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In this episode, you will learn the role of Toxoplasmosis in chronic illness and approaches for addressing it.

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About My Guest

My guest for this episode is Dr. Eboni Cornish.   Eboni Cornish, MD, a highly regarded  physician, provides integrative medicine services to a diverse global patient community.  Currently serving as the Functional Medicine Director of the Amen Clinic East Coast Division, she specializes in autoimmune diseases, Lyme disease, environmental toxicity, gut imbalances, neurology and various other chronic conditions.  Employing a holistic approach, Dr. Cornish identifies the root causes of health issues within the body’s biological systems, offering comprehensive treatment to adults and children. Her treatment philosophy is integrative and evidence-based.  Within Amen Clinics, Dr. Cornish has been instrumental in developing the Neuroinflammatory Intensive program—a two-week inpatient initiative addressing neurological complications arising from chronic infectious diseases, Lyme disease, mold illness, and other chronic inflammatory conditions including SPECT imaging.  Dr. Cornish’s educational journey includes earning honors at Brown University for her undergraduate studies and obtaining her medical degree from Brown University Medical School. She further refined her skills through a family medicine residency at Georgetown University.  As a Howard Hughes Medical Fellow, Dr. Cornish conducted translational research at the National Human Genome Research Institute NIH, working under Francis Collins, MD, PhD.   She currently serves as the Treasurer of the board for the International Lyme and Associated Diseases Society and a fellow of the Institute of Functional Medicine. 

Key Takeaways

  • What symptoms present in those with Toxoplasmosis?
  • What conditions might Toxoplasma contribute to?
  • How prevalent is Toxoplasma?
  • How do people acquire Toxoplasma?
  • What role do cats play in the transmission of Toxoplasma?
  • Can Toxoplasma be transmitted by ticks?
  • What are the best methods for testing for Toxoplasma?
  • What is observed in these patients using SPECT scans?
  • Does mold exposure potentially make Toxoplasma worse?
  • Can Toxoplasma be a trigger for mast cells?
  • How important is immune modulation as part of a treatment protocol?
  • What pharmaceutical and natural options have been most helpful for treating those with Toxoplasma?
  • Is there a place for homeopathy or frequency medicine?
  • What is the connection between Toxoplasma and calcification?
  • How important is limbic system retraining in these patients?

Connect With My Guest

http://AmenClinics.com

Interview Date

February 23, 2024

Transcript

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

[INTRODUCTION]

[00:00:02] ANNOUNCER: Welcome to BetterHealthGuy Blogcasts. Empowering your better health. And now here's Scott, your BetterHealthGuy. 

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 197 of the BetterHealthGuy Blogcasts Series. Today's guest is Dr. Eboni Cornish. And the topic of the show is Toxoplasmosis. Dr. Eboni Cornish is a highly regarded physician and provides integrative medicine services to a diverse global patient community. Currently serving as the Functional Medicine Director of the Amen Clinic East Coast Division, she specializes in autoimmune diseases, Lyme disease, environmental toxicity, gut imbalances, neurology and various other chronic conditions. 

Employing a holistic approach, Dr. Cornish identifies the root causes of health issues within the body's biological systems offering comprehensive treatment to adults and children. Her treatment philosophy is integrative and evidence-based. Within Amen Clinics, Dr. Cornish has been instrumental in developing the Neuroinflammatory Intensive Program, a two-week inpatient initiative addressing neurological complications arising from chronic infectious diseases, Lyme disease, mold illness and other chronic inflammatory conditions, including SPECT imaging.

Dr. Cornish's educational journey includes earning honors at Brown University for her undergraduate studies and obtaining her medical degree from Brown University Medical School. She further refined her skills through a family medicine residency at Georgetown University. 

As a Howard Hughes Medical fellow, Dr. Cornish conducted translational research at the National Human Genome Research Institute NIH working under Francis Collins. She currently serves as the Treasurer of the Board for the International Lyme and Associated Diseases Society and a fellow of The Institute of Functional Medicine.

And now my interview with Dr. Eboni Cornish.

[INTERVIEW]

[00:02:25] SCOTT: I have been wanting to do a show on Toxoplasmosis for quite some time. And now, thanks to Dr. Eboni Cornish. Today is that day. We also had an excellent talk on Morgellons back in episode 112 if you'd like to check that out. Thanks so much for being here, Dr. Cornish. 

[00:02:41] DR. CORNISH: Thank you so much, Scott, for inviting me. I always look forward to talking to you.

[00:02:45] SCOTT: Talk to us about what you see clinically in your patients with Toxoplasmosis, the condition caused by Toxoplasma gondii. My observation over the years has been that people that have Lyme disease but also maybe have Toxoplasma often seem to be more chronically ill. Some of them more significantly ill than those without Toxoplasmosis. What symptoms do you observe in patients with Toxoplasma? And are the symptoms more physical or more psychological in presentation? 

[00:03:19] DR. CORNISH: For my patient panel, I have quite a few patients. I've tests for regularly on LabCorp for any of my patients who present with symptoms or a previous diagnosis, vector-borne illness or chronic infections. It's kind of a standard test in my panel now because I find it's missed so often. But the thing is, Scott, Toxoplasmosis, you don't have to have symptoms at all consistent with this parasite. It ranges. 

I have some patients who may have just the regular brain fog, joint pain, some cognitive issues that are mild who might be coming to me to get worked up for chronic neuroinflammation. And then I test them for Toxoplasmosis, and they're positive. Or the other patient might be someone who's been treated by 9, 10 doctors. Been suffering from really debilitating chronic vector-borne disease with severe symptoms. And then that is what is the missing link. I find it more of doing my detective work than having that classical clinical presentation. Because it does vary widely from patient to patient.

[00:04:34] SCOTT: Some of the things that I've read that can happen with Toxoplasma are hallucination, sleep issues, mood swings, irritability, impulsiveness OCD, paranoia, unusual depression, panic attacks, ADD, ADHD, rage, depression, substance abuse. It sounds like a lot of those are somewhat psychological that maybe people would perceive some of those symptoms as more mental/emotional when, in fact, they do have an underlying microbial trigger. Would you agree that, in many cases, there are some of these mental/emotional seeming symptoms? 

[00:05:13] DR. CORNISH: I definitely agree with that. I would say about 60% of my patients, because I work at the Amen Clinic, and we do focus on brain SPECT imaging and integrative psychiatry, a lot of my referrals who have some of those debilitating, chronic, neuropsychiatric symptoms can have this underlying infection. Especially those patients who have kind of severe schizophrenia. Because that's what the literature shows, a lot of patients have schizophrenia. 

I'll never forget, that was my first Toxoplasmosis patient who presented who had schizophrenia and had been on like eight different meds and had been hospitalized numerous times. And it was unfortunate. Because it was just – okay. And he was 20 years old, Scott. And when we did his Toxoplasmosis testing, his IgM as well as IgG were positive. 

When I'm thinking about neuropsychiatric manifestations that are resistant but also in combination with brain scan imaging, if I do have that access, that's more what we call inflammatory or toxic. I definitely put vector-borne illness and Toxoplasmosis very high on my list. 

[00:06:28] SCOTT: You mentioned that you've seen this so often you now just test for it very commonly. Are there any clues that might lead you to think about testing for Toxoplasma or even other parasitic infections in a patient? When do you clinically start thinking about this possibility? Are there certain things maybe in their history or how they're presenting that lead you to think, "Oh, this is high on my list of things to rule out?" 

[00:06:51] DR. CORNISH: Most commonly, those cats. Right? Cats, they're not my favorite. Sorry, cat people. Because they carry both Bartonella in Cat Scratch as well as Toxoplasma. Pets is always one of my questions. 

Also, patients who I ask a lot about diet. Because Toxoplasmosis is transmitted a lot in pork. Those patients who have a lot of pork or beef in their diet. Those patients, as I alluded to earlier, who have those neuropsychiatric symptoms that just don't get better or they're treatment-resistant. Or maybe even just on numerous meds and not adequately contained with their mood. I'll test them for that as well.

And then some patients, some would think of travel, especially because I see so many different parasitic infections, Toxoplasma is just one of many. You always ask about travel. You always ask about lifestyle. Because I'll see that quite a bit. As well as pets, diet. 

And then because Toxoplasma is so prevalent and severe in those who are immunocompromised, you worry about that as well. Those who you test their immunity and they have more of a compromised state, you put that on the list too. And then kids with visual issues. Because that's one of the things we're screened for when we're pregnant. It's the T in what we call TORCH infections is Toxoplasmosis. We routinely are screened for it. When I see children and visual issues or things like that, I think of Toxoplasma as well.

[00:08:34] SCOTT: You mentioned schizophrenia being one condition where you might think about exploring Toxoplasma. What are some other conditions? Can it contribute to neurologic or neurodegenerative conditions like maybe Alzheimer's, or Parkinson's, or even a contribution to ALS, for example? 

[00:08:53] DR. CORNISH: You know, it's interesting. Because it is so neuroinflammatory, at least the patients that I have seen, right? A lot of frontal temporal dementia has been associated with my Toxoplasmosis patients. A lot of problems with executive functioning. 

I have seen one case, which was wonderful and very interesting. Because I think all of this is so cool. They had been diagnosed with Parkinson's. And they were found to have both IgM in Toxoplasmosis and Babesia FISH positive simultaneously. There's definitely a contributing factor from this parasite, which is intracellular, to those neurodegenerative diseases. Parkinsonian features. 

I've had patients who've been misdiagnosed with multiple sclerosis. And Toxoplasmosis has been a part of their symptom complex. And, definitely, lack of executive function, in temporal lobe dysfunction, frontal lobe. Lack of that, which can lead to more of a dementia DATE, where you do lose some of your ADLs. It's very bad. It's very severe. And it crosses the blood-brain barrier.

[00:10:09] SCOTT: Yeah. There was another famous person this week that was diagnosed with frontal temporal dementia. You wonder if they were to get to someone like you, How often might we find some of these things? I suspect it would be fairly common.

[00:10:23] DR. CORNISH: Definitely. Isn't it's so unfortunate that it's missed in these cases? Because you always ask, especially when they're younger, "What's the ideology?" I get patients who – and that's the beauty of knowing neurological disease, especially Toxoplasmosis, parasites, vector-borne illnesses. Because it can be the root cause of neuroinflammation. And then it gets to the point where you're like, "Oh, man. I wish they would have got tested. I wish I would have caught it." Because it can lead to a lot of these symptoms complex. And it's unfortunate when people miss chronic infections. It's so unfortunate.

[00:11:00] SCOTT: Yeah. And I wish more people were looking at parasites. My mentors in this realm have primarily been Dr. Dietrich Klinghardt and Dr. Simon Yu. And they place a lot of emphasis on parasites. And then there are other mentors of mine that I think are also brilliant but that don't really give a lot of consideration to parasites in general as contributors to chronic illness. 

And so, I think sometimes this idea that, well, if we haven't been out of the US, we're not going to have parasites. I mean, I think we know that's at this point somewhat laughable in my thought process at least.

[00:11:35] DR. CORNISH: I agree with you. And it's so funny you mentioned Simon Yu, who I learned a lot about parasites from. And he taught me a lot about parasites in the oral cavity and foreign dental materials. And just looking at the helminths, and the liver flukes, and Toxoplasmosis in these cases. Because it is so common. 

I would say the majority of us probably have some sort of parasitic involvement in our microbiome, right? But it's just you have to understand what patients are going to be more susceptible to systemic parasitic involvement versus others. And I'm always telling colleagues and patients that parasites are a lot of times the missing link. It's not something you'll see visual. People think of that. But it also takes a lot of work to treat it. 

I thought when I got into Lyme 12 years ago, I was like, "Oh, this is the hardest thing I've ever done. Vector-borne diseases. Oh, gosh." And then it became, "Oh, my God. I hate mold, and yeast, and that. This is so hard." And then you start looking, and then you're looking, and then you're like, "Oops. Now I opened the can of worms or parasites." And that's completely changed my practice, right? Because they can be that key feature in so many people. 

I mean, I can't tell you how many people have been to other – got really good diagnostic work workups. I mean, wonderful workups. And it's like, "Oops. Parasites missing." And I think it's because of the lack of testing we have for a lot of these parasites including that good testing for Toxoplasmosis among others that caused that problem. 

[00:13:15] SCOTT: Let's talk a little bit about the prevalence of Toxoplasma. Is it common? Is it rare? Is it more common in certain parts of the world than others? And then, in your patient population, approximately of those that you test, approximately how often would you say you do find confirmation of Toxoplasma? 

[00:13:34] DR. CORNISH: It's so common. It's more than 40 million people in the US have this. And it's the most commonly, even from the CDC, misdiagnosed parasite out there. It's just prevalent. And that's why I was alluding to it earlier because it's important for listeners to understand that you can have a range of symptoms from being asymptomatic to having these debilitating neurodegenerative states as we're referring to. It ranges across the board.

And in my patient practice, I can't quantify but I know it's a lot of them. Especially when I first started screening in my resistant patients who I was treating for vector-borne, for mold, for tick bites, for everything, environmental toxins. And they just were still stuck. They were still quite there. Then I started transitioning a lot more into looking at parasites. It's very common.

[00:14:34] SCOTT: Toxoplasma is a protozoan parasite as compared to worms, or helminths, or nematodes, this is a very small protozoan organism, can be a key contributor to chronic illness. Why do you think we don't hear more about this? Do you think that conventional allopathic medicine does give it the attention that it rightfully deserves or needs? And then even in the functional and integrative world, it seems like it's also somewhat overlooked. that maybe it's downplayed or not really explored. Any thoughts on why we don't hear more about or look more for Toxoplasma? 

[00:15:10] DR. CORNISH: In general, I think that when you do hear about Toxoplasmosis, it's more focused in the allopathic to HIV. Or those who – or AIDS or those who have really compromised immunity. And because it's so common, the thought process – even some of my colleagues is like, "Well, people will have it and they'll be okay." You know? Why even worry about it? They're fine. They're asymptomatic. Leave it alone. Kind of the same way some people think about chronic vector-borne diseases, Lyme and coinfections, "Oh, we're not going to test about it. People –" and then they come and then they progress to a more critical state. 

And I also think functional medicine, it's tough. Because I'll tell you something. When it comes to the testing, there's the LabCorp or Quest where you can look at antibodies, right? And you can look at IgG, IgM. And you can also look at PCR. Well, I rarely get a PCR test. And I'm lucky if I find an IgM test. You get a lot of IgGs. And I know there are other diagnostic labs like Galaxy that looks at Toxoplasmosis. Vibrant Labs is looking more at Toxoplasmosis. There are other companies out there. But it's just not a lot of quality testing for it. And in the past, it was really difficult to get commercial treatment for it with Daraprim. But I am like the biggest Toxoplasma cheerleader out there about testing for this organism. 

[00:16:45] SCOTT: Let's talk about how people acquire Toxoplasma. Can it be passed from person to person? Is it transmitted potentially by vectors like ticks? If a pregnant mom has Toxoplasma, can that then be transmitted to the fetus congenitally? How are we acquiring Toxoplasma? 

[00:17:06] DR. CORNISH: All of the above. Let's talk about it. With cats and cat litter, stool and cats, you can transmit it from pork and beef. It can be transmitted also across the placenta. You're absolutely right. And that's why we screened for it because it can cause a very serious neurological complication and visual problems in the infant as well. 

Blood transfusions have been associated with transmission of Toxoplasmosis. And then it was interesting because I was preparing for a talk on Toxoplasmosis. I said, "Let's see if it's in tick." And sure enough, I found this paper out of Europe in 1989 showing that Toxoplasmosis could be transmitted by tick-borne vector. And I was, "Oh, man. Here we go. We got another one we should be looking at when we're thinking of vector-borne disease complex. We should put that on the list." But it's very common and easy to be transmitted through those sources.

[00:18:14] SCOTT: And it's interesting too. Because things that we think of as healthy, like food, vegetables, water, my understanding is we can acquire Toxoplasma through those as well. And I read in one place that it's a leading cause of death from food-borne illness, which I really had never thought of. Do you think that food and water are sources where we commonly acquire Toxoplasma as well? 

[00:18:39] DR. CORNISH: Yeah. Because a lot of things – anything you eat can be contaminated not only with Toxoplasmosis but with any of these intracellular parasites, helminths, flukes. Poor hygiene can be transmitted – these organisms. But definitely the food and the water. And that's why I said screening for diet is very important. Because it's so easy transmittable from these things. 

[00:19:05] SCOTT: In cases of congenital transmission, you mentioned sometimes you see visual issues. How might that affect fetal neurodevelopment or neurodevelopment of the child and potentially contribute to conditions like autism or PANS, for example? 

[00:19:22] DR. CORNISH: They show in the literature that Toxoplasmosis has been associated with neurodegeneration in children. And I think if you think of the science behind it, this is an intracellular protozoa, and it's going to cross into the blood-brain border even if it's transmitted from mom to fetus. So, you already have that risk of neuroinflammation. And we know that anything that's potentially neuroinflammatory can cause your body to create these autoantibodies in the nervous system which – as you're referring to, PANS. A pediatric autoimmune process. That's definitely something that I've seen in these patients. 

Also, developmental delays. Looking for those milestones that might be delayed. I haven't seen a lot of literature on autism. But I've definitely seen a lot of information out there on developmental delays, kind of cognitive impairment in children, and the visual component. Which makes a lot of sense?

[00:20:30] SCOTT: At the risk of not being welcomed by the cat lovers, let's talk a little bit about cats as a source of infection.

[00:20:37] DR. CORNISH: I love you, guys.

[00:20:40] SCOTT: Should people be getting their cats tested if the exposure was the pet? Should the pet be treated? Can we clear Toxoplasma in a cat so that it's no longer a potential reservoir or source of ongoing exposure? What are your thoughts on how to manage that cat situation? Can a kitten be born with Toxoplasma? Is it only outdoor cats? Or can indoor cats be a source of exposure? I mean, we talked about kitty litter. I'm assuming it's indoor cats as well. But talk to us a little bit about how we manage this potential exposure from cats that can be sources of Toxoplasma, and as you mentioned, Bartonella and other infections as well.

[00:21:25] DR. CORNISH: Here's the good thing, my lovely cat lovers, is that you can't get Toxoplasmosis transmitted from your cat from their fur, right? That's good. Petting your cat, it's fine. But you do get a lot of transmission like I said from those cat litter boxes. And cats can transmit it in utero as well. 

We know that rodents can have Toxoplasmosis, birds, whenever they ingest one of those infected parasites, they'll be able to transmit this infection for at least two weeks after exposure or more. That is very important to understand. 

It's also known that the cats can definitely share that parasite, Toxoplasmosis, two weeks after exposure. It's transmitted, rodents, birds, cats. And it can cross the placenta. I would recommend, if you're someone who has chronic illness, you have neurological changes, you've been tested. All of my patients who have cats who've been tested positive for Toxoplasma, I have them get their pets checked. I have them go to the veterinarian. At least get their antibodies checked. Because, yes, they can be treated. But I would test if that was your symptom complex. Because you could be getting exposed at home and reinfected. 

[00:22:51] SCOTT: Let's talk a little bit about the life cycle of Toxoplasma. You just mentioned a few of the animals that can be impacted. Are there different hosts for the organism? Does it move from one type of animal to another? What's that lifecycle that keeps the Toxoplasma moving? 

[00:23:08] DR. CORNISH: And that's a great question. Definitely it can be transmitted from cats, but also from pigs, cows, birds, rodents. It was interesting. I had a patient. This was about four years ago. And I think this might have been an anomaly. But they had a hamster. A little boy. And he was tested positive for IgG. And his mom was a veterinarian. She was like, "I think I'm going to test this." I was like, "Okay." 

But then I start reading mice can transmit Toxoplasmosis gondii. You get transmitted. It transmits to the host. And then the host sheds the organism. It's like a circular life cycle that occurs. But there are several different hosts out there that can transmit this parasite. 

[00:23:56] SCOTT: And am I remembering correctly that the organism itself can change how the host behaves? For example, if a mouse has Toxoplasma, they then may not be scared of the cat. And the cat then eats the mouse and then can also acquire Toxoplasma. Or did I make that up? 

[00:24:17] DR. CORNISH: No. You didn't make that up. I mean, that's absolutely right. And I think if we go back to what we're talking about earlier about its ability to impact the mood, impact neuroinflammation, I mean who's to say? And we don't have evidence for that. But let's think of the logic. Who's to say that doesn't also happen in these other hosts, right? Maybe that could be a component to that response, which would make sense. That's why it could be one of the reasons why it's so prevalent as well.

[00:24:49] SCOTT: Where in the body does Toxoplasma live? I think when we hear parasites, most people think of that as being in the gastrointestinal tract. Even though many parasites can go other places in the body. Is Toxoplasma found in the gut? Is it more commonly found in the brain as you alluded to? Other body compartments or locations where it's kind of sequestered? Where does it tend to live in the body?

[00:25:13] DR. CORNISH: It lives in numerous different places. Definitely in the gut, in the central nervous system, cardiovascular. In some Toxoplasmosis, carditis. We talked a little bit about the eyes, right? Even though that we think that's one of those protected areas. But the fact that it can cause ocular difficulty, neuritis. And, again, I was like, "Oh, it can colonize the skin? What?" It can be found in numerous areas. 

And that's why I was saying earlier, the misconception when you say that word parasite is that visual stool look. And are you looking at for worms? Pinworms? Rope worms? Et cetera. But this is a cellular organism. Because it can basically exist anywhere, right? 

[00:26:02] SCOTT: We talked a little bit about blood transfusion. What do we think the risk is of acquiring Toxoplasma from a blood transfusion? Is it something that the blood banks are testing for and have good tests where they can screen and make sure that that blood isn't getting into the blood supply? And then any thoughts about organ transplantation? Is that a potential source for Toxoplasma exposure? 

[00:26:27] DR. CORNISH: It would seem as if, like we said, going back to just basic science, that it can be any of these intracellular erythrocytic organisms, protozoa, to be able to be transmitted, right? We just don't have great tests for Toxoplasmosis. And when they do test during – when they're doing blood screening, that is not one that I've seen on the list. Even though it's something we screen the mom for during pregnancy because that's the kind of what's repeated in the literature is cross-placenta. But you would think, "Well, okay. That's an organ, a uterus, right? Why wouldn't it be transmitted with others?" But it's not something commonly that, unfortunately, that's unfortunate, screened for. 

And the blood transfusion, transmission is very low from what they report. Which is debatable, right? But that's what they – they don't support a lot. They don't have a lot of evidence showing that right now.

[00:27:33] SCOTT: Talking a little bit about testing. You talked about IgM/IgG testing. I find unfortunately immunoglobulin-based testing for a lot of these chronic infections to be just really difficult, right? Many practitioners, if they saw an IgG for Toxoplasma, they would say, "Well, you had it in the past." But the fact that you're still chronically ill, that's unrelated, which may not always be the case. Do you use IgA testing at all? Is there a place for the Immunoblot or ELISA testing? And if someone has only IgG positivity but clinically fits the Toxoplasma picture, would you consider treating them based on IgG alone? 

[00:28:14] DR. CORNISH: Let's first start with that last question. I look at Toxoplasma IgG the same way I look at vector-borne diseases. Because we know that, in the literature – and this was published years ago in the 80s, that Toxoplasmosis can still be active in those who have that IgG presentation. And so, just like with vector-borne illnesses, I treat everyone with that. 

And it's so important to also understand that because some of the treatment, well, the mainstay published treatment, Daraprim, Pyrimethamine, for Toxoplasma is so expensive. It's like $1,000 a pill. However, there are charity pharmacies out there that will – if the provider sends a positive IgG test can potentially get it covered for that patient because that's a significant serology. 

IgG, 100% of the times with those clinical presentations, I will treat my patients even if it's herbal or prescription. Depending on how severe their symptomology is, they're always treated in my practice. 

PCR, IgA, I test for it. It's hit or miss. I rarely get a PCR positive. Like I said earlier, Galaxy Lab is like one of the only ones I know looking at doing more cellular staining and DNA for Toxoplasmosis. But there's really, like you said, with the testing, not a lot out there. But I would recommend that as we're clinicians, right? And we say that all the time. When we're treating these complex illnesses, you have to look at the patient clinically. And you have a patient who has these neurological symptoms, these neuros psychiatric symptoms. You've tried a lot of other things. 

I know a lot of your listeners treat complex illnesses. And you're treating them for Lyme, Morgellons, mold, mast cell, and they're still not there, you need to look at it. And if you see that IgG in that symptom complex and a person is still clinically presenting with neurological changes, I would definitely treat in some form. You do not want to ignore it. 

And it's also interesting, Scott, because another thing I do, because the testing is so limited, that I have found very helpful is that when I get the IgG serology, I track it. And a lot of times, not every time, but a lot, I would say in 70% of my patients, and I have over 200 Toxoplasma patients over the years, I find that there's a trend associated with their clinical presentation, which is unique. 

With Epstein-Barr testing, a lot of times we'll do the serology and we might get greater than 600 for the IgG or VCAs. That's just like the cut-off. And the same thing holds true for Toxoplasma IgG. Greater than 400 is the cut-off. And find myself tracking that and I see the labs fluctuate. All right? I see patients go into normal ranges. I see patients who might present after I put them on like a biofilm protocol or a heavy metal chelating agents and the number shoots back up. And that's consistent with biofilm. 

It's really cool that this is an organism even though it's a limited data that I have seen and I recommend testing for. And I recommend tracking it based on the symptom complex. But not only that, based on what you're giving the patient. Because I do see to it, which is great.

[00:32:04] SCOTT: Coming back to our discussion then on pregnancy. Would a child that had in utero transmission of Toxoplasma, would they even develop antibodies over time to the infection since it's really not something that they would perceive as foreign? Or would the antibodies from the mom be present at the time that the child is born? Can we test amniotic fluid, for example, for the potential of congenital transmission? How do we explore this in young people? 

[00:32:35] DR. CORNISH: That's an excellent question that I've been trying to answer. And I get different perspectives all the time. I've had patients who have had – moms who have had tested positive for Toxoplasmosis and then they've gotten pregnant, and it's shown up on their TORCH test. They have tested the amniotic fluid. They've tested cord blood. But then it's like, "Okay, it's debatable if it's kind of the mom's antibodies or that from the child." 

I think the best way to approach it is to do the testing. If there's a mother who has Toxoplasmosis, to do the cord testing, to do the amniotic fluid testing and see what it shows. And also, to check the child later if you're seeing those symptoms for antibodies. But it's mixed. And that’s the challenge. Toxoplasmosis, because it's so debilitating and it involves a neurological system, it's just so tough. Because we do not have the great evidence and testing to support what we see both clinically and what would make sense scientifically. 

And even like I said earlier looking at immunoglobulins. Who looks at immunoglobulin and checks levels? Conceptually, it just doesn't make sense. You got to understand molecular biology. It just doesn't make sense. And that's unfortunately most of the only things you have out there for this debilitating illness. And that makes it challenging both for the provider and the patient as well.

[00:34:13] SCOTT: Expanding on testing a little bit more, one of the things that you're known for at Amen clinics is SPECT scans. Are there certain patterns that are commonly observed on a SPECT in someone with Toxoplasma? And then do those patterns resolve with treatment and retesting? 

[00:34:31] DR. CORNISH: This is why I love looking at the brain. Because when I started getting at the SPECT scan imaging, it's kind of like, "Oh, I'm treating neurological X, neurological Y, neurologic –" and then I wasn't looking. You really won't know until you look. 

And for our listeners, what SPECT scan does, it's brain scan imaging. It looks at what part of the brain is working too much. What's not working enough? Where the blood flow needs assistance? And it can screen things like toxicity, chronic infections, mood instability, and the like. It tells you more what questions to ask in the anatomy of the brain. And more importantly, it tells you, in my world, kind of the way I got introduced to Amen Clinic was because they would send patients who had what we call toxic brain scans and didn't know the etiology. Because they function – most of the doctors in functional psychiatry. They would have patients, like a Toxoplasmosis patient or a Lyme patient, who would present with treatment-resistant mood instability and say, "Hey, what's going on with this scan?" 

In Toxoplasmosis, what you will see, you will see changes in activity. There's something that we call “scalloping” that you can see on the skull, which is an inflammatory process due to decreased activity of the brain. We also look at blood flow and activity. 

In some of the cases, which is really cool, you'll see what we call the deep limbic system in overdrive, and the basal ganglia, which is part of that deep limbic system, which can keep you in that fight of flight. Keep you more anxious. And I see that a lot. Hyperactive in schizophrenia, and ADD, ADHD, and anxiety. All of which Toxoplasmosis and other neurological infections like vector-borne illnesses have been associated with.

And when you see that limbic system involvement, when you see that what we call scalloping that's showing there's changes in both activity, a lot of times I might see what we call the frontal lobes or temporal lobes which give us that executive functioning be impaired as well with both activity. And you want to get those going. It's more of what we call an inflammatory presentation that you can see. And we call it hypoperfusion. Meaning not enough blood getting where it needs to go. We call it the limbic system or overactivity. Too much activity in certain places. 

And when it comes to mast cell activation, I see a lot of that with Toxoplasmosis. And when I was doing some digging, I found that there is a high amount of mast cells located in the basal ganglia. Just about when I get brain scans, a majority of my Toxoplasma patients have hyperactivity in the basal ganglia region. Just like a lot of my PANS kids. Some of my Lyme patients. But that's definitely an area of interest for me is looking at neurological involvement of infections like Toxoplasmosis and others on the basal ganglia. You do see specific patterns there.

[00:37:59] SCOTT: And when you then treat for Toxoplasma and do another SPECT scan, do you often then see resolution of those patterns that you observed previously? 

[00:38:11] DR. CORNISH: Yeah. We see improvement. But the coolest thing is that we're able to see kind of herxing, right? I've seen patients who want to repeat SPECT scans because they feel like I'm taking the treatment and I'm getting worse. And so, out of curiosity, they want to know what's happening. And we know typically when people take treatment for certain infections like Lyme disease, like Toxoplasmosis, you can have that pre-radical inflammatory Herxheimer response where you feel worse before you feel better. 

And I know I had a patient where I tested their – did their brain scan again right in the middle of this flare and it was lit up what we call like a Christmas tree. I mean, they had this inflammatory process. Hyperactivity everywhere. Low blood flow. It was just amazing. And that was associated with the Herxheimer. And then you can have improvement. 

Now the thing about the SPECT scan is that we're looking for improvement of both inflammation activity and blood flow perfusion. And I do see that when I'm doing a great job to the best of my ability to get some patients better. We do look at re-SPECT is what we call it. And we see those positive changes. You can see Herxheimer response. And you can see positive changes, which is really amazing. 

[00:39:38] SCOTT: I like that. So, R-E-S-P-E-C-T. 

[00:39:41] DR. CORNISH: there you go. Oh, I'm going to tell them that. I'm going to tell Dr. Amen. Like, "Hey, this –" 

[00:39:49] SCOTT: Are there some cases of Toxoplasma that really are acute that the body, the immune system can fully clear and eradicate? Or do all cases of Toxoplasma become chronic? Like some maybe suggest with Bartonella. Once we have it, maybe we continue to have it. Once we think of it as chronic, can we then fully resolve it? Or is it something like Lyme and coinfections where it may require some ongoing attention over time, or some pulsed interventions, or some long-term therapy to really support the regulation of the immune system as well as to make sure that that organism itself doesn't continue to kind of overgrow? 

[00:40:33] DR. CORNISH: And that's the interesting thing about these protozoa, these intracellular organisms. One part is that, when you get this exposure, their life cycle, if you're able to catch it early enough. I am not sure about complete eradication. I don't think I've haven't seen that. I do think that this process, people do better at getting this in remission if you catch it earlier. 

But, unfortunately, with the patient panel that I have, I tend to see patients who are chronically ill, who have been to other providers. It's very rare that I'll catch acute or IgM-positive Toxoplasmosis patient. They're usually – out of the patients I mentioned earlier, IgG positivity. 

And I find that maintenance may be important even if it's like the person gets better, their symptoms are improving. You want to start weaning off some of the harsher antimicrobials and put them on more herbals that I feel like a maintenance protocol, especially for this organism and parasites in general is very important. All of my patients, I have them on some sort of prevention and maintenance. 

Because I feel like with chronic disease in general, when your body is under stress, or you get another infection, or you get another exposure, something else, these chronic diseases, these parasites, they can flare back up. The thing is more putting it in remission versus kind of a curative state. And your immune system is brilliant. 

A lot of my Toxoplasmosis patients, some don't get in remission and they're fine. Just same thing with my vector-borne illness patient. But you still monitor them because these things can be chronic. And then I'll see people reactivate later. It's about kind of that maintenance stage with most of these chronic illnesses that your speakers and guests talk about. Because you have excellent people on here who treat – who are in the trenches, man, and who are treating these complex cases.

[00:42:47] SCOTT: With other parasites, we commonly think of maybe initially treating consistently daily for a reasonable period of time and then shifting to maybe monthly treatment. For example, around the full moon, the new moon. Something like that. Or people maybe are treating one week out of the month, or one month out of the quarter, or something like that. Is there kind of a rhythm that you then would get into from a Toxoplasma perspective so they're not necessarily needing to treat every day? But that we still kind of make sure that we're providing enough support to keep things in remission. 

[00:43:21] DR. CORNISH: I'm so happy you mentioned the moon cycles. Because I'll tell you, and I have to be honest, when I first heard about that, I was like, " that's fu-fu." And that's a functional doctor saying that. A Lyme specialist. How dare I think that? And I treat all these complex cases. What's wrong with me? but anyway, I make sure that any of my patients who have parasitic infections have been diagnosed. That full moon cycle is covered. Even if it's maintenance. They're taking something during that full moon cycle. 

I do transition. But once again, like I told you, I'm more clinical. If I feel like someone's symptoms are better, their immune system is more robust, they're doing all the right things, they've went through their treatment, they're eating right, they're taking care of their lifestyle, they're not exposed to other things, their immune system is more robust. Those are the people that I might put on that kind of full-moon-only protocol where they're really aggressive with an herbal regimen during that time of the month. And then others might require that daily regimen. 

But the thing that's tough about these parasites, Scott, is that there's so many variables that cause difficulty with achieving remission, right? It's not just the bug itself. You ask yourself, "Well, what keeps it resistant?" Which is why parasites become such a challenge in some cases because they lay their eggs, they reactivate. It's this vicious life cycle. And it's more or less getting this into stability with your immunity. 

And I find that, even with Toxoplasma, that's the case. But definitely, with a lot of those worms and helminths, all of these we were mentioning earlier, you have to look at other things. You have to look at biofilm. You have to look at metals. You have to look at environmental toxins. Other things, you have to look at mold. Those things that can perpetuate disease, and compromise your immune system, and encourage that more resistant biofilm development. 

Because I can't tell you, a lot of my patients, I would say a lot of them who have parasitic involvement and even my Toxoplasmosis cases, we find that there's also a metal component or a mycotoxin component as well that's compromising. And if you think about it, they're immunocompromised, right? You look at all the other variables. Because this is usually most commonly the patients who are symptomatic are those who have a compromised immune system. 

[00:45:54] SCOTT: Perfect lead into my next question, which is we talked about the fact that Toxoplasma is more commonly an issue in someone that is immunosuppressed. Wondering if you find immunosuppression in people that are dealing with mold exposure, for example. Or even chronic Lyme disease and the resulting immune dysregulation that comes from that. Are those things, mold and chronic Lyme disease, enough to dysregulate the immune system to open the door for Toxoplasma? And if someone has mold exposure and is dealing with Toxoplasma, do we have to address the mold exposure to lessen that immune dysregulation? To bring more modulation, more tolerance, more regulation to the immune system? And then building on that, is Toxoplasma really ever the only contributor to a patient's chronic illness? Or is it generally in the backdrop of many other factors? 

[00:46:54] DR. CORNISH: You're always so great with your questioning, Scott. I love it.

[00:46:57] SCOTT: Neil Nathan tells me they get a little wordy. And I know sometimes they do. But I like to just – 

[00:47:00] DR. CORNISH: You’re like, okay, what part? But, no. They're always great. And I think it's important to share this. When we're thinking about complex chronic illness, and like you alluded to earlier, I'm treasurer of the International Lyme Associated Diseases Society, and we actually changed our mission statement to state just that. That we treat complex, chronic conditions. That's what these patients suffer from. I don't think it's ever just one thing. Because if it was just one thing, that's probably the person I haven't met. That's the person who has the robust immune system. And that one thing that they were exposed to, lucky enough, it's in remission in some cases, you know? 

But for a lot of these patients, when they come to our office, just like a lot of your guests, they suffer from so many things at once that are chronically like I like to think battling, beating up their immune system. And the analogy I tell my patients is almost like a whack-a-mole. That game where got the go first, you hit one thing and something else pops up. And you hit that and something else pops up. And so, it's kind of like when you do your detective work, the more you look for, the more you find. And then you have to treat.

With patients who have chronic parasites, also chronic Lyme disease, chronic Toxoplasmosis, it is very important that you look at the variables. I tell my patients. The way I phrase it is I have to find out why you're special. They're like, "What does that mean?" I said, "Well, you've had these illnesses. But what makes your symptom complex so resistant and so chronic?" And that's going to mean we're going to have to pull back those different layers to adequately get to the meat. To get through to the parasites. To get through to the Lyme. To get through to whatever bugs might be present. When I'm kind of thinking of a hierarchy, like a titrate or channel and get focused, right? Because it's so easy to take the patient and test for everything under the sun. 

I typically look at – first, before we even get into the mold, and the metals, and things that compromise their immune system, I start with the basics. How is your sleep? How is your hormones? How is your gut? Because if I can get that stable, get that body stable when I find other things, that treatment might work better. 

I work for the homeostasis first. I really kind of get that. Because I'm like, "Well, I can look for these chronic things." But if a person's not sleeping, or eating right, or constipated, or – you know, then it's going to be more of a challenge. I make sure I'm doing that. And you can simultaneously look for other things. 

And I find definitely the environment, like you alluded to. Water-damaged buildings, mycotoxin illness. That is such a barrier to healing in so many patients that suffer from these other chronic inflammatory illnesses. Because if you don't remove that barrier, it's kind of like almost – it's more challenging to get rid of other things, the infections. Most of the time I always – if I don't look for mycotoxin illness, I'm asking about it. That's a part of my screening. What kind of home do you live in? Have you been exposed to mold? Tested for mold? And then we do more details. I might have them do VCS testing or something to give me some indication if I should go down that road. Because like I said, the more you test for it, the more you'll find. 

And then I might also look at, like I said, other environmental things like metals and the like and try to look at treatment of that. And then getting down into the bugs. Because like we said, what makes you so special? What symptom complex is there? And a majority of my Toxoplasmosis patients have other issues. And maybe some of them might even have other chronic infections. 

And what I found now, which makes it even more fun for me being a detective, is that you layer on the viruses. Things like COVID-19 that we know in public can reactivate things like Epstein-Barr. You layer on those reactivated viruses that's also contributing to this chronic inflammatory process and you just really have to try to remove one layer at a time. And I think that's what gets tricky both for patients. Because you might get impatient, right? You're like, "Just treat this one thing." Like some of these people, "Just get Toxo out of me today." And it's like, "Well, wait. There are other barriers here. We have to find out what makes you special. You got to treat environment. You got to treat you. You got to treat the basics. You got to treat your –" and then we can go getting all into the weeds so that it gets better. 

Definitely multifactorial. And you definitely have to do your detective work and get organized. Because I know a lot of doctors who train with me. Because I'm a training doctor for ILADS. I'll train doctors. They'll see my Toxo patients, my Lyme patients. And you should see the look. When I finish an appointment, their eyes are like wide open, and mine probably are as well, as well as the patient. And it's like, "Well, you just have to take a moment. Think of the symptom complex of the patient and prioritize." Because you can't do it all at the same time. But definitely, if they're living in mold and their environment is toxic, then you have to treat that too. You have to. 

[00:52:50] SCOTT: How often would you say you see someone that has chronic Toxoplasma that does not also have mold and mycotoxin issues or other chronic vector-borne infections, Lyme and coinfections, or maybe now long COVID as well? Is it fairly common that one or more of those is often in the picture as well? 

[00:53:12] DR. CORNISH: Exactly. And that's why I was saying, they're multifactorial. Because Toxoplasmosis is typically most active clinically in those that have that compromised immunity. All right? There are going to be other things that are going to cause your immune system to be dysfunctional. A lot of the patients also have vector-borne illness, or mold, or, like you alluded to, viruses. And maybe even other systemic parasites that are causing this compromised immunity to occur.

[00:53:48] SCOTT: You mentioned mast cell activation syndrome. I tend to think of mast cells as being triggered by mold, by parasites, by EMF exposure. There's a lengthy list. I think in the last couple of years we have more awareness that Bartonella can be a trigger for mast cells as well. Do you think of Toxoplasma as being a primary trigger for mast cell activation as well? And do you work to treat or support the mast cell activation in your patients before you really start getting into more of the antimicrobial therapies? 

[00:54:24] DR. CORNISH: Yeah. Mast cell activation as more of a symptom complex due to underlying triggers. I look at it at as the M&Ms. Like the candy. When I think of mast cell activation, I think of mold, multiple infections, and multiple chemicals, you know? Because there are so many things that can lead to degranulation of these mast cells. And it's not like it's just histamine, right? It's so many other mediators that these mast cells produce. 

And I think a lot of times they get an unfair reputation, these mast cells. It's not their fault. They're part of our immune system. We need our mast cells to work. They're breaking down because of those triggers. And if something is inflammatory like Lyme, vector-borne illnesses, like yeast, like mold, like parasites, viruses, chemicals, those are going to lead to degranulation of those cells and cause the patient to be more inflamed and more symptomatic. 

I don't know if I would necessarily say a primary is Toxoplasmosis. I think of Toxoplasmosis, I think a cause of mast cell activation and that kind of M&M process is this Toxoplasmosis because of that triggering effect. And we know how debilitating and multi-systemic mast cell activation is. How it affects just about every system in our body. But because it is an immunocompromising illness and an inflammatory illness, it does trigger that mast cell degranulation in a lot of my patients. 

[00:56:06] SCOTT: And then do you find stabilizing the mast cells and reducing histamine is a key part of your Toxoplasma treatment approach? 

[00:56:14] DR. CORNISH: Definitely, it is. I always tell patients, “We're going to use some stabilization. We're going to use some quercetin, some bromelain, some H1, H2 receptor things in the mix." We're definitely going to do that. And that's true for just about all of my patients. Well, I would probably say 95% of my patients who have chronic debilitating illness. There's usually a histamine mast cell component, especially long COVID, and especially with parasites. It does require that I have a long arsenal of mast-cell-stabilizing agents. 

Some things I find, I try to kill you know two birds with one stone, especially with my Toxoplasmosis patients. Because as we discussed earlier, a lot of them have those neurological and neuropsychiatric symptoms. A lot of which can be anxiety. I might use things like Vistaril or something that's – hydroxyzine, that's more calming to anxiety but it's just a histamine blocker. 

Or they may have insomnia. Because we know parasites in general are more active first thing when you wake up and at night. A lot of parasite acidic involvement, I might use something like a Ketotifen at night to help them not only with their histamine response but giving them that sedative effect in the evening. 

Definitely, it's warranted. You need to calm that response. But more importantly, you're going to have to treat that trigger that's causing it in the first place. And that's what I think a lot of people miss. They're like, "Oh, I'm taking all my histamine things and I'm still reacting." I'm like, "But wait. Do you know what's triggering that?" And that's another reason why it's important to look at Toxoplasmosis especially when you're dealing with mast cell activation. Because you can be on a numerous amount of stabilization and still have breakthrough triggers. And then Toxoplasma's lurking in the weeds. And it needs to be addressed as well.

[00:58:17] SCOTT: I totally agree with that. I don't think personally that the mast cell activation is the core issue that makes people unwell. I know some brilliant people do think of it that way. To me, kind of using the analogy that Dr. Horowitz uses about the nails in the foot. If the mast cell activation is kind of the redness and swelling around the nail, well, we can put the arnica cream around the nail or we can pull the nail out and then put the arnica cream, right? We got to get the nails out and then the mast cell activation becomes less of an issue because the triggers, as you mentioned, are no longer there or at least better support.

When we think about treatment of Toxoplasma in general, how much of the treatment approach is antimicrobial versus treating the effects of the parasite? Such as reducing neuroinflammation or modulating the branches of the immune system. Looking at Th1, Th2, Th17, Treg, all of those things. At a high level, what are the main components of your treatment approach to Toxoplasma?

[00:59:25] DR. CORNISH: That's an excellent point. I'm always working on immunomodulating – immune support for my patients. I'm always using things like low-dose naltrexone, or SPM Active, or dietary restrictions, or things to remove inflammation in general to help optimize immunity. Gut support. That's important in my treatment of any chronic infection that we work on immune modulation. Because if we don't, the immune system is like a hair trigger, right? Then you're going to turn over. And next thing you know you're going to be dealing with autoimmune disease as well. I make sure that's a part of my foundation. And that should be for everyone who's treating these chronic conditions, that you build it up. You start at the basics and you build up accordingly. That's definitely happening. I'm definitely focusing on immunomodulation as we simultaneously treat that underlying infectious process. You have to look at what that infection has done. Because we're calling it chronic. What has it done? What has it caused? And what has it done to your immune system? And then treating the bug itself. 

And with Toxoplasmosis, as we stated, the treatment was not really commercially available. Like the Daraprim, it was just hard to get. But now, like I told you, you can get it now with most pharmacies. Some pharmacies are covering it with serology as well as a charity pharmacy. I find myself using – and even – this is what, Scott, most chronic illnesses a combination of the prescriptions and the herbals. Because I think you need both. And the immune support. It's like a trifecta that must occur if you want to get this immune system working so that it can get these diseases in remission status.

[01:01:19] SCOTT: Let's talk more about the pharmaceutical options for Toxoplasma. As you've talked about, one of the better known, maybe Daraprim or Pyrimethamine, which was in the news for a while with Martin Shkreli's company charging thousands of dollars for a single pill. Talk to us about Daraprim's place in your treatment of Toxoplasma. Is it always a key component? A key go-to in treating Toxoplasma? Or one of many things that are in your toolbox?

[01:01:47] DR. CORNISH: It is one of many things in my toolbox. And unfortunately, because like you said with that controversy and that unfortunate – oh, God. That's like gives me trauma thinking about it. Because I used to give Daraprim a lot and it was four bucks. And then all that happened and then now it's $1,000 a pill. But some patients don't qualify for charity payment. And they can't get coverage by insurance. 

Over the years, I've had to create so many alternative second and third-line protocols just because of lack of access. And then you also have to make sure you're checking labs for a patient. Daraprim is always used with folinic acid, leucovorin. And you want to make sure you're checking G6PD. 

I do have a few patients that have Toxoplasmosis and are deficient. That's usually something that's contraindicated. That G6PD and Daraprim, you have to be very careful. But it's an important part of my protocol. And it's an optimal part of my protocol. 

But at the same time, I've had some benefits with some of the second and third-line treatments. I've seen a lot of clinical benefits and I've had to be creative with things like Bactrim, or Mepron, clindamycin, ivermectin. And just being strategic in my approach. 

But on top of that, as we talked about, it's because there are other things going on simultaneously. I like to use both herbals and antibiotics if I have to because the whole you want to support the gut. You want to just abuse it. But it's required in a lot of cases, especially severe illnesses like Toxoplasmosis. But you can also kind of treat if that person has Babesiosis, or Bartonella, or Borrelia. You can try to choose some agents that can do both and treat both organisms simultaneously. And that's key. And then I also use a lot of herbal antiparasitic as well, which I think have some place with Toxoplasmosis and all parasitic infections.

[01:04:06] SCOTT: What is the general response to Daraprim? Do people have significant Herxheimer reactions? Do they generally just feel better while they're on it? What do you see in your patient population with Daraprim? 

[01:04:20] DR. CORNISH: Going back to our mast cell discussion, a lot of patients with these parasites, even when you're looking at eosinophilia and IgE elevations, that you can also see in mast cell, these patients can be sensitive. They've been through a lot of treatment. You do have to try to find that balance in a lot of my patients who have parasites. Because Daraprim is aggressive. And a lot of these prescription meds are aggressive. 

And in a person who has a high histamine burden or is already having a high inflammatory burden, you may in that case have to go very slowly because of the severity of the potential Herxheimer response. And I see that quite often. I would say in 50% of my patients. I've learned over the years that I have to be patient with myself and my treatment when I'm using more aggressive agents. Because a lot of these patients have other issues. 

And like you said, that whole nail-foot analogy, the histamine response is already elevated. Inflammatory response is elevated. In this case, I try to kind of baby step sometimes. I'll do like trial dosages. As far as the people who are successful enough to take the Daraprim, it can work. And it can work really well in those patients. 

But as I stated, in some cases, I do go very slowly. I might do once a week or once every other day. It depends on the case. And, definitely, with kids, I usually try to do more of a herbal approach or some of the other agents. Because I find that Daraprim really doesn't work well as far as tolerability from both a Herxheimer and GI standpoint in my pediatric population. That's not something I use for kids just in my practice. 

And then when you're using some of the other meds that cover it, like the Mepron, Atovaquone, that also covers Babesia, you go slowly with that. Or clindamycin. You'd be cautious. Because clindamycin is really harmful to the gut and can cause C. difficile. You make sure you're optimizing probiotics as well. 

It takes a unique approach. I used to say, this was by protocol and that was it. But I find that that doesn't work. It's not a one-stop shop for everyone. But people do get better. And like I said, I have some people who are just on herbals. It may take a little longer time. Because they can't tolerate prescriptions. They're just too sensitive. And it works as well.

[01:06:52] SCOTT: How long would the average patient be on Daraprim in terms of their course of treatment? And would you often times start with that as kind of the flagship tool for the treatment of Toxoplasma? Or would you sometimes start with weaker interventions and then use Daraprim later in a protocol, so that by the time they get there, the burden of Toxoplasma's already been reduced in hopes then of increasing tolerance to Daraprim? 

[01:07:21] DR. CORNISH: Usually, I have to wait to introduce Daraprim in the first place because of the insurance issues and needing prior authorization, which is the majority of the cases. I find myself just in general, it's mandatory that I start with a more gentle approach before I go to Daraprim just because that's what it – the time it takes. I'm not going to have a patient wait a month, or six weeks, or two weeks to start their treatment if we have that diagnosis and they're symptomatic. 

Ever since the change in price, I’ve had to start with more gentle agents, which as a result does exactly what you said. It can lower that Toxoplasmosis burden so that their tolerability is better. And sometimes I call it kind of like a desensitization. You start slow and then you build up. And I think that does improve tolerability to Daraprim.

Now not all of my patients require it. Because it does have complications, especially with the gut. But I think if you can use it, it is very helpful. But also, you can use things like Bactrim, Atovaquone, clindamycin, alternatives and herbals that I'm very passionate about to start with and as you pace them. Or even in lieu of Daraprim if you can't acquire it. People get better with different strategies.

[01:08:51] SCOTT: Probably one of my favorite tools in the treatment of Toxoplasma has been Alinia. And so, I'm curious if you use Alinia all in treating Toxoplasma. And then let's talk maybe a little more about some of the pharmaceutical medications. You've mentioned several of them. I know that from one of your prior presentations, you've also looked at itraconazole, for example, rifampin, doxycycline, dapsone, the macrolides like Biaxin and clarithromycin, for example. Are these having a direct effect on Toxoplasma? Or are they working on other things that are then helping the body to have more ability to respond to the presence of the Toxoplasma? How are some of these other medications – like itraconazole, for example? We usually think of that as antifungal. Used in people with mold illness if they have fungal colonization. Where does that fit in the treatment of Toxoplasma? 

[01:09:51] DR. CORNISH: Let's start with itraconazole. I've find that, like we said, a lot of my patients with Toxoplasma also have mold illness and candidiasis. Or different forms of yeast. I think it's kind of like a microcolony of multiple microbes that exist with Toxoplasma being just one of them. I have seen some benefits with a lot of different antifungals utilized simultaneously with this, with my Toxoplasma protocols. 

But as far as kind of the gold standard, some of the agents I'll use in my toolbox as I'm creating different protocols, definitely, Daraprim. I use a lot of Atovaquone, Bactrim. I do a lot of clindamycin. I've had to incorporate – not all at the same time, right? I don't want any listeners say, "Oh, my gosh. She uses 30 things." No. But you have to think about the persistent organism and other things that are there. So, Atovaquone, clindamycin, Bactrim, Daraprim, Alinia, Biltricide, Ivermectin. Those are like kind of the core anti-prescriptions that I might use. 

But do I also get benefits from the antifungals? The macrolides as well? Of course. And I think it's more because I'm also covering for other imbalances and other infections that exist in that individual. I wouldn't say those would be my first-line treatments. But I do think that they help as adjunctive therapy depending on how you design your protocol for that individual. Because it can cover some of the other things that exist. 

[01:11:46] SCOTT: And do you find that people respond well to Alinia when they're dealing with Toxoplasma? Or is that not one of your primary tools? 

[01:11:53] DR. CORNISH: I find that they do respond well. And it is one of my primary tools, especially if I can't get Daraprim coverage or a person can't tolerate Daraprim. I might use Atovaquone, clindamycin,, and Alinia. Kind of rotating protocol. It's definitely something that I incorporate and I have a lot of success with. It's sometimes also insurance problems with that as well. But it's definitely something to consider.

[01:12:23] SCOTT: Yeah. I'm a big fan. Very few pharmaceutical drugs that I really am a fan of. But Alinia is one of those. And I think in this context, we know it can be helpful for Borellia, for Babesia, for many parasites, for Toxoplasma. I think it's one of those also hitting multiple birds with one stone as you mentioned earlier. 

We've heard a lot in the last couple of years about Dapsone from Dr. Richard Horowitz's work. Do we think that Dapsone has some direct impact on Toxoplasma? Or is it more focused on the vector-borne infections? 

[01:12:57] DR. CORNISH: I haven't had as much success as I thought with Dapsone in my Toxoplasmosis patients. Now some of my other populations, like my Morgellons patients, my patients who have Bartonella, Borrelia, even some of the Babesia protocols I use definitely have had some benefits. I've seen a lot of benefits with that. But not as much with our patients there. And I don't know – I wouldn't use the Daraprim if someone's getting treated for persistent infections, Borrelia, Bartonella, I would not use Daraprim and Dapsone simultaneously due to drug interactions. And also their ability to decrease folinic acid, which is why you use Leucovorin. I wouldn't use those together. But I haven't seen as much success with that for Toxoplasmosis.

[01:13:52] SCOTT: In one of your talks, you mentioned antihelminthics in treating Toxoplasma. We're thinking about things that we'd normally be considering for larger parasites. Worms, for example. But do they also have antiprotozoal properties? What are some of the antiparasitics that we think about? For example, you've mentioned Ivermectin, Alinia. I don't think we talked about albendazole, for example. Biltricide, pyrantel pamoate, maybe others. What of the antiparasitics have worked best in your Toxoplasma patients? 

[01:14:26] DR. CORNISH: Definitely, Ivermectin and Alinia. They're the top two that I see quite often. Tried and true. Biltricide, I've been using more probably in the last six months or so because I see it work so well with some of the other helminths. And the more I do stool test and talk to people, I'm like, "Oh, gosh. I got to make sure I've got that on board as well." 

And like we say, the more you look, the more you find. I think that that's had benefit. But I think the top two for your listeners, Alinia and Ivermectin, I've had the most success. But I have used the others as well. 

[01:15:04] SCOTT: The Ivermectin is the other one of my favorite medications that's available out there.

[01:15:11] DR. CORNISH: I think those are really good. I do the antibiotics. But I find myself straying away more or trying to get that get in, get out mentality, right? Because you do need it, right? We have the evidence. And especially some cases, they are helpful if you can tolerate it. But when you layer beautiful herbals with it or kind of get in, get out. That's why get in with antibiotics, get out. And then put the herbals on after you've decreased the pathogen a little, people do really well. Or homeopathy. I'm a big fan of that as well. It takes more than one thing. You don't want to abuse the gut too long. But some, you do need it in a lot of cases.

[01:15:52] SCOTT: That's another great segue. Let's talk about herbs and homeopathy. What about some of the natural options like Byron White has one called A-T. There's formulas from Beyond Balance. Other natural herbal formulations. What are some of the things that you might think about in the herbal realm for Toxoplasma? I've read about in research papers things like ginger, and wormwood, or artemisia, berberine, myrrh, black walnut, oregano, garlic. Even some essential oils have been discussed. What are some of the Tools in that realm that you find the most clinically helpful? 

[01:16:30] DR. CORNISH: Definitely oregano oil. That ADP, that's one of the things by Biotics Research that I love, that I kind of want to have on my list. And then artemisinin. I use Artemisinin SOD by Research Nutritionals for my Toxoplasma patients. We're looking in – and sometimes I have had just because they may have had babesiosis as well, patients on cryptolepis. Not a lot of literature on it. But I have had patients on that. A lot of thyme. A lot of wormwood. A lot of berberine. 

I have a core group. And I do like PARAZOMIN. Beyond Balance. That's a great agent. And then another thing in my really big arsenal is I really like the CellCore Para 1, 2, 3, and 4. That's a great agent I've used quite a bit in a lot of my parasitic patients that I find helpful with that. Mimosa pudica, the thyme, wormwood. And they are pretty well tolerated. I have a long toolbox that patients can benefit from. But it definitely is – that's the one thing. We get a bad rep in functional medicine and be in line. Especially that we just throw the kitchen sink. 

When I'm talking to people, I always say these are my toolbox. But, typically, I'm using as minimal interventions as possible to get you better. You don't want to have supplements – 30. I have patients who come. I'm like, "Oh, my God. You're on 15, 20 things. Who did that? You?" "Oh, I did it? Sorry." All my patients are like, "Dr. Cornish, I have a pharmacy in my house." They get things from doctors. And it's just like so long. 

I always try to find a toolbox and I have the common things I like. And I try to make sure they overlap with other things I'm treating to do the best job I can at minimizing the pills and supplements they're taking. So, that's why when I was listing my arsenal, yes, there are a lot of tools in there. But I do have an order I try to approach so that I'm not throwing 10, 12 things at one time. Because then you don't know the benefits. 

[01:18:48] SCOTT: You mentioned the Research Nutritionals Artemisinin SOD product. When we're talking about wormwood and artemisia, are you generally moving more towards the artemisinin isolate itself? Or in some cases, are you using broad spectrum, full spectrum artemisia? The whole herb? 

[01:19:06] DR. CORNISH: With a lot of patients who are very sensitive, I find myself having to use one herb at a time to really see a response. Because if not, the Herxhimer can be very severe. I do like starting kind of with single herbals to see if I gain some traction. That's where the Artemisinin SOD comes in. But then once I find their tolerance is good, then I might layer more of the holistic, comprehensive herbals on there. 

But I've just found through the years seeing sicker patients that trying to give them something that has six, seven ingredients, they might not accept it or tolerate it. They may have a die-off reaction. And it's frustrating because you have to stop therapy and work more on slow approach. Single herbals I find to start with things like Toxoplasmosis is helpful. And then building as you go, as you find a patient is tolerating it.

[01:20:10] SCOTT: In the Lyme conversation, the Bartonella conversation, we've seen more and more use of methylene blue in the treatment of Bartonella specifically over the past several years since that came out in one of the research papers. Is there a place for methylene blue in the treatment of Toxoplasma? 

[01:20:27] DR. CORNISH: There is actually. But the caveat, like I said, is that I'm treating other things as well. And I see a lot of Toxoplasmosis in Bartonella. And I'm starting to question myself, "Is it the catty litter, kitty litter connection between the two?" Or just the vector-borne disease connection? 

I'll have a lot of my patients who might be on methylene blue for Bartonella. But it's not of my primary go-tos for Toxoplasmosis if that's my primary organism. But I have seen benefit when treating both.

[01:21:03] SCOTT: There are homeopathic products available such as the Toxoplasmosis Nosode from Professional Formulas. There's a number of Toxo remedies from DesBio, such as their Series Kits and their TOXO:HOMO or homochord product. Are you using homeopathics in combination either with pharmaceuticals or with herbals in the treatment of Toxoplasmosis? And do you find that homeopathics are important in treatment approaches? 

[01:21:30] DR. CORNISH: I think, bottom line, homeopathy is very important in treatment of these complex illnesses. I have had – I do. I love it. I have had some benefits over the years, not a lot, with the DesBio Toxoplasma Protocol. I mean, homeopathy is beautiful. It's usually safer. In some cases, it's not as provoking as some of the more aggressive prescriptions. Good for the gut. Good for overall well-being. I am a big fan of incorporating that in my therapies. I really am. And some of my patients, that's all they can tolerate is from a homeopathic treatment option. They can't tolerate the plants, the herbals, or the prescription. I love them.

[01:22:17] SCOTT: And one of the things that I personally like about the homeopathics that are available for Toxoplasma is after maybe you've treated with pharmaceuticals and herbals, and you're talking more than about just kind of keeping the immune system dialed in so that the Toxoplasma doesn't become an issue again, something like a Toxoplasma Nosode or Homochord  seems like it can be really nice just to keep reminding the immune system of what it needs to be doing to support us. 

[01:22:44] DR. CORNISH: Yeah. That's great. I have found benefit with using homeopathy as a maintenance approach. Because that's what I talked about earlier was maintenance. And I try as hard as possible to transition people when they go through the treatment to more of a maintenance with homeopathy or poor herbals just to keep their immune system more robust. But I always tell patients, I'm an MD. But if I could be an ND secretly, I try to play one on TV that might not be real. But I have some value there. Call me MD/ND, I guess.

[01:23:21] SCOTT: I love that. Let's talk a little bit about biofilms. You mentioned earlier that sometimes the biofilm work is a part of your treatment. How often in people with these chronic infections do you find you have to support the biofilm component? And kind of where I'm going with this is, sometimes that is the most difficult aspect of treatment, right? You start treating biofilms. Basically, bringing out these sequestered organisms, and metals, and all of these things. And you can really trigger mast cells. You can trigger immune dysregulation. 

I mean, I've been through this myself. Sometimes the biofilm therapies, you can release a whole bunch of viruses or other co-infections. And so, that process itself is usually unpleasant. Talk to me a little bit about where biofilms fit in your treatment model. And is it something that all of your patients need to do?

[01:24:19] DR. CORNISH: I think that it's very important in a majority of my chronic patients. But as you alluded to, it can be very provoking and stimulate that histamine response, which is why I think a lot of people have such severe Herxhimer responses with it. But I have to make sure I have proper drainage on board, proper detox on board. That we kind of limit some of the other toxic exposures that already cause this inflammatory state. It's like we're not adding as much fuel to the fire. 

I think it might have been Kristine Gedroic years ago. I heard her analogy about the faucet and the drain. And that just like stuck with me. It's like you got to have that faucet open before you turn on that drain or you're going to have a flood, you know? And I think that analogy holds true when you're treating these infections, right? 

You poke the ugly beast, which is that biofilm, that I always say was just living there, evading the immune system, happy that it wasn't being recognized. Not in this planktonic active state. Having their little house party. Because it's a microcolony of multiple different microbes. And then you start opening them because you want to – you need to. I mean, some of this intracellular organism, especially babesiosis, and parasites, and sometimes even Bartonella, and definitely Toxoplasmosis. You have to try to get into that parasitic component. It's about preparing them for that and taking it seriously. 

I find there's a great need for fibrinolytics like Boluoke, or what's called lumbrokinase, or serrapeptase, or nattokinase, and sometimes even Flagyl, Tindamax, just to really get into that biofilm. But keeping in mind that you're going to poke that ugly beast and other things are going to be present. 

And that's why it's important that you lower that toxic burden as much as you can, right? Because you're going to be waking up things that you may not have known were there, like the whack-a-mole. Things are going to pop out and you're going to get shocked, right? You just have to prepare the patient. Don't rush. We all want the victory. We want to go hard and go home. But that's not how you treat this. Because sometimes that inflammatory process can take you backwards. And I learned that the hard way. It was like push through. Yay. You can do it. You can do it. And then next thing you know it's like, "Oh, wait. You're so inflamed. We're back at square one." Because these bugs love a hostile environment. Or, oh, wait. I've done all this and you're breathing mold every day. Oops. Sorry. Oh, wait. You also have yeast in there. And you have viruses that I didn't know. It's really about getting the right detox strategies and drainage and not just the kill. You got to detox and filter out things as much as you kill, especially when you go into those biofilms. Because that's a whole another animal, those biofilms.

[01:27:26] SCOTT: I've definitely learned in large part from my mentoring with Dr. Raj Patel, that a lot of times the body responds better to those interventions that are feathers rather than those that are sledgehammers. And I think you're kind of saying the same thing. I mean, there may be a place in a time where we need something bigger than a feather. But sometimes those sledgehammers, they leave a lot of collateral damage behind. I certainly have experienced that over the years. 

The other thing I guess I would say is, if you're going to use words like drainage, I think you do need to give your MD card back. Because now you've really crossed over. I mean, you're going to start talking about extracellular matrix and those things pretty soon. And then I know you're really in the land of the naturopaths, which is my – 

[01:28:15] DR. CORNISH: That's one of my favorite things to talk about, extracellular matrix. Oh, man. I'll give it up. I'll give it up, guys. I've been asked to give it up for a long time. Just call me ND Eboni Cornish. Maybe I could be an ND/MD. I just wish – that's what I secretly want to be. I wish I was at MD/ND. And I had time, if I didn't have these triplets, to go back to be a naturopath and learn more. But I just learn it because of brilliant things, like what you do, and brilliant conferences, and brilliant people. Because NDs, I mean – naturopaths, it's the way to go. If you're closing your mind, man, you can't treat these things. Get out of here, you know? Sorry. Sorry, MDs. I'm an MD/ND now. 

[01:29:00] SCOTT: One of the tools that I know as an MD, it's not something that is readily used, is talking about the realm of frequency medicine, Rife instruments, the Spooky2, the NIKKI, the Wave1. All of these kinds of things. And so, I'm wondering in your patients with Toxoplasma or other chronic infections, do you find that there's a place for more frequency, more energy medicine that can also be helpful in supporting their recovery? 

[01:29:31] DR. CORNISH: It's about the concept, right? Any organism that enters your body is going to change the energy. It's going to alter that. I think there is a place for it, right? I see other people who do it and I've had mixed results. That's not something I’ve incorporated yet. I don't know if I have to give ND card back just for that. 

But I think, ideally, the concept, there's a place for it. Because it just makes sense. If you're changing the energy in your body because you have all of these foreign microbes in it, there may be a place to use energy medicine to treat it. I just have it incorporated. I have colleagues that collaborate who have. But I'm open. I'm open to learning. As long as it makes you better and it's not too off or too harmful, I think there might be a place in it. And I know there are a lot of real respected people who do it.

[01:30:32] SCOTT: And to some extent, homeopathy is kind of crossing into the energy medicine realm anyway, particularly when you get to certain dilutions that are working much more in the energetic realm already. There is some discussion about Toxoplasma being involved in calcifications in the body, particularly in the brain. Do we need to explore and address calcifications independently of treating the infection itself? 

[01:31:03] DR. CORNISH: That's an excellent question. And I know a lot of that literature on calcifications and Toxoplasmosis is from the HIV literature. That's where I've seen it the most. And I think it does hold true. On SPECT scan, we don't necessarily look for the calcifications per se. But have I seen that in Toxoplasmosis cases? Yes.

And then a lot of my patients are already on things Vitamin D, K. Or some can even be on bisphosphonates if they have issues that can lower calcium. But I measure that in everyone, looking at calcifications. And not something I'll look at neurologically with people. But looking for risk of development. Because it's so prevalent not only just in this neurological parasite but in dementia and other neurological diseases. I definitely think it's a place for that. And that's something that can be considered for treatment.

[01:32:02] SCOTT: There has been some recent work done on immunotherapy for Toxoplasma at Johns Hopkins that targets the PD1 pathway and alleviates the neuroinflammation that's caused by Toxoplasma. Wondering if you have any thoughts on that intervention, that approach. And is anything in that realm currently available or in the near future potentially available for human use? 

[01:32:26] DR. CORNISH: Yeah. I thought that was cool, you know? The paper. And so unique. Because, like I said, I think about things very simply. It's like, "Yeah, if you're doing a PD1 intervention, you're telling the T cells to wake up and shift and stop it." Kind of get organized. Target this underlying infection and not the host. And I think that that definitely makes sense. Because a lot of my patients have so much Th1, Th17, or T cell dysregularity that that would be appropriate. 

I haven't used it yet. I can see that there will be a lot of drugs down the pipeline. Some of the ones that I'm more familiar with are those that are used for cancer. But I haven't incorporated that my practice. But the concept, because I'm such a nerd, it was so wonderful when I heard about it. It just makes sense. When it is available, will I use it? Well, it's probably out there. Have I used it? Not yet. But I think, once again, there's probably a lot of smart people using it and getting great results. 

[01:33:31] SCOTT: You mentioned earlier that one of the things that you can see on the SPECT scanning is this limbic system dysregulation. Wondering if you've observed a place for some of the limbic system retraining programs like DNRS, like the Gupta Program, like Primal Trust? And do you see shifts in brain scans when people are doing that type of work?

[01:33:54] DR. CORNISH: Oh, yeah. I don't know if this is going to be giving my card back. But I know, with limbic retraining, it's so important. And even at the clinic, we do a lot of talking about that, at Amen Clinic. Dr. Amen is a big fan of EMDR. We use a lot of biofeedback. 

I am very familiar with Annie Hopper's work. I'm a big fan of limbic retraining. I know we use at Amen Clinic a lot of EMDR. I know Dr. Amen is a big fan of that. I have done a lot of research. And we even had a doc call with Annie Hopper, which was fascinating, where she spoke to all the psychiatrists on a call about the importance of limbic retraining. 

And I learned first about it with Neil Nathan when he was doing his talks on cell danger response. And, once again, things, when I hear them, they make sense. And I think maybe because I was a researcher. That was kind of how I transitioned into medicine. I was a researcher at Howard Hughes. And I love asking, "But why? But why?" You know? 

And with limbic retraining, it calms down those people who are so sensitive. Gets you kind of out that fight or flight. And in a sense, some of my patients don't tolerate any form of treatment. May that be homeopathy, herbals, meds until that limbic system is retrained. 

And so, I've been looking into Gupta for years. Of course, Annie Hopper. I prescribed – I consider it a prescription. DNRS is a prescription. Because it's mandatory. I just had a patient this week and I was like, "Okay, you must do Primal Trust." T try to find out what the patients – what their personality is. So, a lot of my younger patients have preferred either Gupta or Primal Trust. Definitely, Primal Trust. Because that's one of the newer ones that I actually just, out of curiosity, did. And I loved it. Because I kind of want to see who can I recommend this to? I know someone is really cognitively impaired or really anxious. Which one is going to be tailored to their needs, right? But it is fascinating. 

And sometimes I will tell patients, like, "Don't get disappointed. You must do DNRS before we start treatment." And another one I use, especially with another program I found helpful with my PANS and PANDAS kids and even some of my chronic infection cases is Safe and Sound.

[01:36:20] SCOTT: From Dr. Stephen Porges. 

[01:36:22] DR. CORNISH: Yes. I love that as well. That's another one. Anything you can do that's not oral that can help retrain the brain is very beneficial. And I have seen benefits both in research. I know Dr. Amen, we have a lot of research, especially EMDR, and brain scan, and changes that you can see with that deep limbic system. And I know Dr. Gupta has research as well on just the impact pre-post in his paper. I mean, it's real. And it works if you're committed to it. Now it does take commitment. That's the thing. You have to be committed to the process. It's so helpful in so many people.

[01:37:04] SCOTT: I'm going to have to change the graphic for this episode to say Eboni Cornish ND at this point. Because I think you've just really gone over the edge now with some of these things. 

[01:37:12] DR. CORNISH: Oh, man. I don't know about that. But I maybe put ND/MD maybe, possibly. Wannabe after it. 

[01:37:21] SCOTT: It's been a few years now since we did our conversation on Morgellons. And I'm just wondering, in the few years since our conversation, what has changed in the Morgellons landscape? Any new understanding? Any new treatments that have emerged that really have become a focus for you? What's different now as compared to when we had that conversation? 

[01:37:44] DR. CORNISH: I have found so much different as a way of my approach. I've seen a lot more – I would say, honestly, I have about majority. A lot. It's probably very rare that I'll find a Morgellons patient that doesn't have mycotoxin or biotoxin illness. I think there's an association there. I think research needs to be done. If I didn't have triplets, I would do it. But there's definitely an association with biotoxin illness. 

I've been using a lot more methylene blue for my patients with mycoplasma. A lot more Lauricidin. Because I'm seeing a very high associate that I didn't know before with candidiasis in my Morgellons patient. I'm using more antifungal. That's been a mandatory component. Yes, the antiparasitics can be helpful with those antifungal. Both herbals and pill-form. That's like mandatory. Those are the big things that have become different for me like just routinely with the home testing and mycotoxin testing. Not missing the candidiasis, which I think is key in so many Morgellons patients. 

I mean, I had a one patient who, like I always say, you treat Morgellons like you treat Lyme, right? But now I'm like you treat Morgellons like you treat Lyme and candidiasis and mold all together in one, you know?

[01:39:12] SCOTT: And Bartonella. Yeah.

[01:39:13] DR. CORNISH: Yeah. But the yeast and the mold piece has really changed my practice. And also, incorporating methylene blue for these patients as well is something that I've changed over the last two.

[01:39:23] SCOTT: I know that Ginger Savely has in the past commented that some of the best interventions in Morgellons are those that also treat Bartonella. Is that in part why you're using the methylene blue? Or are you using methylene blue for another purpose in Morgellons? 

[01:39:38] DR. CORNISH: Yes. I'm using methylene blue for the Bartonella coverage. In Morgellons, I found some of my best protocols definitely include the antiparasitics. But incorporating things like dapsone, and rifampin, and methylene blue, and, of course, leucovorin with maybe some doxycycline. And like an antihelminthic of my choice there in the antifungal. Either natural or herbals. But, yeah, that methylene blue for that Bartonella coverage. 

And Ginger is one of my mentors. She's the one who really got me started 10 years ago in Morgellons. But that's something that's key. That methylene blue, if they're not on anti-depressants or SSRIs, I try to make sure, if I can incorporate it, I do incorporate it for that population. I've been very happy with it.

[01:40:30] SCOTT: 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?

[01:40:39] DR. CORNISH: I was not looking forward to this question. Because so many of your people, they're so smart. Like, "I do this, this." I do not practice what I preach in a lot of ways. Yes, I eat healthy. Avoid the junk. Take care of my brain. Take my supplements. But I have to be humble as a doctor. I have terrible self-care. I tell my patients all the time, "Make sure you use the sauna, and the bath, and you meditate." Man, I guess my self-care is treating these patients and just feeling so happy when they get better. And then being with my family. Because having seven-year-old triplets, they're so funny. They made a video of me. They imitated me one day on a video just talking about – I don't know what they made up. It was something on Instagram I said about the gut. And they made a video and it was hilarious.

Things like that, that's my self-care. Just being able to know, "You know what? I'm here for a reason." People are getting better. Yes, it might be stress. Yes, it's this. I'm not a workaholic. But I need to do more self-care. And I was not looking forward to that question. But, hey, I'm real. I eat well. I take my supplements. I do some exercise. But as far as the all nice things I tell my patients to do, if you're listening, I'm sorry. I don't use the sauna like I should or take an Epson salt bath. I apologize.

[01:42:00] SCOTT: I do think though that living in your purpose and your passion is probably one of the most healing things that you can do.

[01:42:09] DR. CORNISH: And your faith. And your faith. Because I think everyone believes that I'm a very – I'm a Christian. And I believe that I was brought here for a reason. It's just like this is what I was designed to do. It's not easy, medicine. There are a lot of sick patients. There are not a lot of people who can do it. But that dedication alone is my gift. That's what God's called me to do. Because, hey, I don't even know how I got in this field in the first place. I didn't mean to be here. And now I'm talking about being an MD/ND. 

But it really is every day looking at that patient who's been dismissed or abused, like I say. They come in so abused by other doctors. It's really a blessing when you see those stories and those testimonials. And it's like, "If I don't do it, there's not a lot of us out there that will." That is my purpose here. That's scary to say. But it makes me happy. It does.

[01:43:07] SCOTT: You are doing great work. I'm just so honored to know you and to have connected with you over the years. And always excited to see what the next thing is that you're going to do. I appreciate that you spent a lot of time with us today talking about Toxoplasma. But even beyond that, I just really want to honor you for living in your purpose and your passion. And helping to minimize the struggle and the suffering of so many. I just think you are incredible.

[01:43:36] DR. CORNISH: Oh, I thank you so much for having me. It's an honor. And you are living in your purpose as well. Don't forget that. You're entertaining us. You are shedding so many complex illnesses to light. Your podcast, it should be rewarded. Because you're one of the only people who are really doing it. You're getting evidence-based experts, everyone I know and love who's on the front line just to educate people for free and bring it to the masses. And you've been doing it for such a long time. And sharing your story and being vulnerable to listeners. 

I'm not saying this just because. I really do admire that and what you do for these patients and who share your journey. Because it helps. I have patients who listen to you. And they'll bring up things like, "Did you know –" I'm like, "Who did you get that from?" Like, "Oh, maybe I do need to listen to that." You know? Because you're doing great work. And this is your calling. And you do an amazing job at it. You do.

[01:44:35] SCOTT: Thank you so much, Dr. Cornish. 

[OUTRO]

[01:44:37] SCOTT: To learn more about today's guest, visit AmenClinics.com. That's AmenClinics.com. AmenClinics.com.

Thanks for listening to today's episode. If you're enjoying the show, please leave a positive rating or review, as doing so will help the show reach a broader audience. To follow me on Facebook, Instagram, Twitter, or TikTok, you can find me there as BetterHealthGuy. If you'd like to support the show, please visit BetterHealthGuy.com/donate. To be added to my newsletter, visit BetterHealthGuy.com/newsletters. This and other episodes can be found on YouTube, Apple Podcasts, Spotify, Google Podcasts, and Amazon Music.

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