ILADS Virtual Mold Seminar - Mold: The Invisible Barrier

I attended the ILADS Virtual Mold Seminar "Mold: The Invisible Barrier" event February 27, 2021.  Mold is one of the most critical things to explore with many chronic conditions.

My notes below are a very small part of all of the information that was shared at this important event.  To learn more about this and other events or to access the recordings, visit ILADS.org.

Disclaimer: Nothing in this text is intended to serve as medical advice. All medical decisions should be made only with the guidance of your own personal licensed medical authority.

Disclaimer: This information was taken as notes during the training course and may not represent the exact statements of the speakers. Errors and/or omissions may be present.

Note: As this information may be updated as any errors are found, I kindly request that you link to this single source of information rather than copying the content below. If any updates or corrections are made, this will help to ensure that anyone reading this is getting the most current and accurate information available. 

Jill Crista, ND spoke on "Mold: The Invisible Barrier" and shared:

• Lyme needs you alive to survive; mold wants to compost you
• Mold has more respiratory, allergy, toxin, genotoxic effects; Lyme more migratory, infection, and no known toxin
• Commonalities: inflammation, immune alterations, neurological, GI, cardio, joint/skin, vision, biofilm/colonization
• Infection may ride into the common area, but not "necessarily" the problem when you get into mold; with mold, colonization is seen, but not necessarily infection
• Lyme disease is an umbrella term for Borrelia species
• Borrelia has to overcome barriers to get into the body; mold helps Lyme to win the obstacle course 
• Innate immune response is non-specific; if you look suspicious, we will destroy you and present to the adaptive immune system 
• Can have an adaptive immune response to mycotoxins; more specific response
• B cells humoral; T cells in T-cell response
• Mast cells and NK cells are part of the innate immune system 
• Innate immune system doesn't feel like the adaptive immune system has its back and overreacts with Borrelia and leads to hyperinflammation and an exhausted innate immune response; adaptive seeming "overreactive"
• Mold impairs macrophage polarization from M1 to M2 and NK cell function, genetically rewires immune system for susceptibility, cytotoxic to polymorphonuclear neutrophils, reduce phagocytosis, and increases survival of mast cells.
• Mycotoxins impede protein synthesis leading to a T and B cell deficiency, increased inflammatory cytokines and chemokines
• Persistent Borrelia survive treatment; most antibiotics are static not cidal
• Mold increases the innate immune system
• MMPs are involved in degradation of the extracellular matrix components; increases followed by mast cell increases as well
• Move lymph for improved delivery to the ECM
• Treat Borrelia appropriately
• Lyme is worse in an inflammatory environment; mold creates inflammation
• IL-1B, TNF-a, IFN-y, IL-17, TLF4 overexpression, TGFb1, VEGF, MMP-9, and M1 to M2 polarization common between Lyme and mold
• Mold is more than spore illness; spores, fragments, mycotoxins, colonization, chemicals such as VOCs/aldehydes/alcohols/mycophenolic acid, biofilm 
• Spores induce, mycotoxins suppress; both deplete 
• People with exposure to damp buildings become allergic to everything; mold is underneath leading to hyper-reactivity
• 500 fragments per spore; tearing out carpet or redoing a bathroom incorrectly can lead to massive fragment release and "mold-othelioma"
• Particulates stay in the lungs until you take action
• Just because we see something a lot doesn't mean it is healthy
• There is wide structural and biosynthetic diversity among mycotoxins
• Mycotoxins are lipophilic; they get into any lipid-rich tissue
• Mycotoxins decrease PC (phosphatidylcholine) ratio of hepatocyte lipid rafts and affect basic function
• Mycotoxins affect CYP450 and glutathione
• Mycotoxins cause mitochondrial damage
• Molds spit out mycotoxins to defend itself via "competitive secretion" 
• Some mycotoxins cross the blood-brain barrier
• Immune suppression via direct action on immune cells, epigenetic alterations to immune response, and direct genetic alterations
• Long-term exposure will lead to IgG subclass deficiencies; subclass 3 is often a gliotoxin exposure
• TGFb1 impairs TReg function
• Gliotoxin can also be secreted from Candida
• If you cannot get platelets up, explore mold
• Mold leads to "sensitive" patients and counterintuitive reactions to medications due to toxicity
• Can have increased bleeding and increased clotting
• She has a questionnaire for the potential of mold illness similar to the Horowitz Lyme/MSIDS questionnaire 
• Peel the Orange: Avoidance, Fundamentals, Protect, Repair, and Fight
• Mold will not increase production of mycotoxin as you attempt to kill it
• Immune Restoration: dilute lipid-soluble toxins with correct fats, restore fat soluble nutrients, push bioflavonoids/polyphenols, support detox, restore mitochondria, choose treatments that do several things
• There is no data on mycotoxin secretion in sweat; may be helpful to support internal detoxification 
• Bile is mycotoxin laden; attempts need to be made to minimize recycling of toxins
• Bile is a detergent that emulsifies fats and eliminates toxins
• Bile deficiency can impact vision
• 10:1 PC to cholesterol
• Bile induces lipase which neutralizes mycotoxins
• Taurine is not a binder but acts similarly; decreases mycotoxin toxicity; acts as a "pre-binder"; protects kidneys (look for dark circles under eyes)
• Vitamin D is important for immune restoration in mold; mold blocks VDR receptors and leads to vitamin D resistance; goal > 60 ng/ml; upregulates MMP-9 expression (watch if Vitamin D seems to be triggering)
• Green tea is a heavy hitter for polyphenols; antifungal, antiviral, and antitoxin effects
• Aloe is a secret weapon; modulates immune system, boosts humoral immunity, anti-inflammatory for mucosal linings, binds aflatoxin; use inner fillet for polysaccharides; whole plant for laxative effect
• Quercetin is a polyphenolic that is a potent antioxidant, anti-inflammatory, and antigenotoxic; downregulates MMP-9; best is liposomal quercetin 
• Artichoke for detoxification; polyphenol rich "detox plant"; protects the immune system 
• Fight phase uses antifungals; uses primarily botanicals starting with gentle approaches
• Uses systemic and intranasal antifungals
• First interface is the sinuses; when she introduced this into her treatment, people got much better; need to knock back fungal colonies
• Strange reactions to antibiotics can occur if the person is reactive to the same mold the antibiotic is made from
• A keynote exposure of mold exposure is tinnitus
• Mold depletes CoQ10
• Statins are mycotoxins
• Side effects from Daptomycin can be a clue for mold illness
• Disulfiram is comparable to fluconazole as an antifungal
• If she uses a pharmaceutical, she uses a natural agent simultaneously
• Garlic, thyme, and oil of oregano may be used to combat resistance of RX medications
• Pau D'Arco is effective in capsules, teas, baths; MIC is similar to Amphotericin B
• IgG subclass 1 and 3 may be affected by mold and Candida
• Starts low and slow with treatments; except for fish oil which is used more liberally 
• Urine mycotoxin testing is an excretion test and can be impacted if the person is a poor detoxifier; leading to false negatives
• In a perfect world, would do both urine and serum testing for mycotoxins 

Chad Prusmack, MD spoke on " Environmental Sub-concussion: The Potential Role of Toxic Burdens in Chronic Traumatic Encephalopathy" and shared: 

• Uses functional medicine for traumatic brain injuries and concussions
• Minimally invasive spinal surgeries
• Environmental "sub-concussion" 
• Traumatic brain injury is the most complicated disease of the most complex organ of the body persisting in an environment full of invisible toxins
• Still lack effective means of prognosis, treatment, and recovery for concussion
• With Lyme and mold, always explore concussion history
• Dysautonomias may be present; POTS being the most common
• Take heart rate and BP while supine and standing; POTS is increase in heart rate of > 30 beats per minute
• Dysautonomia is critical to our danger response and to fight, flight, rest, and digest; impossible to get better if not treated first 
• Uses NeuroQuant to look for Lyme and mold markers
• Low impact exercise within 5 days of concussion can be important
• NAC, Omega 3, D, and ketogenic diet may be used
• Many types: Vestibulo-ocular, Somatic, Cognitive (uncommon), Limbic, Dysautonomic 
• People with CTE have mood-predominant symptoms 
• Midodrine, Propranolol, compression stockings can be helpful for dysautonomias
• Trazadone may be a good sleep option
• EMDR can be helpful in their concussion treatment approaches
• Vestibular system is interrupted in 100% of patients with concussions
• GPS system gets knocked off course; brain becomes more visually dominant and sees the world upright, makes the sea sickness go away, but the timings are then off
• Small lack of timings can lead to long-term back (and other) pain as a compensation 
• Consider glutamate toxicity
• Creatine is the phosphagenic battery of the brain; often used in their programs
• Blood-brain barrier may be injured and systemic toxicities may then gain entry to the brain
• Primary injury is biomechanics; secondary are biochemical, biophysical, blood-brain barrier, microglial priming
• Second impact syndrome potentiates an already swollen brain
• Post Concussive Syndrome is when symptoms last greater than 3 weeks
• May be a long-term effect on neurodegenerative disease
• Alzheimer's is cortical; CTE is subcortical
• Takes a Bredesen-like approach to CTE
• The patient may have been toxic which loaded the gun and the concussion may pull the trigger
• Look at concussion, sub-concussion, and environmental sub-concussions
• Environmental sub-concussion from environmental toxicant exposure that can stimulate chronic neuroimmune activation, ionic shifts, an altered microbiome and other secondary neurochemical events resulting in axonal injury; may be the missing link to neurodegenerative disease 
• Systems approach: genes, toxins, inflammation, imbalances, symptoms
• Looks for Lyme, heavy metals, dysbiosis, gut-brain axis, stool test, HPA axis, nutrients
• Mold and concussion - cognitive impairment from toxigenic fungal exposure similar to TBI
• Mold and tinnitus and oculomotor symptoms associated; impact the vestibular system 
• Mentioned a protein water called BiPro Protein water
• In concussion patients, mold toxicity seen in 38.9%; tick-borne illness 33.3%; dysbiosis 19.4%, heavy metals 11.1% 
• Concussion patients have lower Omega 3 and higher Omega 6
• Concussion patients have lower E, taurine, and indications of oxidative stress
• Concussion patients showed markers of mitochondrial impairment
• Uses Acetyl-L-Carnitine as an energy source
• Concussion patients had more gliotoxin and aflatoxin; he may use Itraconazole as an antifungal
• Stachybotrys, Fusarium, Aspergillus significantly higher in those with concussion and brain injury; may be mediating neuroinflammation
• Treats with NAC, CSM, binders like clay/charcoal/silica, anti-Candida diet, IV PC and glutathione, BPC-157, hormone replacement, Itraconazole/Fluconazole/Nystatin
• Players often exposed to mold in moldy hotels  
• Uses Vibrant, Genova, Great Plains, and LabCorp for lab testing

Lauren Tessier, ND spoke on "Mold Illness In The Pediatric Population" and shared:

• Will not find randomized, placebo controlled studies related to mycotoxins; unethical to expose someone to mycotoxins
• Numerous cases of acute pediatric pulmonary hemorrhage in Cleveland in 90s; CDC found there was exposure to WDBs 
• In 1996, CDC added mold growth, standing water, and dampness to SIDS questionnaire 
• Internal exposure can be from infection, colonization, biofilms, and bioaccumulation
• External exposure can be from food, homes, schools, daycare, church, camps, community buildings, vehicles 
• Schools and daycares are notorious for mold exposure
• 5% of her practice are teachers when less than 1% of the population are teachers; canaries in the coal mine  
• In some cases, the vehicle was the lingering issues after building remediation had occurred 
• Mycotoxins enter the body via the gut, lungs, nose; and in females, vaginal, placenta, and breast milk 
• Systemic circulation = systemic delivery
• Food exposure yields deposition into fatty tissues like the brain and liver
• Inhalation exposure yields to deposition in nasal tissues and in olfactory bulb in the brain
• Children exposed to mold develop increase in IgE sensitivity to non-mold allergens
• Dietary aflatoxin results in significant reduction in SIgA
• Aflatoxin suppresses growth factors and may lead to drops in height and weight
• Fumonisin may lead to decrease in height for age
• Zearalenone demonstrated higher weight than controls; have seen precocious puberty as early as 6 months to 8 years old 
• Mold exposure impacts mental, neurological, and social development
• 70% had abnormal neurological findings including bilateral optic nerve dysfunction and abnormal somatosensory evoked potentials in one study
• Mold exposure may lead to worsening of ADD/ADHD
• Mold exposed ASD children had higher levels of neurobehavioral abnormalities
• Prolonged early postnatal exposure may lead to 3 times the risk of lowered IQ and increase in severity of IQ deficit
• PANS
  • Neurological autoimmunity correlates with mold and mycotoxin exposure
  • Consider testing antibodies against: Neurofilament proteins, Tau proteins, Tubulin, S-100B, MAP-2, MBP, GFAP, myelin-associated glycoprotein 
• Symptoms of mold illness look like Lyme and coinfections 
• Clinical pears for children
  • Delivery: liquids, nebulized/nasal spray, rectal suppositories, sublingual/troche/lollipop/lozenge, lotion/transdermal
  • Binders: blueberry/chocolate smoothie and black lemonade charcoal. applesauce and CSM, increase juice/water, magnesium/trace minerals, D/K, detox co-factors
  • Taste: compounded flavoring, OJ chasers, tongue position
  • Schedule: modified - sometimes is better than never
  • Avoid OTC propylene glycol preparations for constipation 
• Remediation Support for kids: avoidance is the key to recovery
• Kids have important belongings too
• Vacations and positive memories
• Continuity and normalcy is necessary
• Ventral vagal tone is so important
• Counseling/play therapy can be helpful
• Guardians may need support too
• Homeopathic remedies for trauma and grief
• Provokes urine mycotoxin tests for 2 weeks with sublingual glutathione

Jess Peatross, MD spoke on "Mold & Biotoxin Illness: The Hidden Health Hazard" and shared:

• Mold is multicellular forms thread-like structures called hyphae and produces mycotoxins
• Mold forms spores that are easily inhaled and stick in the lungs
• 200 different types of mycotoxins have been discovered
• Consider type of mycotoxin, duration and amount of exposure, age, sex, health status
• Consider combined effects of genetics, dietary status, and interactions with other toxic assaults
• Mold toxicity is a risk in water-damaged buildings and foods; remediation is often not enough 
• Mold can start a process of lowered immunity and/or autoimmunity
• Mold can lead to allergic response and/or to biotoxin illness/CIRS
• In animal models, mycotoxins seem to enhance Th1/Th17; mold illness predisposed to parasites
• Mold "ruins" mitochondria
• Conditions linked to mold/CIRS: sarcoidosis, Hashimoto's, Graves, MCS, MCAS, Fibromyalgia, CFS/ME, Lupus
• 93% of patients with CFS/ME were found to have mycotoxins in their urine
• Mold and mental illness are commonly associated
• Mold can lower IQ points in children exposed to mold long-term
• Mycotoxins damage mitochondria and the ability to produce ATP; leads to excess lactate
• Mycotoxins damage the electron transport chain and can produce free radicals such as SOD and hydrogen peroxide
• Chronic illness is not the body; it is something in the environment or inside of us that leads to the illness
• Living near cell towers does not bode well for patients with mold; may have more EMF sensitivity
• Mycophenolic acid is an immune-suppressant used to avoid organ rejection
• Gram-negative endotoxin / LPS can be tested for with Envirobiomics
• Mitochondrial symptoms: chronic fatigue, brain fog, paresthesias, depression, pain, blood sugar issues
• Mitochondrial supports: fulvic/humic acids, amino acids, CoQ10, NADH
• Uses CellCore MitoATP; like a shot of expresso for many patients
• Drainage and Lymphatic Support: rest/sleep, lymphatic compression, standing, craniosacral, massage, dry brushing, sauna, exercise
• Glutathione conjugation is not the primary detoxification pathway for mycotoxins; glucuronidation impacts a broader number of mycotoxins
• TUDCA is a water-soluble bile acid to support drainage
• Coffee enemas are a mainstay of treatment
• May start with distilled water enemas, then chamomile tea, then coffee enemas
• Castor oil packs can be helpful
• Constipation: colonics, enemas, fiber, extra hydration, exercise, magnesium, senna, chew food well, bitters, whole/real foods 
• Drainage funnel: colon, liver/bile, lymph, organs/tissues, cells
• Need binders that cross the blood/brain barrier to access lipophilic toxins
• Cannot use binders if still constipated
• Cholestyramine is not that good of a binder
• New breakthrough is the bioactive carbon binders that makes other binders obsolete; do not strip the body of nutrition; actually provides it
• Most binders have their energy removed; think cow patties
• Many organ systems responsible for mycotoxin detox; need to keep the body open
• CT Minerals to feed cells
• Advanced TUDCA to move bile
• MitoATP to increase ATP production
• HydrOxygen to hyperoxygenate the body, aid mitochondria
• InflammaControl to calm the innate immune response and inflammatory cascade, activate NRF2  
• Support bowel movements and phase 1/2 liver detox and mitochondria
• Trigger sweating/sauna combined with binders
• Supplement Omega 3; avoid moldy foods
• Nasal sprays like Propolis and D-NASAL spray
• Mold does not run alone' has friends like Candida, tick-borne illness, viruses
• Listen to the body! 

Paula Kruppstadt, MD spoke on "Tools to Identify Concurrent Mold/Biotoxin Illness in Your Pediatric Patients with Vector-Borne Disease" and shared:

• Was treating children for mold illness and found some plateaued; then started exploring Lyme 
• Snakes have venom; molds have mycotoxins; to protect themselves
• Every child that has Borrelia or co-infections should be evaluated for CIRS with HLA-DR, MSH, TGFb1, and MARCoNS; immune dysregulation needs to be returned to normal 
• Eradicating Lyme organisms may not be possible if the environment is not clean or MARCoNS is present
• Pediatric CIRS prevalence is 7.01-12.5%; asthma prevalence 8.3%; CIRS is possibly/probably more common than the most common pediatric illness of asthma
• Many of the children have nocturnal enuresis; bed-wetting
• If child is < 5 years of age and has chronic headache > 1-2 months, abdominal pain > 1 month, fatigue > 2 weeks, evaluate for CIRS. If < 11 years old, 6 or more of the symptom clusters present.  If > 11 years old, 8 or more clusters are present
• Claw hands, think TGFb1
• Top 6 CIRS symptoms in children: fatigue, chronic abdominal pain, chronic headache, prolonged growing pains, enuresis, inattentiveness (ADD/ADHD)
• Fatigue: rule out infections like EBV, influenza, Mycoplasma; no energy to play; difficulty getting out of bed; wired and tired; want to lay on couch; tongue-tie/lip-tie; 
• High levels of glutamate
• 80% of children with PANS/PANDAS have small tonsils; atrophy
• Inattentiveness, memory impairment, ice pick pain, skin sensitivity commonly seen in CIRS
• Little bodies are resilient
• VCS can be used to measure progress and exposure (can become positive in as little as 12 hours)
• Physical findings: aniscoria, anti-gravity muscle weakness, weakness in shoulder extensor muscles and decreased forearm/arm strength, temperature gun on extremities to check for ANS dysregulation, pale nail bends, claw hands, red eyes, nasal congestion, hyperflexibility
• Biomarkers: HLA-DR, MSH, MARCoNS, TGFb1, ADH/Osmo, MMP9, VEGF, VIP, C4a, ACTH/cortisol
• Child > 11 years old needs 5 or more biomarkers along with positive symptom clusters, VCS, physical exam; < 11 years old need 4 biomarkers
• Multisusceptible HLA means any biological toxin can activate the biotoxin pathway
• If the MSH falls below 10, assume the person responds as if they are multisusceptible 
• MSH is the first to fall and last to correct
• 1200mg EPA/900mg DHA for 1-2 weeks before starting a binder and continuing until biomarkers are restored
• Use Symptom Clusters with pediatric standards 
• Use VCS testing
• Do a physical exam to look for signs of biotoxin illness
• Obtain biomarkers and utilize age-appropriate standards for CIRS in children
• Remove from moldy environments
• Start on fish oil and then a binder
• Eradicate MARCoNS 
• For infection testing, has used IGeneX and LabCorp; currently likes Vibrant Wellness
• Finds CSM often works well in children

Kristine Gedroic, MD spoke on "The Role of the Mycobiome in Chronic Inflammatory Diseases: and shared:

• The microbiome is impacted by geography, age, diet, breast or formula-red, vertical transmission (C-section vs. vaginal delivery), medications
• Up to 14,000 strains of bacteria
• Human carries 37 trillion bacteria
• We have as many genes as a fly
• Mycobiome is a growing field starting in 2010
• Molds within us guide inflammatory and anti-inflammatory pathways
• Fungi regulate the autonomic nervous system
• A large part of COVID cytokine storm is probably governed by the fungal response to the virus
• The microbiome is a large biofilm
• Treating biofilms in infections is similar to the microbiome
• Microbiome is a biofilm in the gut
• These biofilms are important in modulating chronic inflammatory disease
• There is "cross-talk" between the fungi and the host
• Fungal-bacterial interactions can be antagonist, synergistic, or symbiotic 
• Many diseases are the result of disturbance in the mycobiome: CF, IBD, chronic liver disease, dermatitis 
• A huge part of the autoimmune epidemic is the dysregulation of the microbiome
• Yeast in the gut can be commensal or infection 
• Fungal biofilms are far more susceptible to natural therapies long-term; garlic, berberines, spices
• Biome has historically been regulated with natural spices and foods now disregarded by modern cultures
• Much of depression and need for SSRIs are due to microbiome no longer efficiently regulating the tryptophan pathway
• Dietary tryptophan is metabolized by Lactobacilli and yeast
• Mycotoxins generated as fungal metabolites contribute to disturbance of GI barrier and immune functions and are associated with chronic intestinal inflammatory conditions
• Treating biofilms and fungal constituents is an important part of her approach
• Mycotoxicoses is "poisoning by natural means"; internal production of molds and internal production of mycotoxins
• Mycotoxins are poisons
• Baby food is often a high source of numerous mycotoxins
• Fumonisins reside in corn; inhibit ceramide synthase involved in creation of myelin, deplete sphingolipids and impact membrane proteins; folic acid receptor is bound by rafts; not able to bring folate across the cell membrane and leading to neural tube defects
• Critical to bring fat levels back up in those with mold/mycotoxin illness; need to restore lipid physiology
• Mycotoxicosis symptoms: fatigue, pain, Fibromyalgia, headaches, paresthesias, limbs fall asleep, GI/IBS, noise and light sensitive, vision issues, ringing in ears, anxiety, panic disorder, POTS/dysautonomia 
• Sees fungal correlation with PANS
• Fungai reek havoc on the body if out of balance
• Treatment Steps
  • Restore lipid balance with PC/PE/Omega 6 (linoleic acid is antimicrobial); PC is anti-inflammatory; mold strips PC; PC inhibits TNFa
  • Reduce inflammation; butyrate, very little manufactured in the biome today; supplementation is critical to lower inflammation
  • Support enterohepatic circulation; gallbladder/liver; CSM can slow this down; increase with cholagogues (bitters) and ox bile
  • Feed the microbiome; pre/probiotics, bone broth, reduce carbs/sugar
• Shake options: PC, Balance Oil, Evening Primrose, minerals, multivitamins
• IV phenylbutyrate works differently than oral; anti-inflammatory effects and CNS effects more evident with IV forms; oral for restoring biome; may be used together; oral butyrate can be helpful in chronic viral syndromes
• Parasite testing is most challenging to get accurate results 
• Ox bile is antimicrobial and modulates biofilm communities; needed for assimilation of fats
• Gallbladder ND, artichoke, bitters can be helpful as cholagogues to cause the gallbladder to contract
• IV butyrate has been a helpful provocation agent for urine mycotoxin testing

Disclaimer: While I attempted to accurately represent the statements of the various speakers, it is possible that the above contains errors or inaccuracies. If you have any corrections to the content listed above, please Contact Me.