They do a lot of the compounding for the places of the country that Hopkintons won't, can't ship to. I've ended up using them a lot. And they've been great, too. Hopefully it'll be smooth for us.

Yeah, they make it. But I don't think that those essential oils that open up Lyme biofilm, I don't think they thin blood. That could be one that's a little separate. Same with EDTA opens up biofilm. But I don't think it thins the blood. But you're right. They both kind of happen simultaneously. And it's hard to know when to add them in, because one person might feel amazing because of the blood thinning effect. And then the next person might feel awful because you opened up too much biofilm.

[01:35:34] SCOTT: Well, and interestingly, if you open up too much biofilm, you can actually then further coagulate the system, right? Because then the babesias and all these other things that are starting to come back out, the mold, the mycotoxins, that then trigger the coagulation cascade.

I totally agree with you. I know some practitioners that start treating biofilms really early. But to me, it makes a lot of sense to kind of wait and open Pandora's Box much later in the process, for sure.

[01:36:00] DR. FOX: Yes, when their body is detoxing and you've gotten rid of a lot of the stuff, and they can handle it, and – Yeah.

[01:36:07] SCOTT: How has your patient population navigated the world of COVID? And when you have worked with long-haul COVID patients, do you find that a lot of the factors that lead them to having more of this long-haul presentation are similar to what we talked about in terms of factors that contribute to chronic Lyme and chronic mold illness?

[01:36:29] DR. FOX: Yes. It's been lovely and amazing. And I'm so grateful because I just really feel like my patience, my Lyme patients, have done really well with COVID. I I've had very few – the ones that have had ended up getting long COVID or it set them way back in the trajectory of healing. They almost all – I think every one of them has had an IgG deficiency. And it's often IgG 1 or 3, subclass 1 or 3.

And outside of those patients, I haven't had any – Not one bad outcome, like, stroke, or anything, hospitalized, or anything. And most of them have really done okay. They've had a yucky COVID. It's not fun getting it. But haven't had a lot of long-term or long-haul COVID. And I sort of assume that that is because of all the work that we've already been doing on detoxing, and anti-inflammatory, and all this stuff.

And when I get a long-haul patient, I do sort of treat it the same. I think it's that same thing. The bucket finally tips over. And so, maybe somebody would have healed from COVID just fine, except they're in a moldy space. And maybe they were strong enough to handle the mold until they got COVID. And then that COVID is this huge inflammatory cascade. And so is mold, this huge inflammatory cascade. Then it's just too much for the system and the system kind of crashes.

And so, with all the other examples that we've talked about with what's important to take care of, and detox, and clean up for Lyme. I find that if you do that with long COVID, they often get better as well. There is some specific things for long COVID. Like, you'll definitely add in blood thinning stuff for the micro clots and certain nutrients and things. But I found it to be kind of the same road. How about you? Any –

[01:38:28] SCOTT: Yeah. No. I think that's definitely true. That, in fact, people early on in the pandemic, probably a couple years ago now when people first started having kind of longer courses of COVID, would ask me what should they do? And my response was find a good naturopathic doctor or a functional medicine doctor that treats Lyme disease and mold illness, right?

[01:38:50] DR. FOX: Exactly.

[01:38:51] SCOTT: I think there is a lot of overlap. Unfortunately, I have seen quite a few people with Lyme and mold that have had some challenging courses with COVID. But I think now we're understanding more about the reactivation of EBV, of mycoplasma, of Bartonella. The coagulation piece I think is so critical that you just talked about. I think the functional holistic way of looking at these things fits perfectly in the long COVID, post-COVID type scenario as well.

[01:39:22] DR. FOX: Yeah, I think we happen to be well-equipped those of us that do this.

[01:39:27] SCOTT: Because I knew we were having this conversation today in your honor, I took some methylene blue right before this conversation.

[01:39:35] DR. FOX: What do you think?

[01:39:36] SCOTT: Well, I actually am a big fan. But it is over the past few years a very popular treatment in the Lyme and coinfection arena, in the mitochondrial arena. I think it became discussed again in the Lyme and coinfection arena around Bartonella and some of Dr. Zhang research in it being helpful for Bartonella. I've had Dr. John Lieurance on the podcast a couple of times. In fact, we did a whole podcast on methylene blue. I think it's helpful in the infection management arena but also for mitochondrial support. And what I'm wondering is what has the response been to methylene blue in your patient population?

[01:40:17] DR. FOX: Yeah, I loved that podcast by the way. It was fun to listen to. He's a riot. So, I have had a few patients just – it was a deal breaker. Everything got better. They told me, "Don't ever take me off this. you could take me off everything else." And so, it's been amazing for some. And then I've definitely had some patients Herx and we've had to go like way down on – start with just a little tiny and work our way up.

I've started experimenting with it based on his podcast for patients that it's kind of like you're always trying to find the smallest number of agents of things to use that hit them most number of things so that they don't have to take 500 things. And so, if somebody has like interstitial cystitis, or I suspect parasites as well, or combo of all those things, plus their Lyme, then I might try the methylene blue because it's so good for all those things. But, yeah, I'm still pretty new to experimenting with it. But I like it so far. I've been using it more and more.

[01:41:23] SCOTT: I want to talk a little bit about the role of the limbic system and vagal tone in chronic illness. How important is doing work like the Dynamic Neural Retraining System, or the Gupta Program, or similar types of things? What are some of your favorite tools for helping to kind of reset that hyper-vigilant alarm switch? The limbic system?

[01:41:44] DR. FOX: Yeah. There's a lot there. Most of my patients, I would say, have to do some form of limbic retraining or vagal nerve - not dysregulation - regulating the vagal nerve. Or EMDR or something. And the reason – or one of the reasons is that when somebody's been chronically ill for 10, 15 years and they've seen 20, 30, 40 doctors that have all said, " You're fine," and they can't get out of bed and they're in horrible pain. They have trauma from just the medical piece, from the medical system telling them they're fine. From people not believing them. And they're not being able to live their lives. They've got all this micro trauma from the disease itself.

And then, also, what I think a lot of us are realizing is some of our most sick patients got sick during a traumatic event in life. And I find that when that happens, they happen to be in the moldy house when somebody they love died or whatever. It gets ingrained a little deeper and it gets a little harder to treat and get out.

And as far as – limbic retraining, the way I try to explain it to my patients is like you have a physical symptom. Let's say mold. Mold, you get some weird neuropathic sensation when you're near mold. You get some symptom. And you've been sick for 10 years. Now, you've spent two years getting well. You're almost 100% better. You walk into a moldy building and the neuropathy comes back.

I have this one patient who walks into a moldy building and he feels water rushing down the backs of his legs. The weirdest thing. I mean, there're so many crazy symptoms. But then – there's this physical sensation. And then there's the emotional response. And the emotional response is generally fear, and freak out, and anger. And they're scared that they're going to go right back to where they were. That it's going to be 10 years ago. And it's a natural response. But that anxiety, and the adrenals firing, and that fear and everything just exacerbates the inflammatory response to the mold itself.

And so, if you can remove the emotional adrenal response from the physical sensation, often it calms the whole cycle down because they sort of perpetuate each other. And I don't mean that in any way to say that it's in your head. It's not in your head. But your head can get it worse. I do find that part to be critical for a lot, especially the ones that they sort of identify now as being sick. And you get those ones that don't really believe they're going to get well. If they really don't believe it, they're really not going to. That work has to get done.

And some of the ones I use, I do – DNRS has years and years of experience and has worked for so many people. The Gupta Program, I love. I do Curable for a lot of patients, which is a little different. It's an app. It's great for pain. And I do – for polyvagal theory, I do a lot more – Do you know SSP? The Safe and Sound Protocol?

[01:45:04] SCOTT: Mm-hmm. Yeah, from Stephen Porges.

[01:45:08] DR. FOX: Yeah. Did he – Well, he did – he's like the founder of Polyvagal. But did he also create SSP?

[01:45:15] SCOTT: Mm-hmm.

[01:45:15] DR. FOX: Oh, cool. I haven't personally found with my patients at the exercises that you can do for polyvagal are terribly effective. Like, gargling, and humming, and all that. But the SSP program has been pretty amazing. And it's something where you listen. You listen to music. You put on headphones. And it's guided with a therapist. And maybe you listen to 20, 30 minutes a day. And then you meet once a week with your therapist. It was designed initially for kids on the autistic spectrum disorder, I believe. But that one's really effective and amazing.

And I sort of assume polyvagal when there's like the belching or the chronic nausea and vomiting. But you never know which direction to go. I usually give my patients six to go check out and see which one resonates. I also love – I mean, you can work with a therapist and do EMDR or brain spotting. And that could really help, too.

[01:46:11] SCOTT: The way I think about it is kind of the limbic system piece and that limbic system impairment certainly could be from a mental, emotional trigger. But I'm always very careful to point out that it can be entirely physical. It can be that mold, that mycotoxin, whatever, that triggered the limbic system impairment. Because I find that people are often very resistant to DNRS and Gupta because then they're kind of coming back to that, "Oh, you're telling me it's all in my head." Well, it's in your brain, which sits in your head. But it's not in your head necessarily, right?

[01:46:44] DR. FOX: Right. You're not making it up.

[01:46:45] SCOTT: Yeah. And so, the limbic system piece could be mental, emotional. But it many times is much more very physically triggered. And then I want to kind of shift into the mental emotional trauma, those abuses and those types of things, which I kind of separate from the limbic system because I think there is some overlap but I think there's also some differences.

Does that mental, emotional trauma play a significant role in chronic illness in your patients? And do you find that the timing of a trauma maybe correlates with when they had a significant change in their level of health? And then what are some of the tools – maybe a little different from limbic system. What are some of the tools that you might think about for dealing with more of those deeper mental, emotional traumas and conflicts?

[01:47:32] DR. FOX: Okay. You're talking life trauma. Not so much the trauma of the disease itself. That kind of thing, right? Yeah. I mean, I am a huge fan of EMDR for trauma. I would try to get them into a therapist that does EMDR, brain spotting, a variety of things so that they can kind of pick the one that works best for them. But, yeah. I mean, that has to get dealt with especially if it was around the same time as they got sick.

[01:48:00] SCOTT: Any thoughts around tools like ketamine or psilocybin? Or any experience with those?

[01:48:04] DR. FOX: Oh, sure. We use ketamine for – therapeutic ketamine here – it's good for pain. It's good for depression. For some people, anxiety. It tends to be really good on the people that have dissociativeness and derealization. And can be really good for chronic pain and nervous system stuff as well. Yeah, therapy with IV ketamine can be pretty powerful for healing trauma. And then I use the nasal spray as well, the ketamine nasal spray and the troches for some of my patients. I live in Boulder. There there's lots of people doing plant medicine of all kinds. And sure, I think there's a great role for that especially for trauma and healing.

[01:48:51] SCOTT: If people are interested in working with you and your office, how can they learn more about your practice? Are you taking new patients?

[01:48:58] DR. FOX: I am booked out for a little while. But taking new patients. And you can go on my website, BoulderHolistic.com.

[01:49:06] SCOTT: And my last question is the same for every guest, and that is what are some of the key things that you do on a daily basis in support of your own health?

[01:49:13] DR. FOX: I do a lot of detox. And these days, a lot of immune support as well with the COVID. And I do a lot of methylation support. I do NAD Platinum. And then I do it with – Thorne makes Collagen Plus, which has nicotinamide riboside. And for some reason, the two together, it's like, "Bing!" I just feel – Like, I can feel it. It's lovely. I do those.

And then I do binders. Not every day. Maybe a couple times a week just because the world is toxic. And I do a lot of probiotics, I believe, in the microbiome. And then modulation. And I have a history of sleep stuff. I take a lot of natural stuff before bed as well.

[01:49:56] SCOTT: Excellent. Excellent. This has been such a treasure trove of wonderful information. I know that many people are going to benefit from listening to this conversation. I just want to thank you for spending a couple hours with us. But really thank you for the work that you do, for all of the great things that you're digging into and the solutions that you're finding for your patients. And just really honor you and appreciate you. Thank you so much for being here, Dr. Fox.

[01:50:20] DR. FOX: Oh, thank you. Thanks for having me. And I'm so happy you exist out there in the world.

[01:50:26] SCOTT: Thank you.


[01:50:27] SCOTT: To learn more about today's guest, visit boulderholistic.com. That's BoulderHolistic.com. BoulderHolistic.com.

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