Episode #223: TOXIC and Beyond with Dr. Neil Nathan, MD

Why You Should Listen

In this episode, you will learn about the latest approaches to healing your body from mold toxicity, Lyme disease, and other complex, chronic health conditions.

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About My Guest

My guest for this episode is Dr. Neil Nathan.  Neil Nathan, MD has been practicing medicine for over 50 years and has been Board Certified in Family Practice and Pain Management and is a Founding Diplomate of the American Board of Integrative Holistic Medicine and a Founding Diplomate of ISEAI. He has written several books, including "Healing is Possible: New Hope for Chronic Fatigue, Fibromyalgia, Persistent Pain, and Other Chronic Illnesses" and "On Hope and Healing: For Those Who Have Fallen Through the Medical Cracks."  He has been working to bring an awareness that mold toxicity is a major contributing factor for patients with chronic illness and lectures internationally on this subject which led to the publication of his eBook, "Mold and Mycotoxins: Current Evaluation and Treatment, 2016" (now updated to 2022), and then to his best-selling book "Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities and Chronic Environmental Illness."  2021 saw the publication of "Energetic Diagnosis," a discussion of the value of intuition and energetic devices as an aid to both diagnosis and treatment of medical illness.  In 2024, his book "The Sensitive Patient’s Healing Guide" was released with a focus on how to approach the treatment of sensitive patients.  And most recently, in late 2025, the second edition of his book "Toxic" was released with several years of new information and insights on healing from complex chronic conditions.  Dr. Nathan has been treating chronic complex medical illnesses for 30 years now, and Lyme disease for the past 20 years.  As his practice has evolved, he finds himself increasingly treating the patients who have become so sensitive and toxic that they can no longer tolerate their usual treatments, and his major current interest is in finding unique ways of helping them to recover.

Key Takeaways

• Is Long COVID the Great Unmasker?
• Is POTS an underlying cause or is it a symptom?
• How might the Radiance Long Hauler testing be helpful?
• What supplements or botanicals may be helpful for those in a Cell Danger Response?
• Are hormones generally well-tolerated when one is in a Cell Danger Response?
• When might be the right time to introduce PC?  VIP?
• What are the more common sensitizers of a sensitive patient?
• What are the more common drivers of MCAS?
• What are some strategies for modulating the inflammatory response?
• Is MCS the same as MCAS?
• Should limbic retraining be more active?
• How often are mycotoxins seen in patients with Alzheimer's?
• Does HLA-DR impact a patient's recovery potential?
• How do you handle a suspected mold illness patient when their urine mycotoxin testing is negative?
• What is the best binder for mycophenolic acid?  Chaetoglobosin?
• Do the benefits of bentonite clay outweigh the potential risks?
• What is the source of gliotoxin in the body?
• How is the treatment of fungal colonization approached?
• What role have Actinobacteria and endotoxins played in treating patients?
• Can Bartonella be treated with natural antimicrobials alone?
• Does treating mold and Lyme improve EDS?
• Can secondary porphyria be an indication that the antimicrobial is working?
• What is the role of EMFs in chronic illness?
• How large of a factor are parasites?
• Do mold and Lyme contribute to ME/CFS, Fibromyalgia, autism, and PANS/PANDAS?
• What is the role of nitric oxide in recovering health?

Connect With My Guest

NeilNathanMD.com

Related Resources

Toxic 2nd Edition: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illness

Interview Date

September 29, 2025

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]

[0:00:02] 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.

[0:00:35] SCOTT: Hello, everyone, and welcome to episode 223 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Neil Nathan, and the topic of the show is TOXIC and Beyond. Dr. Neil Nathan has been practicing medicine for over 50 years and has been board-certified in family practice and pain management and is a founding diplomate of the American Board of Integrative Holistic Medicine and a founding diplomate of ISEAI.

He's written several books, including Healing is Possible: New Hope for Chronic Fatigue, Fibromyalgia, Persistent Pain, and Other Chronic Illnesses and On Hope and Healing: For Those Who Have Fallen Through the Medical Cracks.

He's been working to bring an awareness that mold toxicity is a major contributing factor for patients with chronic illness and lectures internationally on this subject, which led to the publication of his eBook, Mold and Mycotoxins: Current Evaluation and Treatment 2016, which has now been updated to 2022, and then to his best-selling book, Toxic: Heal Your Body From Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Mental Illness. 2021, saw the publication of Energetic Diagnosis, a discussion of the value of intuition and energetic devices as an aid to both diagnosis and treatment of medical illness.

In 2024, his book, The Sensitive Patient's Healing Guide, was released with a focus on how to approach the treatment of sensitive patients. And most recently, in late 2025, the second edition of his book, Toxic, was released with several years of new information and insights on healing from complex chronic conditions.

Dr. Nathan has been treating chronic complex medical illnesses for 30 years now and Lyme disease for the past 20 years. As his practice evolved, he finds himself increasingly treating the patients who have become so sensitive and toxic that they can no longer tolerate their usual treatments. And his major current interest is in finding unique ways of helping them to recover. And now my interview with Dr. Neil Nathan.

[INTERVIEW]

[0:02:50] SCOTT: Today, I'm honored to welcome back my mentor, Dr. Neil Nathan, to the podcast. This is his seventh appearance on the podcast, I believe, our most frequent podcast guest to date. And just for those of you who haven't listened to some of our prior discussions, take a look at episode 19, where we talk about cutting-edge medicine. Episode 85, where we talk about the first edition of Toxic. Episode 121, we talked about the Cell Danger Response. 122, Precision Mycotoxin Detoxification. Then in episode 160, Energetic Diagnosis, which is a fantastic book. Episode 200, another amazing book, Sensitive Patient's Healing Guide. So, please go back and listen to those.

And particularly for those people listening to this conversation, I would urge you to go back and listen to episode 85 that talks about the first edition of his book, Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illnesses. We're not going to rehash the basics of that conversation but really focus more on the updated content in the second edition of the book and some listener questions as well. With all that out of the way, it's my great honor to welcome back Dr. Neil Nathan to the show. Thanks for being here, Dr. Nathan.

[0:04:11] DR. NATHAN: Thanks, Scott, for having me.

[0:04:13] SCOTT: So let's start by talking about a big topic these days, which is long COVID now impacting over 35 million people in the United States. I remember years ago we used to call Lyme the Great Masquerader, and wondering now if we might call COVID the Great Unmasker. Meaning that things like mold, Bartonella, Mycoplasma, Epstein-Barr maybe come to the surface when we have long COVID. Maybe we had them, they were well-managed. But at some point, now the bucket is kind of overflowing.

Some people that I've spoken with didn't even know that they had mold exposure or Lyme until they had COVID, spike protein, now dealing with long COVID, and really that overflowing bucket leading to symptoms. So, I'm wondering how you view long COVID. Is it an unmasker? Is it a toxicity from spike proteins triggering inflammation? Could it be persistence of SARS-CoV-2 in some people? Or is it a combination of all of those potentially?

[0:05:25] DR. NATHAN: It's a combination. The way I look at it is you can have exposure to any number of potentially toxic or infectious agents. You can be exposed to mold. You can be exposed to Lyme. And if your immune system is robust, you'll be able to function and kind of fend it off. In the same way that there are untold number of viruses that we were exposed to in the past that are not every single virus is expelled from our body, then they're probably floating around in us somewhere. But our immune system, if it's robust, will keep us healthy. It recognizes it. It keeps it under control. That's its job. Its job is to keep our immune system up and running at the highest level to fend off whatever threats we have to us.

So, it's not uncommon for people to have spent years in a moldy environment and still be okay. Maybe they have some symptoms, maybe not at all, but they're okay until their immune system takes a hit. Now that hit could be an infection of some sort of which COVID is a biggie, which we'll talk about, but it could be any flu, any serious infection, bacterial, viral, you name it. It could be childbirth. It could be a surgical procedure. It could be any emotional upheaval. The betrayal by a friend, the loss of a loved one, some form of abuse. You name it.

But when that immune system takes a hit, it loses containment of whatever was there. Be it mold toxin, be it Lyme disease, or coinfections. And COVID was a major player in this weakening of the immune system that allowed what was there to emerge because we lost containment. That's kind of how I look at it.

[0:07:34] SCOTT: So, since the pandemic started, my observation at least is that we see a lot more POTS or dysautonomia. And wondering what you see as the common drivers of POTS. Is it infection? Is it toxicant, mold, Bartonella? Maybe COVID. Maybe just vagal dysregulation. And then talking about POTS specifically, what are some of the tools that you're finding helpful for patients? And then building on that, I'm wondering if POTS is really an underlying cause of someone's symptoms or if it is the result of something else? Very similarly conceptually to mast cell activation being more a symptom than a true root cause.

[0:08:24] DR. NATHAN: I think that it is the result of perturbations in the body. And I think that there are two main components to POTS. And sometimes when people work on only one, they don't make the improvement that they need to. But ultimately, POTS is a dysfunction of the autonomic nervous system, for one. Second, many of the things that trigger POTS, like mold toxicity, like Lyme disease, like Bartonella, affect the pituitary's ability to regulate their hormones. And one of those hormones is the adrenal hormone family mineralocorticoids. The mineralocorticoids are made by the adrenal gland, and their job is to regulate blood pressure. So it is very common in our affected patients to have a mineralocorticoid deficiency, which gets their blood pressure too low.

Now, that is a major component of things like fatigue and lightheadedness. Because basically, if your blood pressure is too low, it's like having low water pressure in your home and trying to take a shower. And basically, water comes out as a trickle. So that's kind of what's happening in your bloodstream, which is you're not perfusing your body with blood adequately. And so, obviously, with that, you'd get fatigue, not enough blood flow. And if you stand up suddenly, turn your neck suddenly, move suddenly, get up, and you get dizzy, lightheadedness, because the bottom drops out of your blood pressure. And your pulse goes up to try to push blood through your system a bit harder.

I think it's both often and that it's helpful to work at it from both perspectives. So, for example, a simple thing that I found useful over the years for the mineralocorticoids is to take a medication called Florinef, which is again a synthetic adrenal type material, which will raise our blood pressure a little bit. It will never cause high blood pressure, but it might raise the systolic and the diastolic by 10 points each. That is often enough to improve blood flow to the point that we can be much more comfortable. And if we combine that with rebooting the autonomic nervous system, then I think we can treat POTS very effectively.

Keeping in mind that we have to ask the question: What is messing with that autonomic system in the first place? And then we come back to primary causes like mold toxicity, Bartonella, Lyme disease, other forms of infection, and anything that messes with that part of our brain, which is the vagal system, is a fault. And to make this a smidge more complicated, there is a very profound interwoven interaction between the limbic system, a different part of the brain, and the vagal system, so that you can't factor that out.

What that means is that – let's take COVID as our working example. One of the most profound things that COVID did as soon as it arrived on the planet was to absolutely freak the entire world out. It was palpable. The media jumped on it and added immeasurably to scaring the wits out of us. We were all looking at film versions of New York, and Boston, and San Francisco of overloaded emergency rooms and overworked healthcare professionals and being told there are not enough respirators on this planet to take care of all of you. We're going to get sick. And the whole world went, "Ahh!" And we're off to the races.

To a certain extent, that has still not died. There are still people wearing masks and staying six feet apart, which, forgive me, are not viable alternatives; never have been. It was just a desperation effort to go, "We've got to do something to help people feel like they can help take care of their own healthcare." Where the truth is, if you got exposed, you're going to get exposed.

But the fear that it engendered added a whole layer of limbic dysfunction to every human being on this planet, with few exceptions, and it's still not gone away. So, we're dealing with limbic dysfunction, vagal nerve dysfunction, and for people with the causes of those things out there, we're also dealing with mineralocorticoid deficiency, as what I think causes POTS.

I mean, there are POTS clinics in almost every university center now. And from my perspective, very, very few of them are looking at causation. Okay, they'll give you midodrine or Florinef as the medications you might use. They'll tell you to take more salt and drink more fluids, but they're not dealing with mold toxicity, Lyme disease as a cause.

[0:14:19] SCOTT: I know you have been very excited about the COVID-19 Long Hauler test from Radiance Diagnostics based on Dr. Bruce Patterson's work, where we can potentially distinguish between long COVID, or post-vaccine injury, or chronic Lyme, maybe, thanks to you in the future, mold as well. In his work, he talks about the S1 subunit of spike protein that gets stuck in the monocytes and really drives long COVID. He has the treatment intervention, maraviroc and pravastatin to treat his patient population. A few questions for you.

What has your work with Dr. Patterson identified around the potential to use this test for mold illness? And then have you found that before and after testing with this 14-cytokine panel using some of the treatment interventions that you might be using, do we see it move the needle? And then lastly, how do you determine when to order the 14-cytokine panel versus his S1 immune subset panel, looking more to the spike protein itself?

[0:15:33] DR. NATHAN: Very good questions. So, you are right. I think that the potential of this cytokine panel is profound as a game-changer, and helping us to tease apart the complexity of what we're looking at. And to be specific, what I mean is many of our patients, because they have a weakened immune system, not only have Lyme disease and co-infections, but they also have mold toxicity and opportunistic infections. Old viruses may reactivate, things like Epstein-Barr, and cytomegaloviruses, and HHV-6, Chlamydia species. All of these Mycoplasma species, all of these are this infectious toxic soup that our patients are in. And we need to tease apart which of these are the main drivers for this. They're not all equally players for all of our patients. Some are more relevant than others.

And the difficult part as a clinician is I've got this complicated patient. The symptoms of mold toxicity, Lyme disease, coinfections, and long-haul COVID are very, very similar. You can't tease it apart by just taking a very detailed history. There are hints, there are clues to help distinguish this. But by and large, you can't look at this patient who presents to you with fatigue, and brain fog, and anxiety, and depression, and peripheral neuropathy, and GI symptoms, and shortness of breath, and palpitations and go, "Okay, where do I start?" And for many of our young physicians who are just new to this field, that is the hard question.

So, it's important to understand that for most of these patients, my experience is mold, Lyme are the two biggies. But I can't rule out long-haul COVID, which is also a player here. So, let me go back to what you started talking about unmasking, which is many physicians who don't know much about mold and Lyme will look at someone who's had COVID and go, "Ah, this complicated sick person obviously has long-haul COVID." Okay, some do and some don't. It's a very real thing. So, how do we distinguish them? How do we tease it apart?

For that, I find Dr. Patterson's test groundbreaking, which is he has figured out that certain patterns of cytokines are much more common in long-haul COVID, certain patterns are more common in Lyme. And what he and I have been working recently on which patterns are more common in mold toxicity. So that if we're looking at the cytokine panel, that gives us a snapshot of what is this immune system wrestling with right now most. It kind of teases this apart. So that by looking at these numbers, we have a much better idea of what we're looking at.

Examples. If someone presented in the same way but their long-haul index on his test was minuscule, then I can basically say that, "No. That's not a player here." I can then look at the cytokines that are associated with mold toxicity and Lyme and go, "You know, the Lyme cytokines seem to be the most prominent. That's what we need to focus on." Or conversely, the cytokines that are related to mold toxicity. And for the listening audience, the two that's so far apparent, and hopefully Dr. Patterson and I will – actually, we've begun collecting data on this. And hopefully, before too long, we will crunch the data through his AI mechanism and really have some validated numbers to publish and make this known.

But preliminarily, the RANTES and the sCD40L are the two cytokines that we see most prominent in the mold field. And we often don't see that anywhere near as much in the Lyme field. To me, this is very exciting because we have a tool which could be the first thing that a physician does when you're faced with a complicated patient. Meaning, okay, it'll tease this apart, and then we can order the tests most appropriate for what that test seems to be showing us.

In the mold field, we can then get urine mycotoxin testing. In the Lyme field, we can get an IGeneX ImmunoBlot for the appropriate agent. Or if we want a more immediate read on that, we can get Dr. Mozayeni's TLab test to know exactly what's in our body right now. So that's my excitement is that I think we have a tool to really help us tease this whole thing apart.

What the spike protein is doing in the body is the same thing that mold toxin is doing in the body. It's the same thing that the Lyme or Bartonella bacteria are doing in the body. It is triggering an immune response that is causing all of our patients' symptoms. That's what long-haul COVID is. And the treatment of it is to turn off that immune response. And that means in these three different major conditions we're talking about, we're going to have three different approaches. It's not the same way. You don't treat Lyme the way we treat mold or the way you treat long-haul COVID.

Although maraviroc is an antiviral drug, its primary job is to reboot or shut down the toll-like receptors in the body that are a major driver of this whole inflammatory response. And to that we add a statin drug to take care of inflammation on another level, which is, after a while, the goal is to quiet the inflammatory response enough that our underlying immune system takes over, and we get healthy again. And honestly, that is the goal of all of these treatments.

People get distracted, for example, in mold toxicity, and they think the treatment is really about taking binders and antifungals. Yes, they work. But the goal is to strengthen that immune system to take away enough toxin that the immune system reboots itself. And at that point, it can go back to doing what it did when it was a robust immune system. We can be healthy in that way. Same thing is true of Lyme. We take antibiotics or herbals enough to take down that inflammatory infectious load. The immune system reboots itself, and now it's really about appealing to the body's innate ability to heal itself by removing the impediments to healing.

[0:23:28] SCOTT: And I would almost say that as much as strengthening the immune system, removing those stressors also brings more discernment to the immune system, right? That a lot of times it's that ready, fire, aim kind of mentality that the immune system has that creates a lot of the symptoms that we experience.

[0:23:48] DR. NATHAN: Yeah, I agree. And I think that a lot of the opportunistic infections which pop up completely go away once that rebooting takes place. It means we don't have to always also treat the virus or the Chlamydia, or the Mycoplasma species. Once the rebooting takes place, we're back where we were before we ever got sick, which was we have a viable immune system which is able to deal with what the world is throwing at us, and we can handle it.

[0:24:20] SCOTT: Have you found value in using the spike protein antibody testing from Labcorp? If so, do you see that over time it reduces? And then I'd be interested in hearing a little bit about what are you seeing helpful in terms of spike protein binders. So, I tend to think of Augmented NAC. Many people getting good results with that. There's the nicotine conversation that I know Dr. Jill Crista talks about as well. Maybe even extending into the realm of helping with mast cell activation, maybe Ehlers-Danlos, those kinds of things. So, curious if you find the spike protein antibody testing helpful. And then how might you approach dealing with those spike proteins?

[0:25:05] DR. NATHAN: It can be. And what I mean by that is just because you have spike protein doesn't mean you have an immune problem. Again, I'm going to come back to my basic overall writing concept that if your immune system has recovered and is robust, you can have spike protein, and it's not going to affect you very much at all. In the same way that you could have mold toxicity, and it's not going to affect you much at all. It can be there. But merely being there doesn't mean it has to be treated, or it's even helpful to be treated.

Having said that, for some people, I believe that the spike protein is creating pathology and is helpful to be treated. And again, there's a number of fairly tried and true methods out there. Nattokinase has the ability to break down spike protein. Ivermectin is known to be able to do that. A number of other supplements would be helpful in that regard. And if you know you have spiked protein, why not get rid of it? To me, it's like a ticking time bomb. Same way with mold toxicity. You might feel well, but if there's mold toxin in you, it's much better to get it out because otherwise, if you do have an infection, surgery, or an emotional upheaval, then you could get really sick, and then recovering from that can be very difficult.

Dr. Dr. Jill Crista has put together a beautifully orchestrated understanding that one of the things that spike protein does is it affects the acetylcholine metabolism in the body, the receptors particularly. And that's one of the reasons that people lose their sense of taste and smell in that issue. And she's found that starting with tiny doses of nicotine, cutting a patch in a quarter or an eighth or something of that nature, and then slowly increasing it has helped a lot of people symptomatically recover from their spike protein and damage done to them physiologically.

[0:27:24] SCOTT: So, I want to move on then and talk a little bit about the Cell Danger Response. We talked about that in detail in episode 121 based on the work of Dr. Robert Naviaux. Essentially that the cells enter this protective hypometabolic state, kind of a survival mode, where extracellular ATP from the mitochondria now is a danger signal rather than an energy currency. And while I've always felt that the theory is compelling or the idea is compelling, it is a little difficult, I think, for people to figure out how to put that into practical clinical application. So, I'm wondering, are we getting any closer to having some testing that will allow us to determine if someone is in a CDR1, or 2, or 3 kind of phase?

And then building on that, we know the one antipurinergic substance that could help and did help in some of his trials was Suramin, not available to us. So, there's a number of supplements, botanicals, other things that I'm interested in your thoughts around whether or not you consistently find them helpful for people that are in a Cell Danger Response for kind of dealing with that hypometabolic protective state. And so, I'm going to throw out a few of them. And then if you want to just pick out a few, if there's any, that you find consistently helpful. If we think of lysine, or skullcap, or kudzu, apigenin, quercetin, luteolin, resveratrol, EGCG, ellagitannins, genistein, berberine, fucoidan, B6, vitamin D. I mean, there's so many. Are there any of those that you find are tolerated and helpful in people stuck in Cell Danger Response?

[0:29:17] DR. NATHAN: Okay. So, I'm still in love with the Cell Danger Response as an overriding biochemical understanding of what is happening in almost all chronic illness. However, we're not any closer at this moment to having something that we can measure to tell us where a particular person is in their Cell Danger Response cycle, whether they're in Cell Danger Response one, or two, or three, which is a healing cycle process.

For me, the most valuable concept to come out of the Cell Danger Response is to understand that you can't use all of the tools that would logically be helpful until the patient moves from Cell Danger Response 1 to a healthier Cell Danger Response 2. Now, there's no test that I'm aware of that would show that. And I have talked to Dr. Naviaux many times about this, and I had the great joy and privilege of having breakfast with him a couple of weeks ago in San Diego, and we're still not there.

So, is there a clinical test that can tell us no? So, clinicians need to use their own judgment, their own discernment to get a sense of, "Is this patient ready for the treatments that would really help their mitochondria to heal?" A biggie is all of this is about mitochondria. All of this is about – it is the mitochondria, which are the organelles inside the cell, which not only make energy, but monitor the safety of the cell. And if they don't believe the cell is safe, they trigger this whole biochemical process of shutting down the cell's chemistry until safety is restored.

And as a rough guess, when my patients are about 50% better, then I can start to try some of the treatments that they may need. And what I mean by that is I can try the supplements we use to help the mitochondria function better, things like CoQ10, l-carnitine, l-taurine, malic acid, d-ribose, all of those will help the mitochondria to function better if it is ready for it.

So, when most of my patients come in really sick, you can give all those things, and it will not help one bit. And that frustrates the patient. It frustrates the physician. "I don't understand it. You have mitochondrial dysfunction. I'm giving you something for mitochondrial dysfunction. Why is that not working?" The answer is because I'm not ready for it yet. Okay, you have to wait until I am safe enough. I'm on survival mode right now. All the things you're giving me is all well and good. I can't use that. I'm freaking out here. I've got to get safer, meaning less mold, less mold toxin, less of an infection to whatever is triggering that, to the point that now I can respond.

And to me, I think that concept would help a whole lot of physicians who are otherwise confused about, "Well, you have zinc deficiency. I'm giving you zinc, and it's not doing anything. Why is that?" Or, "You're not methylating, so I'm giving you the supplements for methylation, and you're getting worse. How is that possible? The answer is because you're not in tune with what that body needs at that moment." And to me, that's profound. That in my own practice really helped me to understand that, okay, I tried this and it's not working. I'm not going to keep hammering away of that, thinking, well, if I give you more of that, that'll work. Your body is saying not ready for it yet. I need to listen to that. And then I can help you optimally.

So, Suramin is particularly amazing because there are 19 known purinergic receptors. Purinergic refers to things like ATP, which is a purine. And with everything in the body, you need a receptor on a cell to accept what it's being given so it can do something with that. And so there are 19 purinergic receptors that we know of. The beauty of Suramin is it blocks all of them, so that we're literally shutting down this inflammatory response and potentially reassuring the cell that it is now safe.

And just as a by the way, Suramin won't work until the body is safer also, because it's still shut down. So, it's not like this is the cure-all that all we ever need to do from now on in is give everyone Suramin and we'll reboot their response and they'll get well. Doesn't work that way. We still have to get rid of the toxins and treat the infections enough that now this shutting down of the immune system will be effective to it.

So all of the things you mentioned work on one purinergic receptor. And I know that Dr. Naviaux has studied specifically many of those materials as to whether or not it shuts down the process, and they don't by themselves. So, the problem is many of things you mentioned have multiple beneficial effects. Many of them, our free radical binders will take care of that. Many of them have multiple benefits for multiple reasons. They're really good supplements. But from a purinergic receptor perspective, not enough.

[0:35:28] SCOTT: We know that some hormone-related interventions could be working in opposition to the Cell Danger Response maybe against the innate intelligence of the body. So, we see people all the time, I'm going to start testosterone replacement or thyroid medication. And the way that I think about it is those are kind of pushing on the accelerator when the body is intelligently tapping on the brake or slamming on the brake. When do you incorporate tools for the adrenals, the thyroid, and potentially for sex hormones relative to where the patient is in the Cell Danger Response?

[0:36:08] DR. NATHAN: The way that mold toxicity and Lyme affect the pituitary's ability to regulate hormones, it's hitting a moving target. Fluctuating levels of mold toxin means fluctuating effect on the pituitary. It means fluctuating effect on all the hormones regulated by the pituitary, most importantly thyroid, adrenal, and sex hormones. So, you got a moving target here.

However, I don't think of hormonal treatments as a band-aid. Rather, I think of them as supporting a deficiency that will help that patient to heal faster while we're fixing what's really wrong with them. So, I do find that if someone has a DHEA, adrenal deficiency, giving that helps. If they have a cortisol deficiency, giving that helps. If they have a thyroid imbalance, getting the thyroid into better balance helps. Same thing with estrogen, progesterone, and you mentioned testosterone. All of that helps. But it's important that physicians not try to be precise about that, because you can't, because you're hitting a moving target. That you can get them into the arena of balance. But that's as good as you can hope to get, and that will be helpful.

Now, when it comes to testosterone specifically, I have concerns when young men are given testosterone directly. Because when they take testosterone, the biofeedback mechanisms of the body go, "Oh, you've got all the testosterone you need. I'll stop making it." And in young men, I have had quite a few who were given testosterone, not by me, but given testosterone directly. And when they were done with that and no longer needed it, they found they couldn't get off because their body had shut down so completely.

So I just wanted to say that other things than testosterone would be my way of working on that specifically, namely Clomid, which helps the body make more luteinizing hormone. It's not directly testosterone, so it doesn't get into that biofeedback loop. It's just some people again have this simplistic, "Oh, I am low in testosterone. I'll take it." I understand the logic, but bodies are not that simple. You need to understand the biochemistry quite a bit at a deeper level to know what kind of intervention you want to give in order to really help that person and not mess them up further down the road.

[0:39:02] SCOTT: And I think with some of these things too, maybe testosterone in particular, if some is good, more is not necessarily better, right? We see people a lot of times pushing their testosterone really high, which may not be ideal.

One of our listeners noted that you have consistently "professed your love for phosphatidylcholine". Wondering how one might know when the right time could be to introduce PC. I know there is that kind of cellular rigidity that happens as part of the Cell Danger Response. So, can phosphatidylcholine be helpful when someone is in that CDR and potentially move them out of it? And then slightly related, but the same concept about when in the Cell Danger Response, when in someone's recovery, have you found VIP to be the most accepted and helpful?

[0:39:54] DR. NATHAN: Yes, I have repeatedly said that I love intravenous phosphatidylcholine. Yes, that is a correct quote. Love is a strong word. I love my wife. I love my dogs. And I love my kids. Not necessarily in that order. I like phosphatidylcholine a lot. Every cell membrane in the body is largely composed of phosphatidylcholine. And when the body holds on to toxins, it often holds them on the cell membrane.

I remember a number of years ago, Patricia Kane, who popularized intravenous phosphatidylcholine, showed some electron micrographs of cells that were exposed to toxin. And you could see on the outside of the cell, it was chock-full of these little dots of toxin all just – almost like it became super saturated on the outside. You literally see it. So, using phosphatidylcholine is a great way to assist the body in unloading some of those toxins.

Now, in very sensitive people, if you do that too quickly or with too much of a dose, you can make them very sick by, yes, you will offload that toxin, but faster than their body can process it, and it'll get worse. So, for very sensitive people, sometimes we have to start with half a cc or 1 cc phosphatidylcholine. Typically, 5 ccs is 250 mg, comes in these little vials.

Other people, you could start much higher doses. You could give them a full vial, two, three. And a number of people are giving much, much more than that. Again, I don't find super high doses that helpful. Some of my colleagues do. So, you can help reestablish the flexibility of the membrane. You can specifically reduce the toxicity. You can make the membranes healthy. And membrane health is super important to the entire healing process.

But again, each person is different. It's not like this is a panacea. You have to figure out for each person how much can you take. And you can take starting it at whatever dose as soon as it's available. Now, not everyone has access to it. Some clinics have access to it, and some don't. But if you have access to it, it's a great tool.

Now, the other tool that you mentioned was a VIP, vasoactive intestinal polypeptide. This was a material which was popularized by Dr. Ritchie Shoemaker as something that could again reboot this process. VIP has some profound effects on rebooting the immune system. It does. I have not had the profound or seen the profound benefits that he reports.

So, in my experience, when the mold is out of the system, about 20% of our patients will respond with an obvious reboot of their immune system. Most specifically, energy gets better, pain gets less, and cognition improves. Sometimes those are dramatic. I've even seen an occasional patient where they get their IV, and by the time the IV is almost done, their eyes are open, they're going, "Wow, my brain feels clear for the first time in years." So, it can do that, but not to the extent that he sees. So, we see different populations.

When he started using VIP, and I was working with him at the time, it was very clear, it should not be used when people still had active mold toxicity because it wasn't going to work. Since then, he has revised that, and he has started using VIP earlier on and in much higher doses than we used before. I have tried that approach. We've shared a number of patients, and I have not seen it work very well. So, do I like VIP? Yes, I do. But it needs to be used from my perspective when patients are well along on the healing curve to optimize its value because it is somewhat expensive.

[0:44:30] SCOTT: In episode 85, we talked about the toxic versus the sensitive patient. One could have mold toxicity without sensitivity. But toxicity can also be a driver of sensitivity. And I suspect that there probably aren't too many sensitive people who are not also toxic. So, there is some overlap there. Sensitive people are more reactive to toxins. Toxic people become more sensitive. The exact treatments that you may need to support that patient may not be tolerated. And so that's where one of the many wonderful things from my knowing you was really you shifting my thought process to put that foundation of limbic system retraining, vagal tonification, and stabilizing mast cells really early in the process, so that the toolbox of therapeutic interventions grew that the patient could potentially tolerate.

So based on your work, I tend to think of the more common sensitizers as mold, Bartonella, mast cell activation, and limbic and vagal dysfunction. And then I tend to think of the drivers of mast cell activation being mold, Lyme, Bartonella, babesia, EMFs, viruses like COVID. We certainly see COVID triggering mast cells for some people, parasites in some people as well. So, what might you add to those more common sensitizers of sensitive patients or to the more common drivers of mast cell activation that I just mentioned from your patient population?

[0:46:17] DR. NATHAN: Okay, that's a fairly long discussion. And at the risk of being self-serving, that is the entire subject of my book, The Sensitive Patient's Healing Guide. So, once you have looked at what I call the basics. So, the basics of sensitization are, without any question, limbic, vagal, and mast cell dysfunction. And I'm going to add EMFs to that as well. Those are super basic.

But there are many people that, once they get sensitized, other systems become affected and add that to the sensitization process. To be specific, some people will develop oxalate sensitivity, salicylate sensitivity. Some people are withdrawing from some of the medications that they've taken, like benzodiazepines and SSRIs, and they're in a withdrawal effect, which dramatically increases their sensitivity.

And then there are some structural components to sensitization. Most specifically, two that I want to comment on. One is the structure of the face and jaw. For whatever reason, the body prioritizes that our teeth occlude comfortably and correctly, that our bite is just fine. If it isn't, the body kind of freaks out. It goes, "I'm not balanced here. I'm totally out of balance. I've got to fix this." And it will move heaven and earth to try to find a comfortable position.

But if, for example, someone has a fairly severe case of TMJ where they've got – I see it particularly in people who had dental surgery when they were younger and actually had jaw resection, and had all kinds of things done to their jaw, often those folks never got put in position correctly, and they just can't get aligned correctly. When that happens, their sympathetic nervous system essentially goes freaking out and goes, "I cannot –" there's a Cell Danger Response from that perspective, which is, "I can't calm down. I cannot get quiet until my jaw is balanced."

And for some reason, and I've had several dozen people like this, you can do all the limbic, vagal, mast cell rebooting you want, they can't quiet down. They stay in this absolutely fired-up position. They need to get into the hands of a dentist who can do like an ALF appliance coupled with osteopathic cranial work to very slowly bring that jaw back into alignment. It cannot happen quickly. It can't, like, "Okay, you're out of alignment. I'm going to put you back in alignment." That is a way to absolutely throw someone under the bus. It absolutely can't do it that way. It has to be a very careful, orchestrated, slow process. But when those people have gotten their jaw aligned, then every other treatment they do works like a charm, and they can then heal. It's a unique sensitization process that many people are not aware of.

A second one is what's called cranial cervical instability, nicknamed CCI, in which the ligaments at the base of the skull, where the skull attaches to the first cervical vertebrae, are loose and the skull collapses on it, compressing lymphatics, veins, arteries, nerves. And in that process, again, the body goes into freak-out mode, going, "Until this is comfortable, I cannot relax, I cannot be comfortable." And some people will need some kind of treatment for that area, which may even require surgery, before their system can calm down, and then they can move forward, and all the other treatments that we have then begin to work.

Now, I will segue this into let's discuss what causes ligamentous weakness and instability, which often goes currently under the name of EDS, Ehlers-Danlos Syndrome. Because years ago, that was considered to be a genetic, rare, unusual condition. And now we're seeing it very, very commonly. And I believe that, again, the genetic form is rare. But we're now seeing the inflammation triggered by the things we're talking about, treating, weakening those ligaments, triggering an Ehlers-Danlos-like condition. Again, these are folks where – and I can't do it, where you can take your thumb and put it and touch it down to here, and their ligaments have gotten loose.

And the proposed understanding of that is the mold toxicity and/or Lyme disease is triggering mast cell activation. In mast cell activation that we have over a thousand different biochemical mediators released, some of which are specifically inflammatory to the ligaments of the body making them loose. And I believe that it is the mast cell activation triggered by mold and Lyme that is causing this. I will call it a secondary, not primary, EDS. Now, the treatment for that is fix what's causing this. So, there's no real treatment for EDS, but we can fix what's triggering it. And the majority of the people who had it no longer have it when we get the mold and Lyme out of their body.

[0:52:39] SCOTT: That's huge. That has been probably the one topic over the last 3 to 5 years that seems that I hear more and more and more about it. I think it's very hopeful that there are ways to improve or resolve that in many of these patients.

You've talked more recently about the role of inflammation in disease, and I'm wondering if your approach to inflammation largely mirrors how we approach mast cell activation syndrome. Meaning, do we both need to use anti-inflammatories and at the same time get to the root causes or triggers? And how much of inflammation that we have in the body is the result of a poorly modulated or dysregulated immune system? And then kind of extending on that, I'm interested in what are some of the tools you're finding most helpful in your patients for reducing inflammation? Do peptides play a role? Are they more supportive therapies? Are they more core at this point? Give us your thought process on inflammation?

[0:53:42] DR. NATHAN: Inflammation is increasingly being recognized as the underlying process of almost all chronic illness. There is virtually no illness that you can name that's chronic that doesn't have an inflammatory component. Now, that helps us to get a better handle on how to treat it. I mean, until now, we viewed things like chronic obstructive pulmonary disease, and chronic kidney disease, and cardiovascular disease, and chronic fatigue syndrome, and fibromyalgia as separate things. But what ties them all together is inflammation.

In medicine, traditionally, inflammation has been measured with two simple tests. The Erythrocyte Sedimentation Rate often nicknamed the SED rate, and highly sensitive CRP, C-reactive protein. Those are measurements of a kind of inflammation, and conventional medicine has not really recognized that. It's pretty typical for someone to say I'm inflamed. You'll measure those things, they're normal. And someone will say, "No, you're not inflamed." Well, that's only a kind of inflammation. We're now recognizing that there's all kinds of different inflammations and that we need to intervene differently in those inflammations to make a difference.

Let's take cardiovascular disease, for example. The essence of cardiovascular disease is inflammation of the endothelial lining of blood vessels. And when that inflammation occurs, it allows LDL, the low-density lipoprotein particle, to migrate past the endothelial lining into the muscular layer of a blood vessel. A blood vessel very simply is a tube with a thin lining of skin on the inside called endothelium, and muscular coats on the outside which help to pump the blood through the body, and then another layer of skin on the outside. Now that's what that tube is.

Our digestive system, by the way, is the same kind of a tube. Same kind of a design to it. When the endothelium gets inflamed, LDL can migrate into the muscular layer, causing what are called foam cells. There's no problem if the LDL is not oxidized. But if the LDL is oxidized, it creates these foam cells, which run the risk of bursting. So that that will then set off a clotting process. So that the clots will cause strokes and heart attacks or it can cause a blockage of the artery. By the way, the foam cells accumulate so that it literally pushes out and blocks the arterial blood flow. All of that's inflammation.

There are a bunch of very clear tests that we now have, which can help us identify that this is happening at a very early stage, so we can do something about it long before anybody's at risk of having a heart attack or a stroke. That is different than the inflammation that we've been talking about with mold toxicity, Lyme disease, chronic fatigue, fibromyalgia in which other inflammatory markers are present.

For example, Dr. Shoemaker early on discovered TGF-β1, and C4A, and MMP9 were markers that, if elevated would indicate that there was the possibility of an inflammatory condition like mold. Now, those are not specific for mold. They can show other things as well. But I think what I'm trying to delineate is I think the science of inflammation is right now in its infancy, and that will be where we want to go with it.

Okay. I want to segue that into a broader discussion right now, which is when we're talking about treating mold toxicity and/or Lyme disease, people tend to fall into two different camps. One camp is, in mold toxicity, just get the mold out of the system. That's it. Then you'll be cured. In Lyme disease, just use antibiotics or botanicals. Get the bugs out of the system, and then you'll be cured. The other camp is, no, what's really happening here is it's an inflammatory process, and you need to quiet the inflammation, and then the body will heal itself.

And people often are polarized into these two different camps. But to me, it's obvious that both apply. You have a situation where you have inflammation, and you have to fix what is triggering that inflammation, be it a toxin or an infectious agent. And somewhere in that process, and this is the art form, and we're just getting there, you need to reverse the inflammatory process. So, you may get the mold toxin out, and some people still need their inflammatory process rebooted. And that it wasn't sufficient to get the toxin out.

Same thing with Lyme. Some people have treated their Lyme for dozen years with antibiotics, and they were not working on the inflammatory process as well. Sometimes that needs to be rebooted. Both need to be included in the way we conceptualize doing this. And I think that is going to be key in terms of how we improve our ability to do all of this.

For many people, peptides are still not what the body needs when it's in Cell Danger Response one. And so, in my experience with most of the people we work with, if you take BPC-157, thymosin alpha, thymosin beta-4, KPV are some of the common ones we're using, they often don't work particularly well early on.

Later, as the toxin is dissipated, as the infection comes under control, they become extremely potentially helpful in reversing this whole process. LDN is a particularly helpful material in that concept. Because LDN, again, blocks the toll-like receptors, which are a major driver of the entire infectious process. But again, if you take it early on, it may not do much. Again, this is what we talked about earlier of the art of medicine is knowing when to do these things, not do I have a whole toolbox of good things to use. Yeah, I do. But the art is knowing when to use it.

So, it's my impression that most of the peptides are much better used later on in the course of treatment, and they will work much better then. And by the way, they're kind of expensive. So, it isn't something that you want to bankrupt someone with by taking it before their body's ready to use it.

Having said that, some of my colleagues have found an occasional patient where, when they take the peptides, it makes an obvious difference, and patients do improve with it earlier on. My answer is yes, they have a role. Yes, they are valuable. And then the art is knowing when to incorporate that into the healing process.

[1:01:55] SCOTT: As we wrap up our conversation on sensitivity, I want to talk a little bit about just briefly on multiple chemical sensitivity and whether or not you currently view that as being driven by mast cells. In other words, is multiple chemical sensitivity essentially the same or significantly overlapping with mast cell activation with limbic dysregulation? Are those the same conditions?

[1:02:24] DR. NATHAN: Yes. Yes. And yes. Claudia Miller recently with Tania Dempsey and Larry Afrin wrote a paper a couple of years ago showing that there is a profound connection between mast cells and multiple chemical sensitivity, which didn't come as a surprise to most of us. It's kind of like, "Duh?"

I have this viewed multiple chemical sensitivity for years as the result of a limbic system, mast cell system that has been triggered by the things that we've been talking about. And in my experience with multiple chemical sensitivity, the vast majority have mold toxicity as a primary driver. When we cured the mold and we worked on the limbic and mast cell systems, the vast majority of those people got cured. Not better. Cured. So, I really want to emphasize that I see chemical sensitivity as simply another sensitization process, not different than sensitization to light, sound, touch, food, EMF. All are driven by the limbic system. And the limbic system is profoundly interfacing with the mast cell activation. And we cure what's causing it, and we quiet those systems down, and people aren't sick anymore.

Too often, I see people as helping those things. And even some of the folks who teach the limbic rebooting view those as standalone techniques to treat it. And they do for a few people. For a few people, limbic rebooting will cure multiple chemical sensitivity. But for most, you have to figure out what the driver is and get that, also, if you're going to really get that cured. So that you have now have a nervous system which is no longer wired to overreact to these stimuli.

[1:04:39] SCOTT: So, what I also heard you say in that is that mast cell activation syndrome itself is not the core issue. It is not something we have to have for the duration of our life. It is also a symptom or a presentation of something else. And if we can address the something else while also calming down that mast cell response, we can fully resolve mast cell activation syndrome.

[1:05:08] DR. NATHAN: Absolutely. In the same way that we have POTS clinics in every major university center, we now have mast cell clinics in every center. And unfortunately, because these are academic centers, many of them feel compelled to not give someone the diagnosis unless they have any of several biochemical markers that are elevated, particularly tryptase, for example. And I cannot count the number of people that I have seen who have been to these clinics and been told, "You can't have mast cell activation because your tryptase is normal." And they do.

Relying on these tests and taking them out of context is not helping a lot of the people who do have mast cell activation. Again, in these clinics, rarely are they looking for the drivers, which is, "Okay, I'll give you an H1 blocker, an H2 blocker, mast cell stabilizer," and people will get better. But you're going to need to take that for the rest of your earthly life unless you fix what's causing it. And that's my objection to the underlying thinking process of those clinics, which is not comprehensive enough to really help the people that are presenting to them.

[1:06:36] SCOTT: We know how critical limbic system work and vagal work are to create the foundation for healing. And I'm wondering how much of limbic and how much of vagal work should be active versus passive interventions, like maybe a device. My sense is that limbic work should largely be more active, more driver's seat, more participatory. That vagal tonification could be either active or passive. But that the more passive tools probably work better for the vagal side than they do for the limbic system. We know about DNRS, and Gupta, and Primal Trust that are really more active limbic system tools. I'm wondering what your thoughts are on the need for active versus passive tools in the limbic and vagal realm.

[1:07:26] DR. NATHAN: Well, I think the way you put it is absolutely correct. I agree with that. One of my overriding concepts is the people that I'm working with, many of them have not been correctly diagnosed or treated for many, many years. Many of them come to us pretty much behind the eight ball, not functioning very well. Some are bedridden. Some have kind of given up hope.

And I think that whatever treatments we give them, it's really important to empower them in their treatment, like letting them learn a skill that they then have that they can use not just when they're sick, but forever afterwards. Often when I'm working with someone, I'm trying to ascertain what level of functioning are they at? What tool would be helpful to give them that degree of empowerment that they can take charge of their life? Not to depend on me or a device, but on their own ability to function.

That goes into my thinking about which of these different tools I want to use for which patients. As they get better, I still want to empower them to do even more so that they no longer feel like a victim, but rather, "I can do this. I can control my limbic system. I can control my vagal system. I can get well."

[1:09:01] SCOTT: I want to talk a little bit now about mold and mycotoxins. You were one of the early voices in the mold illness realm, along with people like Dr. Ritchie Shoemaker. I think more and more today, people are talking about mold illness. Dr. Dale Bredesen in the context of Alzheimer's, for example. Years ago, I believe that he estimated about 60% of his patients with cognitive decline had a mold and mycotoxin component to their illness. Does not mean that was the single cause, but it was a piece of the puzzle. What does he estimate that number to be today?

[1:09:35] DR. NATHAN: 90%.

[1:09:37] SCOTT: Are you still largely of the opinion that while HLA-DR might be a predisposition for biotoxin illness, that it does not correlate well with one's ease or difficulty in treatment and ultimately recovery?

[1:09:54] DR. NATHAN: The latter. Again, when I first started working and I was working closely with Dr. Shoemaker, he felt that that was the deciding factor in which people got well or which people didn't. If you had the "dreaded" 4-3-53 or other genetic predispositions. And here you are, Scott, better.

[1:10:17] SCOTT: Yeah, because I don't use that word that you just used.

[1:10:21] DR. NATHAN: I used to joke that I dread the word dreaded, but that's another issue here. But I began to see – I was testing people, but I found that people with these supposed genetic predispositions got well as fast or faster than my patients who had no supposed genetic predisposition. I saw no correlation with whether a person could get well versus what genetic makeup they had. I just didn't feel like that was a valuable tool. It was scaring people. Some people use it as an excuse for why they didn't get better. "Oh, I can't get better. I genetically can't process mold toxin." And in my experience, no. If you treat it in a comprehensive way, the vast majority of people will get well regardless of what your genetic predisposition was. I am on a point that – and gosh, it was 10 years ago that I made that observation. It seems to me that the majority of people that I work with have come to the same conclusion.

[1:11:32] SCOTT: There is an ongoing debate about urine mycotoxin testing. I know it's one of your top tools. I've also found it very helpful. In my mind, if there is significant mycotoxin coming out of you, the question then is where did it come from? And I know you've discussed before that food likely plays a very small, largely insignificant role. We know that the first urine mycotoxin test is often the tip of the iceberg, and that as people start to detoxify. The next test will commonly be significantly higher could be a very good sign if symptoms are also improving. But I'm wondering what you do when you suspect mold or mycotoxin illness and the testing is completely negative. How do you decide whether to move on and rule that out, or come to the potential path where you're thinking that the person simply is not able to excrete a significant mycotoxin burden?

[1:12:36] DR. NATHAN: I've had, I would say, dozens of patients who fit that description where they know they've been exposed to mold. They got sick when they were exposed to mold, their symptoms fit mold toxicity, and their test from RealTime, for example, is completely negative. Depending on how much they want to prove or not prove it, the vast majority of these people probably have mold toxicity. And their ability to detoxify is so compromised that they can't get it into their urine to be able to show up on a test.

The vast majority of them, when I have treated them, the next test after we've begun to get the process of improving their ability to detoxify, we'll have higher tests, much higher tests. So, you mentioned the tip of the iceberg. That is an example of that. Sometimes, and I'm not wedded to RealTime being the only test that I recommend. Sometimes I will recommend either Vibrant or MyMyco as, "Let's get another test just to see if it shows up on another method of testing," because they use different methods.

At this point, the RealTime test uses ELISA technology. Vibrant uses mass spec and liquid chromatography, and MyMyco uses a different type of antibody technology to detect. Any of these tests, if positive, tell me that they have it. For follow-up testing, I do find RealTime more accurate. But if I want to make the diagnosis, I may ask somebody to do another test and clarify it. Or if they will accept my experience and go ahead and treat it empirically, the vast majority of those people really do feel that was the right approach and were happy that we did so. So, you can't rely on any test so completely.

I mentioned before the tests for mast cell activation are really weak. Relying on a test as opposed to relying on your clinical experience or diagnostic ability is not the right thing to do. There are many, many aspects of medicine where our clinical diagnosis is key. An example of that is Lyme disease. The CDC admits that the diagnostic criteria using the tests currently available are not completely accurate. And so, they will admit readily that making the diagnosis of Lyme disease is a clinical diagnosis. This is the same.

[1:15:33] SCOTT: In the second edition of the book Toxic, on page 66, you have an updated table for which binders are best for specific mycotoxins. So I have a couple of questions related to that. First, I want to talk about mycophenolic acid, which Dr. Crista talks about as being an indication commonly of current exposure. And that, without that exposure, it generally clears fairly quickly. In the book, you mentioned that binders for ochratoxin could also work for mycophenolic acid. So, do you commonly see persistence of mycophenolic acid if the source of the exposure has been addressed? Can mycophenolic acid in your thought process be from colonization, or is it always more environmental exposure? And then the second question would be for those that are dealing with Chaetomium, or Chaetoglobosin, the mycotoxin from Chaetomium, there isn't really a lot of data available. So, research data aside, what do you commonly see clinically helps in those people dealing with Chaetoglobosin?

[1:16:39] DR. NATHAN: Those are good questions. Yes, I agree that mycophenolic acid usually represents ongoing exposure. If you get out of it, it should go away by itself. And it seems to me, and I don't have any data, and I don't know quite how it could be studied – actually, I could figure out a way to study it, but that's a separate issue here. By taking the binders that I typically use for ochratoxin, it seemed to clear mycophenolic acid even faster. That's not a scientific comment. There's no papers published on it. Just my observation.

The same thing is true of Chaetoglobosin, which is taking what I consider basic binders like charcoal, clay, chlorella will almost always clear Chaetoglobosin. There's no scientific study showing that. But my experience is when you have this in your urine, and you take these things and you recheck the urine, and it's gone, to me it would seem like it seems to be binding it.

[1:17:46] SCOTT: I'll take your observations over science any day of the week. Those meet the mustard here.

Bentonite clay seems to be the binder that assists with the excretion of the highest number of different kinds of mycotoxins. However, we also know that bentonite itself contains heavy metals. Wondering if you have any concerns about the duration of use of bentonite that were potentially removing one toxin but leaving behind another.

[1:18:16] DR. NATHAN: From my research, the amount of heavy metals in bentonite clay is so trivial, but it's there. That despite prolonged use of clay, and I'm talking 3 to 5 years daily, has not resulted in anyone in my experience getting any heavy metal toxicity. Yeah, it's there, but I think the benefits far outweigh any negatives.

[1:18:47] SCOTT: How does the concept of binding mycotoxins in bile change if someone does not have a gallbladder? Meaning, if there's not a bile bolus from the gallbladder into the small intestine, how do we remove those mycotoxins when that bile is instead dripped into the intestines over a longer period of time? And given the key role of fat, healthy oils, maybe even phosphatidylcholine, how do we best support the breakdown and utilization of healthy fats in those without a gallbladder?

[1:19:23] DR. NATHAN: Well, the gallbladder basically concentrates bile. Doesn't make it. It's made by the liver. Whether you have a gallbladder or not has no effect on whether you're still making bile. And bile is made in the liver. It comes through the hepatic ducts. It just doesn't get concentrated.

I mean, that's one of the reasons that for decades, people have viewed getting your gallbladder taken out as no big deal, which is you're not losing an essential organ. Now, I believe that God does incredible work, and that everything in the body has a very important purpose. But some organs are less important than others, apparently, or at least to surgeons. I'll put it that way, if you don't mind my sense of humor here. I have not found any shift or change in people who don't have a gallbladder, that it still continues. Bile will continue to come through the system bound to toxins. And then when it gets into the intestinal system, the binders will do their job. I don't see any hiccup there even.

[1:20:35] SCOTT: When you see elevated gliotoxins, which could come from Aspergillus, could come from Candida, maybe Penicillium as well, do you think of that as a mold exposure that is resulting potentially in fungal colonization? Do you think of that as yeast overgrowth? What is more likely believed to be the source when gliotoxin is present? How do you determine whether to go down the fungal colonization versus the yeast path?

[1:21:07] DR. NATHAN: Well, I don't think it's possible to know whether Aspergillus or Candida is the source. But from a practical point of view, the vast majority of the time, I think it's Candida primarily. And what I found from a treatment perspective is those people do much better if I give them nyastatin and Diflucan to treat the Candida. I will lower their gliotoxin level much faster than if I didn't do that. It is my assumption that Candida and mold coexist greatly. And that the vast majority of people that I work with usually have it.

If we had other tests – now, the diagnosis of Candida can be very difficult. It doesn't always show up on a stool test. When it does, it's floridly present. Doing Candida antibody testing is of not particular help because it tells us that the immune system was exposed to it at one point. But because of immune memory, we don't know if it's still being exposed. The two tests that I find most useful are the gliotoxin test, which we're already getting in the urine, and arabinose on an OAT test. And what I typically see is that there is an association between those. When people have an elevated arabinose and they have an elevated gliotoxin, those both come down with treatment much better when I'm providing them specific anti-Candidal components.

[1:22:43] SCOTT: There is such a focus on methylation. But it seems that if we're talking about mycotoxins, glucuronidation is potentially even more important than methylation. I personally think methylation, the whole discussion is a bit overblown, maybe oversimplified. I think the body is more complex in ways that we don't fully understand. But if I were to ask more broadly, how can we support and optimize phase 2 detoxification pathways for those people dealing with mold and mycotoxins? What bubbles to the top of your list?

[1:23:18] DR. NATHAN: Well, in Toxic, we have a table which goes over that in detail, which, with the late Beth O'Hara and Emily Givler, we did a deep dive research into which phases were most helpful for which mycotoxins. And that table lays it all out. So, you're right, glucuronidation is far more important as a detoxification process than methylation for mycotoxins.

Again, methylation plays very, very little role in detoxification from mycotoxins. It's very common for me to have someone who's had an MTHFR testing done for their SNPs and go, "Oh my god, I'll never be able to detoxify. This is terrible." And I'm going, "Not so." That doesn't work that way. There are 39 SNPs that affect methylation in complex ways. Some improve it, some decrease it. As you're alluding to, it's a very complicated process.

More important, clinically, most of our sensitive patients, if they take the supplements we use for methylation, will get worse initially. And so, it's not an option for many of our patients. And some, again, get worried, like, "Oh my god, I won't be able to detoxify if I can't take B12 and 5-methyltetrahydrofolate." And my answer is, "Yes, you will. Because you have lots of other detoxificational pathways that your body can utilize, and that's not an issue."

My biggest issue with methylation is, as you say, it's been given too much – is it important in the body? Absolutely. For detoxification, not so much. And like everything we've been talking about, the body has to be ready for it, or simply being told, "Well, you're not methylating. I've got to give you these supplements." Methylation is intentionally compromised by the Cell Danger Response. It's one of the first things that happens.

When someone tells me that, "Well, the reason I'm sick is because I'm not methylating well and because my mitochondria aren't working well," I'm going, "Yes, but those are downstream effects. That's not the cause. That's really not what's going on." The key here to me is to use the right kind of methylation treatment when the patient's ready.

[1:26:10] SCOTT: I think that that conversation around MTHFR, maybe HLA-DR, that when we then internalize the sense of brokenness or unrepairable, that that internalization or that emotion or thought probably has more of an epigenetic influence on far broader genes in our system than the MTHFR or HLA-DR had on our health by themselves.

[1:26:42] DR. NATHAN: Yeah, I completely agree.

[1:26:44] SCOTT: So that table that Dr. Nathan was referring to is on page 79 of the book.

One of the things that Dr. Crista, who contributed to your new book, talks about is the role of bioflavonoids and the value in supporting the kidneys. Given that a lot of mycotoxins move through the kidneys into the urine, I feel like over the years of my health recovery, the kidneys was one area that I didn't focus on enough. So, I'm wondering, do you find a role for bioflavonoids to optimize that mycotoxin excretion process to protect the kidneys? How are you supporting the kidneys through this detoxification process?

[1:27:27] DR. NATHAN: Excellent point. I think Jill is correct. That, I think, in my thinking, I have focused on the liver as the primary organ of detoxification, and the kidney is playing a bigger role than I had allotted to it. And I thank Jill for setting me straight about that. And I agree. I think that taking the homeopathic RENELIX can be helpful improving the kidney. Frequency-specific microcurrent can be helpful in improving it. Drinking adequate fluids is always standard a part of this. Again, there are some peptides later on, like KPV that could be helpful in that particular regard. One of the reasons that I had Jill write her addition to the mold chapter because I think she's got a tremendous amount of experience in this field, and that it's very valuable.

[1:28:26] SCOTT: I'm going to ask several questions around the colonization topic and then just let you run with it. But once binders are on board for 6 to 8 or more weeks at the target dose, we might then think about the potential for antifungals to address colonization. I'm wondering, are there any tests that have emerged that are better in terms of gaining clarity around the potential for colonization? And then once you start treating colonization, do you start with the sinuses first, the gut later? Do you start them both at the same time? Do you start with mild tools and work up to more aggressive ones over time? Talk to us a little bit about your approach to colonization. And then extending on that, I'm wondering how often the source of the colonization could be outside of the sinuses or the gut, maybe the lungs. Or even Dr. Bredesen talks about the potential of fungal organisms impacting the brain.

[1:29:29] DR. NATHAN: It's a tricky question. I always start with binders. Um, the vast majority of my patients have colonized. Now again, Scott, understand that my patient population for years is referral from other physicians where their patients weren't making the kind of progress they wanted. By definition, they're a bit more complicated. And the odds of them colonizing are higher. So, I can't speak to, because I don't see them, people who recently exposed. Recently the family's affected, only the first few months, those are people that I don't typically see.

Then for those patients, just taking binders may cure them. If you haven't colonized, just taking binders will cure some small percentage and higher percentage if you're just walking off the street. Typically, I will give people awhile on binders if their urine mycotoxin tests aren't changing in a profound enough way to make me feel like, "Yep, this is doing it." I'll flip that around. If you're doing urine mycotoxin testing and they drop precipitously once you've started binders and the second test is much lower, great. I may not go past that. This is all this person needs to do, and that's wonderful. If they're not making progress, then I will certainly consider that colonization is likely.

I typically will start treatment with the part of the body, be it the sinus or the gut area, that is bothering them the most. If their symptoms are primarily gastrointestinal, primarily start with that. Primarily, if they have a long history of chronic sinus infections and runny noses, and they have a CT scan which shows thickening of the sinus mucosa, then I might start with that. And for many, they will eventually go on both.

Originally, I learned a lot about how to do this from Joe Brewer, an infectious disease specialist from Kansas City. And Joe felt that sinus colonization was more primary than gut. I'm not sure I agree with Joe on this. That both occur. There is no question. And again, what I may do is put them on GI-based treatments for antifungals. Again, if their numbers aren't coming down, if they are not improving, then I may add sinus treatment. What I do depends on the patient's response to what I've been doing.

Colonization in the lung is known. There's a medical condition called Aspergillosis, which is simply Aspergillus that has gotten into the lung area. It's considered a serious medical concern, which requires months of strong antifungal treatment to get it out of the body. It's not considered particularly common. I've probably seen a dozen cases of it in the 20 years that I've been doing this work. And it's not easy to diagnose. You need to do culture on bronchoscopy washings to see if someone really has aspergillosis. Happily, it's not that common.

I believe that it is it is possible that there is fungus in the brain going on. I think the primary issue in things like Alzheimer's and Parkinson's is mycotoxin, which goes to the brain, causing the inflammation that we see in that area. Again, the response, often dramatic, to getting mold out of the system. And Dr. Bredesen's research work with now hundreds of reported cases of marked improvement in cognition would make me think that there's probably not mold there, but mycotoxin, which we're getting out of the body.

If there was mold in the brain, our treatments do not penetrate the blood-brain barrier very well even when we're using things like Sporanox or Voriconazole. It's hard to imagine that there's actually fungus in the brain as a primary issue because of how it's responding to our treatment.

[1:34:09] SCOTT: How long would the normal treatment be for colonization with antifungals? What determines the end point? Is it the normalization of fungal metabolites on an organic acids? Is it a negative urine mycotoxin test? Is it based on symptoms? And then once we stop antifungal therapy, how do we minimize the future potential of recurrence? I know Dr. Crista talks about maybe using medicinal mushrooms to bring in health-promoting fungal organisms. I know some talk about probiotic nasal sprays and things of that nature. How do we not potentially slip back and become recolonized after antifungal therapy?

[1:34:54] DR. NATHAN: So, I'll go back to a question that I didn't answer that you asked earlier, which was what other tests do we have of colonization? The OAT test does have fungal markers on it which, if present, can help us to understand that, yes, colonization is happening. There are certain metabolites which indicate that, yes, there is colonization that's occurred in the body. And we know that because it's making these chemical substances that we can measure. It's a weak test. And if it was negative, and no way does it rule it out, unfortunately, some people look at that test as, "Well, that was negative. They can't possibly have colonized." Not true at all. It's a very weak test. It will show it occasionally, but not consistently.

Typically, it takes people at least a year to get this mold out of their system. I think people need to understand that if mold and Candida are growing in their body, it's very happy in their body. They are fabulous hosts. The temperature is perfect. Nutrients abound. It's dark. It's moist. Why would they leave? So, they are not eager to leave the body. And we really have to make them leave in order to get well.

I think it's frustrating for everybody that it takes as long as it does. And sometimes it takes two years. I've had a number of people who took four or five years to fully clear it. Mostly not. But it does take that period of time. And you have to continue the treatment until it's gone. I define cure as when a RealTime test shows not present in every category. Then when that happens, I encourage people to keep up their treatment for three more months. Now, that's an empirical observation.

When people were cleared early on, I would tell people, "Okay, we're done. You don't need to do anything anymore." About 15%, 20% of people would relapse. They weren't happy about it. And I discovered that if – and this was purely observational, if they continued their antifungals and binders for three more months once they were clear, that to my knowledge, nobody relapsed, unless of course they wound up being in mold again in a major way. But the mold was gone. It didn't regrow.

To add to that second part of your question, I believe that we live in a very toxic world, and I encourage people to take binders at low doses forever. That means, for me, what I do is one charcoal, one clay, one chlorella. I take it every day. I believe that that is helping my body get rid of the massive load of toxins that all of us are being exposed to on a regular basis. Regardless of the fact that I eat organic and I'm careful, you can't avoid exposure in this planet.

[1:38:19] SCOTT: There is a lot of discussion these days in the biotoxin illness world around Actinobacteria, around endotoxins as being causative agents in CIRS. I wonder how much endogenously created endotoxins or lipopolysaccharides might play a role, but I don't think that's a current thought process in the CIRS community. So, wondering how important these new puzzle pieces have been. Have they changed your treatment approach or your clinical work in any way?

[1:38:51] DR. NATHAN: I'm studying them. I'm intrigued by it. So far, I haven't been impressed that people who have been measured to have high Actinos or high endotoxins, that fixing that alone and not working on the mycotoxins, hasn't helped almost anybody that I've worked with. Whereas, if I get the mycotoxins out, those people universally get well. From my perspective, getting the mycotoxins out is central.

Are endotoxins and Actinos a part of the inflammatory soup that people get exposed to when they're being exposed to mold toxins in their home? Absolutely. But to what extent they are key players, I haven't seen it. And some of the treatments that we use would also work on that. Meaning, Welchol or cholestyramine are an excellent binder for endotoxins.

[1:39:54] SCOTT: I want to do a few rapid-fire questions on Bartonella. Given that Bartonella is a key-sensitizing microbe that you talk about in the vector-borne infection realm. We know how difficult it can be to treat. What are some of the interventions today that you're finding helpful for Bartonella? Is it still your opinion that people generally need to be using some pharmaceuticals when they're approaching Bartonella treatment? And then lastly, how often do you see Bartonella as the main driver of sensitivity in a patient in absence of mold?

[1:40:33] DR. NATHAN: Well, in the absence of mold, it would be a very common one. It is a main driver. It's also a gram-negative bacteria and it makes endotoxins. Viewing your previous comment, yes, there are other sources of endotoxin in the body, and Bartonella is definitely one of them in terms of how we treat it or how we get it out of the body.

I have not found that purely herbal approaches have been enough to get Bartonella out of the body. I have found that antibiotics are the primary tool that we use. And I'm very fond of Dr. Mozayeni's antibiotic approach. I think that's very effective. It's similar to one that I've used myself for years. And then for people who still have problems with persister cells, Dr. Horowitz’s Dapsone program can be very effective for them as well. But these require antibiotics.

I have had quite a few people who insisted they didn't want antibiotics. They wanted a purely herbal approach. And they've used all kinds of combinations of the Buhner herbs, Lee Cowden's tinctures, Beyond Balance materials, Byron White's materials. Even combining them, I've not had much success in getting people well just with those. Now, I like to add the specific tinctures that Beyond Balance makes, Byron White makes. I like to add them to the program. I use a lot of the Buhner herbs. I like Lee Cowden's things, but not as a standalone.

[1:42:22] SCOTT: Let me ask that last question slightly differently. In your sensitive patients that have Bartonella, what portion of them also have mold versus only having Bartonella?

[1:42:36] DR. NATHAN: Oh. Well, the vast majority have mold.

[1:42:38] SCOTT: I want to briefly touch on porphyria. Because as much as it seems to me like maybe not a super common condition, I actually do get a number of people reaching out and asking questions about it. I had a podcast on secondary porphyria with our friend Beth O'Hara several years ago, if people want a deeper dive. It seems that one of the common triggers for porphyria is the treatment of Chlamydia pneumoniae. But a lot of these things that we're using to treat are also broader, affecting many different infections and microbes and things in the body. And so I'm wondering if someone having a secondary porphyria could be a sign that the antimicrobial treatment that they're on is, in fact, working very well, and it's just too aggressive. And then extending on that, any other new advances in the realm of porphyria treatment.

[1:43:40] DR. NATHAN: Yeah, I'm not aware of any advances in this area. It's a very tricky area because the treatment of porphyria, especially nutritionally, is completely different from the treatment of mold. That porphyria requires a high-carb diet, which is the opposite of what we're doing with mold. The tip off to me in working with porphyria and patients was a Herx that lasted for weeks. And the essence of the Herx was especially severe nausea, vomiting, and especially intense anxiety. When that lasted and we measured their porphyrins in the urine, they tended to be high. And then if we treated them with intravenous glucose, they got much better.

When I was looking for it a number of years ago, and I started testing more people for it, I found it more common than I realized. But I think it comes into play sporadically. It's not like it's a condition that is a constant in someone's life. That the antibiotics, as you mentioned, for Chlamydia, are also the same antibiotics we use for Bartonella.

In treating Bartonella or Chlamydia with those antibiotics, those people had a higher incidence of secondary porphyria. And it took me a while to figure it out, and it took a while to realize that we had access to IV glucose dextrose and that that really would help them. But once the acute porphyria was over, then we went back to our normal treatment. And you're correct. Cutting back on the antibiotic dose or switching to a different antibiotic. Some of the antibiotics are less prone to triggering a porphyric reaction than others.

[1:45:36] SCOTT: It could be that that porphyric reaction is also an indication that the therapy from the microbial impact is actually working very well and that the body just isn't ready to go there.

[1:45:52] DR. NATHAN: Right. Oh, absolutely. That is entirely possible. But the people that I was working with were so miserable from the reaction that we had to figure out a way around it.

[1:46:02] SCOTT: When someone has both Lyme and mold, we would generally work to address the mold first. Not always, but generally. Addressing the environment, the mold, the mycotoxins can help to modulate, bring discernment, strengthen the immune system to better deal with chronic infections like Lyme, Bartonella, and Babesia. I hear some people saying, "Well, if you address the mold, that the Lyme and coinfections will go away without treatment." I have not commonly seen that. In fact, I'm not sure that I've ever seen it. I'm sure you have. But I'm curious if do we still need to address Lyme and coinfections after addressing mold? And is maybe the benefit or one of the benefits of addressing mold first that then we can do the lime treatment maybe more gently, maybe with shorter duration.

[1:46:57] DR. NATHAN: Yes. Yes, I almost always treat mold first. Theoretically, if you got mold out of the body and the immune system rebooted itself from that, it could theoretically bring the Lyme and coinfections under control. I'm not sure I've ever seen that. What I typically see clinically is when we get the mold out, people will be anywhere from 50%, to 70%, to 80% better, but they'll still have residual symptoms that point us in the direction of Lyme or the coinfection that's triggering that. We can hone in on it. With that layer of inflammation out of the system, the treatment can be much shorter and much more effective with the antibiotics for the next stage of treatment for mold, for the Lyme.

[1:47:53] SCOTT: I want to just touch on the environmental toxicant exposures that we all have. I'm curious, the more plastics, microplastics, BPAs, PFAS, forever chemicals, all of these things, many of which are newer in the conversation, what are some of the things that you do to help the body deal with the onslaught of environmental toxicants?

[1:48:17] DR. NATHAN: Right, tough question. We're all exposed. And there's not a place on this planet you can go to to not be exposed. Again, taking some binders on a regular basis is something that I do. Sweating of any form, be it a sauna, or a hot tub, or sweating is a great way to get toxins out of the body. Fiber, according to Joe Pizzorno, the number one thing you can do to remove toxins from the body is be sure you get a lot of fiber in the body. It binds to many of these toxic materials. Those are just super basic. Eating organic, being sure the water you drink is good, living in an area where you minimize exposure to toxic air. Not everyone can do that.

[1:49:12] SCOTT: One of the things that you talk about in the book that I think is potentially exciting and probably an area to continue to expand over time is the potential use of some beneficial bacteria to help the body deal with some of these exposures.

I want to touch on glyphosate briefly. We've heard from Stephanie Seneff on that topic. We know that glyphosate potentially substitutes for glycine in our systems. Wondering how much of a role glyphosate toxicity might play in the connective tissue disorder realm, maybe even hypermobility and EDS if it is in fact substituting for glycine in our tissues.

[1:49:53] DR. NATHAN: I believe it is. I don't know that we know the fully extent at this point. I mean, I've eaten organic for 30 years. And I measured my glyphosate a few years ago and was shocked that it was in the 95th percentile. It's like, "How did that happen?" But, as I said, living on this planet is risky. There are ways of removing glyphosate from the body. So, I've got an ionCleanse foot bath device and use it regularly. And Biotoxin Binder has been shown to remove glyphosate from the body.

And if you use the ionCleanse device taking glycine, it helps to remove the glyphosate and replace the glycine that it has messed with. A trick that actually Jill Crista taught me. And my glyphosate numbers are now back in the normal range. But you have to work at it, and you have to kind of know it in order to even know if you have a problem. Even eating organic is not proof positive about these exposures.

I think there are so many of these chemicals that we just don't even know much about. On the horizon, I think it's close, we're going to be able to do envirobiomics, in which we'll be able to measure hundreds of the things we are being exposed to and get a little bit of a blueprint of what's in our bodies, what have we been exposed to, so we can be more intelligent about how we take care of ourselves.

[1:51:33] SCOTT: I did not know that you use an ionCleanse. So, I have to say that's nice new information. I also use an ionCleanse.

I want to touch briefly on EMFs and then a couple more topics as we start wrapping up. So I first heard Dr. Dietrich Klinghardt talk about EMFs January 2006. I think back then, no one was really taking him seriously. I think more and more people are catching on to the impact of all of the frequencies in our environment. Wondering what you've seen with patients in terms of the increase in EMFs and if EMF reduction or mitigation positively is impacting their mast cell activation, their overall sensitivity. What strategies are you finding clinically best for your patients?

[1:52:19] DR. NATHAN: I think that electromagnetic sensitivity is yet another component of limbic sensitization. I think that all sensitizations in the body are controlled, modulated, and regulated by the limbic system. So, there's always going to be a limbic piece to it. Then there is going to be what triggered this in the first place. And here's no surprise, Scott. Mold toxicity has been present in a huge percentage of the people who developed EMF sensitivity.

When I look for and treat mold and treat the limbic system and their mast cells, then the majority of these folks will get well. So, it's treatable, but we need to know, we need to be aware of it and look for it. I wind up asking almost every patient that I consult with, "What's your EMF exposure? And does it bother you? And most people go, "I don't know." And so I very much encourage almost everyone who's chronically ill and sick to get an EMF meter, measure their exposure to all of the devices that they're close to in their home so they can get an idea of what devices need to be shielded, how they need to be shielded to minimize that exposure, because it is a real player.

And yes, it has risen exponentially in the last 20 years. It was relatively rare when smart meters came out in California. I had quite a few patients who had been high-functioning people who went literally brain dead and their energy, their cognitive function just shut down by exposure to the smart meters. And they had to literally go find a place to live in the woods where they weren't near anything to function. It's a very real thing.

[1:54:19] SCOTT: You have for years talked about how the functional medicine approaches to healing the gut may not be the ideal first step in someone dealing with mold and mycotoxins. That we should address the mold and mycotoxins and then come back to those functional medicine approaches for healing the gut. Extending on that same concept, wondering how much of SIBO is potentially SIFO or fungally-derived. And how much of SIBO and SIFO may be coming from whatever is colonized in our sinuses, in our oral cavity in that we're seeding the gut with those microorganisms every time we swallow?

[1:54:59] DR. NATHAN: Huge. And I think that a lot of SIFO is what's causing SIBO. So, there are many people who have SIBO, they take one course of Rifaximin and they get well. Those are people who I suspect had not colonized. But then there's quite a few people who take multiple courses. They get better for a short period of time and then it recurs. Those are people who almost certainly have a fungal Candida overgrowth that, as you're saying, yes, I believe that needs to be addressed first, and then the treatments for their gut will work infinitely better.

[1:55:41] SCOTT: And when we're thinking about the gut, I'm wondering what your current lens is on the parasite conversation. And I know historically treating parasites has not been one of the primary issues that you've worked with in patients or maybe not been a top needle mover for your patients. So, are parasites playing a role in more people today than in the past? And when would that come into your overall treatment timeline?

[1:56:09] DR. NATHAN: It's interesting. I have not seen parasites play much of a role. And I've looked for them. I've treated them aggressively. I've used the same protocol that Simon Yu and Dietrich Klinghardt uses, which is a very aggressive treatment protocol. And I have not seen it help a single patient that I work with. Nor do I doubt some of my colleagues who see a lot of it and feel that that needs to be addressed in order for some of their patients to get well.

I attribute this to patient selection, which is for whatever reason the people who come to me have a certain clinical presentation and they we resonate, and I am able to help them. They sought me for that reason. And I suspect that people with parasites find someone who resonates differently. I haven't seen it, but neither do I doubt Dietrich and Jill Crista, who see it much more commonly than I do.

[1:57:12] SCOTT: You talk about the stigma of ME/CFS being deemed as a psychological condition. You've said that many of these conditions are not psychological but they are neurological. How different are ME/CFS, fibromyalgia, from mold, from chronic Lyme? Are the contributors essentially the same? And when we're talking about ME/CFS and fibromyalgia, are we really looking more at labels where what you're looking at is root causes? Or are there true ideological differences in those conditions?

[1:57:47] DR. NATHAN: Well, first of all, I think that chronic fatigue and fibromyalgia are on a spectrum. The people who are not as ill, have chronic fatigue syndrome, and the worse it gets, then it moves into fibromyalgia. So, I think it's one thing. And recent research on cytokines shows that that is the case. Both conditions have elevated very specific cytokines that we can measure and show that to be the case. And by the way, because of that, it is not psychological. We can literally measure cytokines and say you have this type of inflammation in your body and it is not in your head. We really need to put that to rest.

I think the study that I quote most often is Joe Brewer in 2013 took 112 patients with chronic fatigue syndrome and measured their urine mycotoxins. It was positive in 92%. And when he treated them with our mold treatment protocol, the vast majority got well. I believe what a lot of people being diagnosed as having chronic fatigue and fibromyalgia actually have is mold toxicity and Lyme disease, which is not being diagnosed. And I would actually go so far as to say that a majority probably fall into that category.

[1:59:14] SCOTT: If we then think about the spectrum you just talked about, many children today dealing with autism spectrum, dealing with PANDAS, with PANS, how often do you find mold and vector-borne infections playing a role in driving those conditions? And are the factors that are impacting those children unique, or are they similar to the same factors that adults with chronic Lyme, or ME/CFS, or maybe older in life, neurodegenerative conditions, Alzheimer's, MS, Parkinson's, maybe even ALS are experiencing?

[1:59:48] DR. NATHAN: I think they are completely related. Amy Yasko started writing about this in the 90s, and she believed at that point that the state of your nervous system, dealing with a particular type of inflammation, showed up as autism spectrum in children, fibromyalgia and chronic fatigue in adults, and neurodegenerative disease in older people. And I believe that Amy's observation is correct. I see the same thing. In all of those conditions, we see the same triggers over and over again. So yes, a lot of the kids on the autism spectrum have mold toxicity or Lyme, unrecognized. Other exposures that we don't even know how to diagnose and treat at this point. Environmental exposures of different types. I mean, it's exploding. And I think I am a little bit stunned that the pediatric world hasn't started freaking out about the incidence of autism spectrum disorder because it's obvious that it went from being unheard of when I was in medical school to being one in every 30 births in some states, which is – I mean, sorry, but this is an epidemic. How are we not looking at this? How are we not studying this?

[2:01:15] SCOTT: Yeah, I was shocked recently. I think now in California, the most recent numbers in boys is 1 in 12.

[2:01:21] DR. NATHAN: And it keeps going up. Every time we look at a study, it's more. And so this should be of great concern. And yet people are, "Oh, dear. Yes, it's going up. Too bad." It's like, "Wait a minute. These are our future here."

[2:01:40] SCOTT: I'm going to get to our last three or four questions here and then we'll wrap up. I have more recently become interested in exploring nitric oxide. Planning a podcast on that soon. And in the book, there's discussion around nitric oxide potentially leading to peroxynitrite, which is a free radical. Wondering if you found nitric oxide to help some of your patients to potentially complicate the situation for some of your patients. And then building on that peroxynitrite conversation, which is an oxidant or free radical, we have others, superoxide, hydroxyl radicals, and so on. How do you generally like to approach the redux conversation that oxidant-antioxidant dance or balance? Are you finding hydrogen water, or catalase, or glutathione, or melatonin, or other tools helpful?

[2:02:33] DR. NATHAN: In the 70s and 80s, when we discovered free radicals, that seemed to be the cause of everything. And we treated everything with heavy-duty free radical scavengers, and we were shocked that it didn't make much difference. It just didn't do much. I find the nitric oxide thing. Again, I think I first heard about that maybe 15 years ago. I began to take it personally myself and used it in a lot of my patients, and I didn't see it do much.

My suspicion is, yes, biochemically, it is very definitely a player. But I suspect that it's a drop in the bucket in the entire process that it's taken out of context by itself. I'm not sure that it's going to be doing much. That's just been my experience with it. I've been doing this for 40 years using antioxidants. And by themselves, I have rarely found them to be particularly helpful. It almost always comes back to I've got to treat the cause.

And you might say, "Well, the cause is free radicals," but free radicals generated by what? And that has enabled the vast majority of my patients to get better, finding the cause and treating it successfully. Just working on taking antioxidants has not resulted in the kinds of things we would have expected.

[2:04:12] SCOTT: And I think we now know that some of how the body responds to infection, responds to cancer is through oxidation. So maybe too many antioxidants actually have some potential downsides as well.

[2:04:25] DR. NATHAN: Yeah, I would refer back to Bob Naviaux's paper on oxidative shielding rather than oxidative stress, in which his basic concept, which is brilliant, which is they are shielding us, not damaging us. And we need to look at it in a different context.

[2:04:44] SCOTT: When someone has been ill for years, decades, they potentially have a disease or illness consciousness where the illness has really taken over their life. And this can go as far as to potentially be in a situation where the body itself – this is from your work, the body itself finds it somewhat threatening and feels more comfortable with illness, feels more comfortable with staying in that rut rather than something that is change or different. So, how do we smooth out the path from illness to wellness to allow the body to transition to health in a smooth fashion?

[2:05:29] DR. NATHAN: That is a very good question. And, of course, that depends on the person. At a certain point in treatment, when people who have been sick for a very long time are getting better, I have always started a conversation with them about, "Okay, if you were well, what would your life look like? What do you want to do with your life? What gives your life meaning and purpose? And are you on track for that?" And most of the people that I had that conversation with didn't have any answers for that.

And so, we need to slowly introduce wellness consciousness into them so they would be okay with being well. I've seen a number of people, by your description, start to get well and then get so freaked out by it that they couldn't handle the concept that their life would change as they knew it. Change, being a negative for many people. Even if it's a positive change, still a negative. And some people are unable to shift their consciousness to the point that they can accept healing. And that's a very complicated, difficult, sad process, but it is very real. Introducing a different kind of consciousness is imperative in the healing process somewhere along the line where or people will not be able to tolerate or move past a certain point.

[2:07:09] SCOTT: My last question is the same for every guest. You've probably answered it half a dozen times before. What are some of the key things that you're currently doing in support of your own health?

[2:07:20] DR. NATHAN: Gosh, I think I have answered this many times. But number one, my motto, as I think you know, and has been for years, is to be mindful, be grateful, and to be of service. And I have tried to live that life to the best I can. And honestly, I have created a life of love. I adore my wife, my kids, my dogs. I love where I live. I live in a small coastal town in Oregon, and I have clean air. I can breathe the air very comfortably here. I love that I can still help people. And that especially as I've gotten older and I've had more medical problems that I've had to face, I find that I have to spend more attention to taking more supplements, watch my diet more carefully. I still walk two or three miles a day. I do tai chi and I do Pilates on a regular basis. Ride my bicycle when I can. Walk the beach, which is literally five minutes from my house. But it's really about living in gratitude, which is I am just blessed and so grateful for it that living this way just feels right.

[2:08:46] SCOTT: I love that. I want to remind everybody to check out the second edition of your book, Toxic. It is incredible. I learned a lot of new things, learned new things from this conversation. I will say that one of my biggest blessings in this life has been to know you, Dr. Neil Nathan, and to learn from you. I honor you. I appreciate all you've done to make my life better, to make our community's life better, to make the world a better place. So, thank you.

[2:09:20] DR. NATHAN: And right back at you, Scott. Your tireless work at delving into the depths of healing has affected countless tens of thousands of people. And just stay with it.

[2:09:38] SCOTT: To learn more about today's guest, visit NeilNathanMD.com. That's NeilNathanMD.com. And to get your very own copy of the second edition of Toxic, you'll find the link in the show notes.

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

[2:10:29] ANNOUNCER: Thanks for listening to this BetterHealthGuy Blogcast with Scott, your BetterHealthGuy. To check out additional shows and learn more about Scott's personal journey to better health, please visit BetterHealthGuy.com.

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Disclaimer

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.