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ISEAI 2022: Cultivating Resilience: The Environmentally Acquired Illness Framework

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I had the honor of attending the ISEAI 2022 event "Cultivating Resilience: The Environmentally Acquired Illness Framework" on May 20-22, 2022.  

It has long been my opinion that many of the complex conditions we face today are the result of our external environment.  ISEAI is a leading organization sharing this message; as well as fostering collaboration and sharing solutions to improve the quality of our lives.

I strongly encourage practitioners working with complex, chronic illnesses to join ISEAI; become part of the conversation and ultimately the solution.

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.

  • 90% of more of one's time is spent indoors
  • Need to look at the indoor environment in those with complex, chronic illnesses

Mark Su, MD spoke on "ISEAI Framework: Advancements in the Treatment of Chronic Complex Patients" and shared:

  • May need to continue to layer in additional explorations, testing, and treatment options
  • He has been using the Cyrex Lymphocyte Map to explore balance of Th1/Th2/Th17
  • 3 part model health map: self (you), exposome (not you), interfaces (self/non-self interaction)
  • Exposome: subclinical pathogens, biotoxins, synthetic toxicants, food reactants, environmental allergens
  • Interface: skin, respiratory tract, gut
  • Self: immune, hormones, neurotransmitters, genetics, autoimmunity
  • Weaker interfaces leads to greater assault from exposome on the self
  • Subclinical pathogens: tick-borne pathogens, virus, yeast, mold, parasites, other bacteria in gut/sinus/oral
  • Toxicants: heavy metals, EMFs, persistent organic pollutants, pesticides
  • Biotoxins: mold, cyanotoxins, neurotoxins
  • "Back 9" are not the root causes but often need to be explored: MCAS, SIBO, hEDS, hypercoagulation, dysautonomia, ECM dysfunction, sleep disorders, malnutrition, mental health and limbic system
  • Where do you go with a patient that has been treated and is not seeing improvement?  There are so many possibilities
  • Mold and mycotoxins are often a kingpin in patient presentation
  • Additional comments from Q&A
    • MCAS is a common issue
    • SIBO seems to be lessening
    • Hyperlaxity is an important consideration

Michael Schrantz spoke on "Day 1 Overview: The Exposome - ISEAI Approach to Mold and the Indoor Environment" and shared:

  • Mold and bacteria are often found in water-damaged buildings; but there are allergens, chemicals, VOCs, and EMFs as well
  • IEP is "Indoor Environmental Professional" and essentially the doctor of your home
  • There are different types of IEPs in the industry
  • Need to find a balanced IEP; some may not do adequate testing; others may trigger the limbic system; don't want a minimalist or an extremist 
  • IEP and remediation should generally be different companies to avoid conflicts of interest
  • To find an IEP, visit ISEAI.org or Building Biology Institute or American Council for Accredited Certifications
  • CIEC or CMC for assessor
  • Within ISEAI, there is an IEP committee that are working on providing resources and documentation such as ISEAI Mold Remediation Fact Sheet

Larry Schwartz spoke on "Overview of Indoor Environmental Health: Assessment, Air Quality, Water Quality, EMFs" and shared:

  • IEPs keep things from coming into the bucket; doctors work on emptying the bucket; symptoms are an overflowing bucket
  • 5-10% have allergy and inflammation to mold and water-damage; often upper respiratory; symptoms resolve when not in the presence of mold if one is dealing with allergy; this is the primary conventional paradigm
  • 24% of the population have a genetic predisposition to chronic inflammation with exposure
  • Mold inspector performs visual inspection and testing; may perform spore trap tests, tape lifts, swabs, inside wall checks, bulk samples, culture plates, and more; perform visual inspection and testing for post-remediation; create a report of observations and testing plus possibly remediation plans
  • Testing does not locate where reservoirs of mold may exist
  • Often no testing of chemicals, EMFs, RFs, electric fields, VOCs, particle densities, chemicals
  • Creating a Safe Indoor Environment
    • Assess indoor air quality, exterior drainage, interior, HVAC, ventilation, VOCs, EMFs, chemicals, water quality
    • Find sources and causes of items found and how to eliminate
    • Create a treatment plan
    • Offer a plan to keep the indoor air quality safe over time
  • Prioritize remediation steps in order to get the best result for the investment
  • Humidity should ideally be between 40-60%
  • Run air purification and clean duct work, furnace fan, and evaporator coils
  • Molds, bacteria, and numerous biological microbial contaminants
  • 10 specific species of Actinomycetes
  • Elevated levels of endotoxins from dead outer cell walls of gram-negative bacteria; more common than gram-positive in water-damaged buildings
  • VOCs and mVOCs which are created from molds
  • Chemicals on surfaces of mold spores; mold particles can be in higher density than spores themselves
  • In priority, he finds these items trigger stress in inflammatory patients: water damage (100%), VOCs (90%), mold VOCs (90%), chemicals (80%), EMFs (70%)
  • Each patient will have a different trigger point that leads to symptoms; will react differently to different trigger levels
  • Want a "medically-sound" IEP that understands the health implications of these exposures
  • Faraday cages are a primary way to address EMFs; mesh is grounded to drain what it captures in the air
  • There are many potential stressors to consider besides mold
  • Within Actinomycetes testing by EnviroBiomics, 33 human/13 soil habitat; 5 pathogenic in human and 5 in soil habitat
  • Expand horizons; look outside-the-box
  • Air purification devices all have limitations; they may or may not be enough
  • Additional comments from Q&A
    • Can get a formaldehyde and total VOC meter for a couple hundred dollars; not perfect, but gives insights
    • Dryer climates still have plenty of bad stuff to create similar problems
    • Whole house humidifiers may be needed in dryer climates
    • Need 40% or higher humidity for PCO devices to create hydroxyl-radicals
    • Likes HEPA filtration and purification; PCO is not filtering but is a chemical reaction that creates OH molecules that grab contaminants; these work differently and likes a combination of both; want a device that does not create ozone
    • Homes have negative pressure from fans; may suck air out of drain pipes; can contaminate the air; keep water in drains that you do not use; mild detergent and water with vinegar to brush up/down in the drain, repeat, flush with water, and then use hydrogen peroxide in the drain, sit 10-15 minutes, and rinse

Kellyn Milani, ND spoke on "Mold Illness Diagnosis & Treatment" and shared:

  • Environmentally Acquired Illness may be related to mold, biotoxins, Lyme, persistent infections, chemicals, pesticides, heavy metals, pollution, dust, and other irritants in the environment
  • Illnesses caused by mold: allergy, infection, GI yeast colonization, sinus colonization, mycotoxicosis from food, WDB Illness/CIRS
  • CIRS is multi-system, multi-symptom; more than mold; toxic soup of mold, bacteria, viruses, VOCs, dust mites, protozoa
  • Mold spores are 1-20 microns; viruses 0.004 to 0.1 microns; mycotoxins 0.1 to 0.3 microns
  • Mycotoxins can cross the blood-brain barrier
  • Inhalation, ingestion, and dermal absorption
  • > 50% of buildings in the US are water-damaged
  • Light sensitivity, sound sensitivity, smell sensitivity are common in mold illness
  • Dermatographia is commonly seen in mold illness
  • Can present with anxiety, depression, fear, anger, irritability, mood swings, impaired executive function, inability to learn new information, distractibility/poor focus; consider MoCA testing can be helpful at start of treatment and to follow
  • Important to consider exposure history and history of environments mapped to symptoms
  • Has found several patients that had mold related to automatic ice makers or water dispensers on fridges
  • Don't forget to explore churches, friends/family members homes, grocery stores, or other frequent exposures
  • Slab foundation is better than having a crawlspace
  • Schools are notoriously terrible
  • IEPs are at risk due to their profession and higher exposure rates
  • Renovators and house-flippers may have higher risk
  • The faster a patient can create a relationship with an IEP, the faster they can recover their health
  • Differentials: ME/CFS, Lyme, Fibromyalgia, MCS, EDS, MCAS, autoimmune disease, celiac, IBD/IBS/SIBO, psychiatric, endocrine, diabetes, cancer
  • VCS testing is 92% sensitive with false negatives in artists, engineers, and those with excellent vision; 98% specific with false positive with occupational chemical exposure; vcstest.com and survivingmold.com
  • Labs: TGFb1, MMP9, C3a, C4a, MSH, VIP, ADH, urine mycotoxins, IgG/IgE antibodies
  • Others: VEGF, anti-cardiolipin antibodies, Von Willebrands, ACTH/Cortisol, testosterone/DHEA, CD4+CD25++, HLA/GENIE, immunoglobulins
  • Want to look at more traditional labs as well such as: CBC, CMP, insulin, lipids, iron/ferritin, thyroids, ANA, hsCRP, amylase/lipase, rheumatoid factor, anti-CCP, HbA1C, D, hormones, GI, tick-borne disease
  • Galaxy or IGeneX for tick-borne disease testing
  • MARCoNS can lead to worsening of inflammation
  • NeuroQuant has strong reliability; available nationwide
  • Removal from exposure is the most important step
  • ERMI can be helpful
  • Mold sabbaticals can be helpful; complete avoidance and minimal belongings for at least 2 weeks
  • Binders open the drain to mop up the mess; decrease enterohepatic recirculation; hard to take multiple times per day; can lead to constipation, gas, bloating; can see intensification reaction in those with Lyme; empty stomach 30 minutes before or 60 minutes after; 2 hours before meds/supps or 4 hours after meds/supps
  • CSM and Welchol are the two primary RX binders; Welchol is 25% as effective as CSM but better tolerated
  • Charcoal, clay, chlorella, modified citrus pectin, zeolite, fibers, okra, chitosan
  • EDTA/silver or EDTA nasal spray for MARCoNS
  • When MARCoNS persists, explore ongoing exposures, dental work/cavitations, replace toothbrush and CPAP parts, explore partner, consider saline rinses, Xylitol, ozone
  • Correcting inflammation: anti-inflammatory diet, omega 3, curcumin, EGCG/green tea, resveratrol, NAC, glutathione, melatonin, CBD, berberine, Scutellaria, Gingko, LDN, Losartan, Actos (black-box warning), VIP
  • Mold illness is an oxidative process
  • VIP may be a therapeutic option for Long COVID
  • Behavioral: diet, mind/body, limbic retraining, somatic experiencing, counseling, exercise, sauna, sleep
  • Care should be individualized; meet the person where they are at

A few comments from BodyBio Q&A:

  • PC makes up the majority of cell membranes; gives cells what they need to repair membranes; toxins and biotoxins attached to old membrane components are removed
  • BodyBio is a blend of 4 different types of phospholipids
  • PC can support mitochondria, brain health, cellular repair, detoxification
  • Liposomes interact with the mucosal layer of the GI tract to increase time nutrients spend at areas of absorption
  • Lecithin powder contains about 15% PC; higher grade may be up to 50-95%
  • Lecithin can turn into TMAO; clinically has not seen that issue with BodyBio PC
  • Mitochondrial health: PC/PE, linoleic acid; B1, B2, B3, carnitine for citric acid; NAC, carnitine, and CoQ10 for electron transport chain; antioxidants like R-ALA, C, E, glutathione; TUDCA and ox bile for fat digestion
  • In research, butyrate is fuel for colonocytes, improves tight junction and brain barrier integrity, is effective against all forms of cancer; improves insulin sensitivity and glucose regulation; prevents mast cell degranulation; crosses blood-brain barrier and can be a fuel for the neurons
  • There is no soy protein remaining in the BodyBio PC product
  • Membrane-stabilizing Power Shake contains BodyBio PC; other ingredients in the shake may become liposomal; want to consider any excipients, toxins, etc. that you do not want to become liposomal

Lauren Tessier, ND spoke on "Mold, Mycotoxins, and The Possible Connection to Autoimmunity" and shared: 

  • Mycotoxins can evade removal from the body via impacting Phase 1 and Phase 2 detoxification pathways
  • Types of mold illness: fungal infection/colonization, fungal allergy, mycotoxicosis, CIRS/EIA/Chronic Inflammation
  • Once a mycotoxin hits the bloodstream, it is delivered to all parts of the body
  • 5-7% of the population has an autoimmune disease; 80-100+ autoimmune conditions
  • Autoimmune causes: genetics, environmental factors, infections; results in altered gene expression, molecular mimicry, epitope spreading, and apoptosis
  • There is a less of self-tolerance in autoimmunity
  • Th1/Th2/Th17/Tregs; Tregs modify function of Th1/Th2/Th17 as well as the ratios
  • Initially thought Th1 drove autoimmunity; now recognize Th17 are more associated with autoimmunity
  • Tregs are the cells that fight against autoimmunity; want healthy levels
  • Fungi trigger robust Th17 responses
  • Response to Aspergillus fumigatus may trigger a response to cross-reactive human tissues
  • Long-term antifungals may reduce beneficial fungi and increase problematic fungal species and exacerbate autoimmune conditions
  • 2003 study with peripheral neuropathy and mold exposure showed significant autoimmunity
  • Mold exposure may lead to neurological tissue autoimmunity
  • You don't want to give antifungals to someone that still has exposure; they can get reinoculated
  • All testing for mold illness is flawed; there is no perfect test
  • Mycotoxin testing is a metabolite testing; what has left the body; not diagnostic, but helpful for success/tracking treatment when considering clinical improvement; changes can be related to changes in Phase 1 and Phase 2 detox pathways
  • Specialists are amazing for testing for autoimmunity but don't often look for root causes
  • Autoimmunity happens in kids as well; PANS/PANDAS cases are not just Strep
  • Addressing Mold Illness
    • Identify likelihood of illness
    • Address exposures (internal and external)
    • Gut and detox preparation
    • Binders and detox
    • Correct inflammation
  • To address autoimmunity, support reduction of IL-17 and support modulation of Th17; melatonin, Artemisia, zinc, Schisandra do both
  • Support Treg cells; Salvia miltiorrhiza, melatonin, Artemisia, zinc, CoQ10, and others
  • Melatonin, zinc, LDN, Artemisia, quercetin, NAC have been helpful interventions for autoimmunity associated with mold illness
  • Treatment
    • Calm the immune system
    • Address stress/limbic system
    • Address comorbidities 
    • Address MCAS
    • Address mold illness (see above)
  • Nrf2 support is needed to address the impact of mold/mycotoxins
  • Avoidance is the cornerstone, but perfection is entrapment

A few comments from RealTime Labs Q&A:

  • They test for 5 different groups of mycotoxins
  • Uses ELISA testing
  • Values should come down over time with sequential testing
  • 3-6 months is a reasonable period of time to re-test
  • Results of EMMA (dust testing for molds and mycotoxins) can often be correlated to the mycotoxins found in the urine testing
  • The lab does not recommend doing a provocation with glutathione prior to the urine collection
  • Urines are diluted at a certain concentration which makes creatinine adjustments not relevant
  • Reference ranges are based on unprovoked samples from random patients; not mold patients only
  • Equivocal results should be explored as positive results

JW Biava spoke on "Mold Assessment & Testing: DIY Considerations" and shared:

  • He is the owner of ImmunoLytics
  • Two methods
    • IEP - $500-$6,000
    • DIY - $15-$600
  • Spore traps, gravity plates, HERTSMI, Swabs, Tape Lifts, ERMI
  • DIY can be helpful for longer-term monitoring
  • Important to have a system to provide interpretation and guidance; not just results
  • 3rd party sampling is best for litigation
  • When time is critical such as a home purchase or rental, DIY may not be ideal
  • Errors in Mold Testing
    • Sampling errors - insufficient samples, sample location, poor air flow, disturbance by occupants, non-steady state building conditions
    • Analytical error - human error / variability between analysts, instrumentation or reagent variability
  • Increasing number of samples increases statical confidence
  • False negatives can be from inefficient sampling
  • Collect as many samples as budget allows; balance cost and information
  • Swab all visible molds; Stachybotrys and Chaetomium don't stay in the air and drop to surfaces quickly
  • Samples areas with known water damage
  • Collect samples from areas that you spend the most time in
  • Note areas with strange smells or that feel weird
  • qPCR or MSQPCR is the technology; ERMI/HERTSMI are report interpretations and may not be ideal; good for Stachybotrys and Chaetomium; detects small fragments; dead or alive mold; expensive; only detects 36 molds (100,000+ known)
  • 5mg dust used for qPCR testing; pinch of salt weights 360mg; average home collects 40 pounds of dust per year
  • Spore traps: industry standard/most common; alive and dead mold; microscopy detects more species than ERMI/HERTSMI; typically an inspector; 5-10 minute sample period; compares inside/outside (not the best idea idea; average outside sample is 6 times worse than inside); ~$50 per sample
  • Bulk samples (swab, tape): alive/dead; more species than ERMI/HERTSMI; identify sources; detects mold not present in air; ~$35 per sample; does not directly correlate to health symptoms
  • Mold Check-Up Plates: not the same as gravity plates from Home Depot; $3/plate or $33 with analysis; can do tap testing (4 taps); detects many molds missed by other tests; best combined with swabs; only detects live mold; does not detect Stachybotrys; not as precise as spore traps; not as sensitive as qPCR

Bill Weber spoke on "Indoor Air Quality: Building Defects & Construction Considerations" and shared:

  • Typical patient either recently moved into a house or has children with symptoms
  • Air sampling can be better with longer and increased number of samples
  • Activity in the sampled area impacts air sampling results
  • Comparing indoor and outdoor is not a fair way to assess; snowing outside would lead to lower outdoor levels
  • Most molds cannot be identified to species; Aspergillus and Penicillium; some are pathogenic, toxigenic, or allergenic; species can matter
  • Likes to do both MSqPCR (alive/dead/dormant) and culture (viable)
  • Investigation may explore sampling data, historical data, architectural plans, real estate documents, climate considerations, inspection of attic/crawlspace/interior/exterior/HVAC
  • Fog on the coast is water vapor; wets surfaces and drives moisture into buildings
  • Crawlspaces are the only unimproved area and least inspected area of most homes; Stack Effect is where warm air rises; damp or wet soil; lack of ventilation
  • Spray foam insulation is not recommended for those with chemical sensitivities
  • 28% moisture is when wood starts to rot; 16% can support mold growth
  • Stack Effect
    • Warm air rises in winter
    • Warm air comes down in summer
    • Air in attic and crawlspace have an effect in the living space
  • Vinyl floors with felt backing have an indicator dye that can look like mold; still an indication of a water-intrusion problem
  • Mold grows on dirt and dust with moisture and oxygen; does not have to be organic matter
  • A home built from 1920s to 1950s may have button board which can create a mold issue
  • Neodymium magnets can be used to find fasteners in drywall to differentiate from plaster
  • Vaulted ceilings often lack ventilation
  • Need teamwork: Physician, IEP, forensic building consultant, remediation contractor
  • In most instances, the misuse of air sampling doesn't provide the data needed to make good decisions
  • Successful remediation can be done if a thorough assessment of the property is performed
  • Hidden reservoirs are often found int he least likely spaces; crawlspaces, attics, unvented vaulted ceilings

A few comments from EnviroBiomics Q&A:

  • DNA testing for bacteria and mold; as well as endotoxin and mycotoxin testing
  • ERMI is MSQPCR; they also have some tests that use Next-Generation Sequencing
  • The offer free consultations of test results
  • Can pay for same-day testing for cases where quicker results are needed
  • With the Swiffer method for collection of dust samples compared to carpet collection, the results are comparable
  • IEPs stay away from certain surfaces including floors at times to avoid false positives; may be tracking something in which originated outside and does not always reflect a mold problem indoors

A few comments from the IEP Panel:

  • Wood products will generally come with mold; problem is when they become wet or become enclosed/wet; can be death by a thousand cuts
  • 95% of Actinos have elevated prevalence index; explanation of the Actinos index
  • Highest levels of Actinos are the rooms occupied by the most people for the longest time
  • Highest level with testing has been dust coming off of mattresses; main factory for Actinos
  • ERMI score itself has not been a good indicator; need to focus on the specific molds
  • Ideal not to use any paper-based gypsum (drywall) in any structures; eliminating drywall eliminates mold food
  • Greenboard is water-resistant; not waterproof; not recommended for use in homes
  • Testing furniture can be done with mold plates and tap testing; 4 times tapping the plate to the object; have had great success with tap testing
  • Many times, new furniture is as bad as the furniture you already have
  • It's often not what we know, but what we don't know that is of biggest concern
  • With belongings, remove as much as possible, observe the new health baseline, and then slowly reintroduce items and monitor for reactions
  • Ventilation techniques can be significant in improving an environment
  • Neutral or positive pressure will help to minimize pulling contaminants from outside into the home

Mary Ackerley, MD, Georgina Hale, MD, Kelly McCann, MD, and Lauren Tessier, ND spoke on  "Clinical Wisdom for Approaching Mold Exposure with Complex Chronically Ill Patients" and shared:

  • Least constipating binder is person-specific; chlorella can be well-tolerated but can also trigger MCAS in some; Sacc B, NAC, probiotics; glucomannan; open detox pathways, work on vagal nerve which plays a role in constipation; LDN can be a miracle in some
  • Dr. Ackerley feels people need to get into their bodies; the Gupta Program is a go-to limbic and vagal program; visceral massage can help the vagus nerve; there is no "one and done" program
  • Dr. McCann feels somatic experiencing can be a helpful tool for getting back into the body; fascial counterstrain is a modality that needs more awareness
  • Difficult to measure the impact of EMF on inflammatory markers given that mold, COVID, vaccination, and many other factors may impact these markers; many assume EMFs will influence biotoxin markers
  • CDP choline, magnesium, zinc, PC can be helpful for ADD
  • Levels of TGFb1 can vary based on many factors; lab tech and drawing can impact/elevate the results; Dr. McCann checked thousands early on; everyone had a TGFb1 of 4000-5000; does only periodically these days; these are not perfect tests; Dr. Ackerley suggested "normal" has crept up; normal now she sees as 4000-5000; has seen 40-53K; some have reported up to 100K; more variables have emerged; should come down as a patient improves; baseline should be below 10,000
  • Dr. Tessier addresses urine mycotoxins before exploring biotoxin markers
  • If in a moldy building, it is unlikely that one will clear SIBO/SIFO; need to look more for root causes
  • Treatment should go low and slow to prevent huge fallbacks
  • Tremendous value of all the fats that we don't fully understand; fish oil, PC, evening primrose, BodyBio Balance Oil, and others
  • Getting oils and bile going will help with constipation
  • Mycoplasma grows in water-damaged buildings; olive oil can be very helpful with Mycoplasma and cleaning of the cilia; often undervalued, helpful for persistent cough
  • Some may not tolerate oils; gallbladder may not be working well; need to work on bile flow, TUDCA, bitters before adding oils
  • For Mycoplasma, Houttuynia, Researched Nutritionals Myc-P, Woodland Essence MYCO Formula, Byron White A-MYCO
  • Patients are much sicker now then they ever were in the past; practitioners need to remain curious and committed to learning
  • There are connections that are unseen; we need to follow our intuition, put the puzzle pieces together, and find the data
  • As an infectious disease specialist, Dr. Hale shared the importance of mast cells first; antimicrobials first can make things worse

Kelly McCann, MD spoke on "Lyme and Co-Infections Demystified" and shared:

  • The scope of the problem is massive; vector-borne disease is common; 476K cases annually in the US; likely still an underdiagnosis
  • Lyme will be renamed to Borreliella (not a spelling error) burgdorferi, relapsing fevers will retain Borrelia
  • IDSA suggests that there is not persistent infection, and it is "Post Lyme"
  • Lyme is in all 50 states in the country
  • 43% with Lyme are unable to work; others miss work or need to work at home
  • 46% with chronic Lyme spend at least $5,000 per year on medical care
  • Alpha-gal, a sugar, is found in mammal products; meat; it is an allergic reaction 
  • Found in pork, beef, rabbit, lamb, venison, gelatin, cow's milk, and milk products
  • More common after a Lone Star tick bite
  • Treatment is avoidance; possibly immunotherapy in the future
  • More pain, cognitive issues, depression, neuropathy in chronic Lyme
  • Only 9% get a bull's eye rash; 25-30% remember a tick bite
  • Horowitz MSIDS questionnaire is a validated questionnaire 
  • Migratory symptoms are the hallmark of Lyme disease
  • Many neuropsychiatric symptoms can be related to Lyme and co-infections
  • Tick-borne is a misnomer; more likely vector-borne
  • Babesia is "North American Malaria"; impacts brain an autonomic nervous system, drenching sweats, temperature dysregulation; more about cognitive dysfunction; air hunger, shortness of breath; over 100 different species of Babesia
  • Suspects Babesia when CD57 is < 30
  • Blood donations are only screened for Babesia microti
  • Bartonella has swollen glands, flu-like symptoms, pain syndromes, interstitial cystitis, pain in soles of feet, anxiety, lymph nodes, sore throats, neuropathy, psychiatric manifestations, ocular manifestations
  • Over 20 species; only known since 1990
  • CDC maintains Bartonella is not transmitted by ticks
  • One study in California showed 19% of ticks had Bartonella
  • Ehrlichia and Anaplasma can lead to elevated liver function tests; similar to Rickettsia; rashes, congestion, edema, blurry vision, hypercoagulation
  • Rickettsia found in 42% of dogs and 79% of cats
  • Chlamydia and Mycoplasma need to be treated; difficult to eradicate; can be involved in atherosclerosis and MS
  • Mycoplasma creates an exotoxin that increases virulence
  • CDC still recommends two-tiered testing
  • CDC specifically recommends against many different types of tests for Lyme that are in use
  • Bands 31 and 34 were removed from most commercial tests as the Lyme vaccine used these and could then result in false positive tests
  • Stony Brook, IGeneX, MDL, Infectolab, ArminLabs, Galaxy, Fry Labs, Immunosciences, Vibrant, DNA Connexions
  • EliSpot and IGXSpot look at T cells and can be helpful for acute infections
  • Red Labs looks for bacteriophages for Borrelia
  • Lyme is a clinical diagnosis
  • Relapsing Fever Borrelia's are increasingly common; even more than Lyme Borrelia in some studies and geographies
  • Integrative approach includes: lifestyle, sleep, diet, detox and reduction of exposure to mold/EMF, nutrition, GI, immune, mitochondrial, adrenal/endocrine, genetics, methylation, membrane therapies, ozone, HBOT, LDI, antimicrobials, emotional, structural, physical therapy, cranial work, chiropractic, visceral manipulation, neural therapy, acupuncture, laser, energy medicine, movement/exercise, spiritual, SOT, Family Constellation
  • Borrelia and TBRF have multiple forms; are intracellular and extracellular; create biofilms
  • Many antibiotics; using a couple simultaneously
  • Stationary and persister forms often not impacted by antibiotics; specific compounds found more helpful for persisters
  • Dr. Horowitz has a "Double Dapsone" protocol
  • Disulfiram has emerged as a "repurposed" drug in the Lyme community
  • Herbs and essential oils have been found helpful in recent studies
  • Methylene blue, Daptomycin, and Clotrimazole may be helpful for Bartonella
  • Uses Byron White, Beyond Balance, Researched Nutritionals, NutraMedix, Return Healthy
  • Die-off and Herx reactions are real; support prior with detox, drainage, and organ support
  • Most patients have multiple infections; have to identify as many as possible
  • What are the primary infections causing the majority of symptoms?
  • Usually starts with less toxic things first and ramp up if needed
  • Treatment may take 18 months or longer
  • Sauna, coffee enemas, colonics, metal chelation, mold remediation, emotional/spiritual work can all improve outcomes

Tom Moorcroft, DO spoke on "Advanced Topics in Tickborne Disease: Bartonella & Brain Detoxification" and shared:

  • Once the brain is cleaned, 20-30% is detoxified along the nasal lymphatics
  • Glial cells / astrocytes are involved in the glymphatic drainage from the brain
  • Deep cervical lymphatic drainage is important in brain detoxification
  • Most lymphatics need muscle movement to support flow
  • Head forward posture can diminish lymphatic flow; optimize posture with head over neck and shoulders back and down
  • Want to support drainage before attempting to dump toxins out of the brain
  • Every cranial nerve has glymphatic drainage along the nerve
  • Drainage from the brain into the gut
  • Optimal communication between the brain and gut are important
  • If the vagus nerve were clipped, we would have issues with episodic and spatial memory
  • There is a connection between the gut and heart and brain and heart
  • Polyvagal healing, getting into heart, gratitude are key to healing
  • Brain detoxification cannot happen optimally without considering the nervous system
  • Hypersympathetic states makes brain detoxification difficult
  • 70-90% of glymphatic activity happens in slow wave sleep
  • Higher levels of amyloid with lower levels of sleep
  • As people age, there is often less slow wave sleep and less glymphatic activity supporting detoxification of the brain
  • Group A Strep impacts the nasopharynx and resulting Th17 cells and inflammation, blood-brain barrier breakdown, and inflamed glia
  • SARS-CoV-2 impacts the nasal passages and may block the lymphatic vessels
  • Risk factors for more severe SARS-CoV-2 are chronologic age, obesity
  • MARCoNS and fungi/mycotoxins could lead to chronic infections that create an autoimmune encephalitis and Th17 cells being produced to fungi from mold exposure
  • Borrelia can persist in the brain and be associated with amyloid plaques
  • Chlamydia pneumoniae can persist in the sinuses
  • Risk of Alzheimer's increases by 5 fold with Chlamydia; 4-10 fold with spirochetes
  • Bartonella henselae can look like autoimmune encephalitis but not be
  • Bartonella can trigger or mimic PANS
  • Bartonella: over 35 species, gram negative, intracellular; hangs out in microglia, erythrocytes, endothelial cells, macrophages, CD34 stem cells
  • Vectors: fleas, lice, sand flies, possibly ticks, animal bites and scratches, blood transfusion
  • Seems mostly Bartonella henselae and moderate amount of quintana; others may cause human infection
  • Bartonella is the number 1 cause of neuroretinitis; many eye issues
  • Studies are mixed on whether or not Bartonella comes from ticks
  • Up to 70% of ticks in Europe have some type of Bartonella
  • Bartonella may be transmitted perinatally/transplacentally and possibly sexually
  • Migratory peripheral neuropathy, tremors, migratory muscle fasciculations, foot/heel pain seen in Bartonella; alcohol intolerance common
  • Mild anxiety, depression, OCD, rage, change in personality, regressions, unilateral symptoms, tics, PANS/PANDAS
  • Bartonella may impact the vascular system and lead to tracks or striae; confirmed in 2019 though unclear if correlation or causation
  • Bartonella striae should blanch, lymph nodes swollen, subcutaneous nodules on the inner forearm or lateral thigh
  • May be treated with Azithromycin, Clarithromycin, Rifampin, Bactrim DS, Cipro
  • May use Doxycycline with Rifampin
  • Duration of treatment 3-4 months; treat until symptom free + 2 months
  • Relapse is known to recur after treatment withdrawal
  • Bartonella can participate in biofilm colonies
  • Methylene blue and Clotrimazole have been helpful for stationary form Bartonella
  • Front runners: Azithromycin or Rifampin with either Cipro or Methylene Blue
  • Methylene blue was the first commercial anti-malarial drug; seems to help with air hunger, but unclear which Babesias it may be working for
  • Same clinical response with standard or liposomal; tends to go with standard
  • Clotrimazole shines with yeast, aflatoxin, PANS
  • Cryptolepis, Black Walnut, Japanese Knotweed, Scutellaria can be helpful in Bartonella stationary forms
  • Similar herbs as were found in a study for stationary Lyme; Cryptolepis, Black Walnut, Japanese Knotweed, Artemisia, Cat's Claw, Cistus, Chinese Skullcap
  • Best for Borrelia: Cryptolepis, Japanese Knotweed, Chinese Skullcap, Black Walnut, Artemisia
  • Best for Bartonella: Cryptolepis, Japanese Knotweed, Chinese Skullcap, Black Walnut
  • Cryptolepis is one of the best anti-Lyme/anti-Bartonella treatments
  • Chinese Skullcap and Cryptolepis also found to be helpful for Babesia duncani
  • Best overall: Cryptolepis, Chinese Skullcap, Japanese Knotweed, Black Walnut, Artemisia
  • Studies are on single herbs, but combinations of herbs can also be clinically helpful

 Darin Ingels, ND spoke on "The Use of Botanical Medicine in Lyme Disease" and shared:

  • Herbs have become an important part of his treatment strategy for Lyme
  • He is a recovered Lyme patient; has dealt with the rollercoaster of Lyme
  • Botanicals: may be safer, more comprehensive/broader activity, less negative impact to microbiome, often cover Lyme and coinfections, support immune function, cost-effective, clinically effective, option for antibiotic failures
  • Herbs often impact several forms; antibiotics often impact only a specific morphological form
  • Most effective for Borrelia from research: Cryptolepis, Japanese Knotweed, Black Walnut, Artemisia, Cat's Claw, Cistus, Chinese Skullcap
  • Most effective for Bartonella from research: Cryptolepis, Japanese Knotweed, Black Walnut, Scutellaria baicalensis, Scutellaria barbata
  • Most effective for Babesia from research: Cryptolepis, Japanese Knotweed, Artemisia, Scutellaria baicalensis, Alchornea
  • Allicin is antimicrobial; also improves circulation and mild anti-inflammatory
  • Andrographis has broad antimicrobial activity including for parasites; good anti-viral; likes 50% standardized extract
  • Artemisiae effective mostly for Babesia but also Borrelia; suppresses autoimmune reactions and is anti-inflammatory; do not have to pulse as some suggest; want Artemisia annua
  • Anything that treats malaria is highly likely to treat Babesia
  • Campsiandra most broad spectrum herb against Lyme and co-infections; potent anti-inflammatory; strong Herxheimer reactions; good for Babesia
  • Cat's Claw is rich on POAs that stimulate the immune system; potent anti-viral, downregulates inflammation; protects oxidative stress
  • Coptis has broad antimicrobial activity for bacterial, viral, fungal, parasitic infections; as effective as some antibiotics, potent anti-inflammatory
  • Cordyceps increases T helper (primarily Th1) cells and activates NK cells and macrophages, improves circulation, helps fatigue, reduces inflammation, lowers blood sugar; contains beta glucans
  • Desmodium supports detoxification and stops Herxheimer reactions
  • Houttuynia is anti-bacterial and antifungal; supports immunity; breaks down biofilms; need to dose three times a day due to short half-life
  • Japanese Knotweed is a broad antimicrobial, potent anti-inflammatory, immune modulator
  • Lion's Mane can improve cognitive function and help with supporting myelination
  • Otaba supports Lyme and co-infections, anti-inflammatory; works well with Cat's Claw
  • Pueraria can help blood flow, anti-inflammatory; caution with POTS
  • Wireweed from Sida acuta is broad against bacteria, virus, fungus, liver support, immune modulation
  • Yellow Dye Root from Cryptolepis helpful for malaria, antibacterial, antiviral, anti-inflammatory
  • Also uses Gou teng for neuroborrelia, Chinese Skullcap for Lyme/Bart/Babesia, Astragalus for immune modulation and inflammation, Hawthorne, Alchornea for gram positive bacteria/yeast/parasites
  • Very little chance of resistance of microbes to herbs; rarely see this like can be seen with antibiotics
  • Showed herbal combinations from Beyond Balance to show combinations of herbs that have many different effects
  • Has seen herbs turn around severe neurological Lyme cases
  • Everyone's Lyme experience is different
  • Herxheimer: curcumin, Boswellia, alkalize, sodium and potassium bicarbonate; potassium bicarb increases glutathione, reduces arachidonic acid and muscle wasting
  • Breaking down biofilms: Serrapeptase, EDTA, trypsin, alpha lipoic
  • LDI: may help with stopping autoimmune responses that have been triggered via molecular mimicry; has turned off overreaction to Lyme; has been a game changer
  • Th17 pathway is an important mechanism through which bacteria stimulate the immune system in a negative way
  • EBV, Lyme, and other organisms may impact MS via molecular mimicry 
  • LDI helps the immune system to stop treating microbes as allergens and more as organisms

Dr. Carnahan talked about herpetic viral reactivation post-COVID as being a common observation

Jocelyn Strand, ND spoke on "The Role of Dysbiosis and GI Dysfunction in Histamine Dysregulation" and shared:

  • Worked with Biocidin in a pediatric patient and found that her respiratory/histamine symptoms resolved
  • Up to 85% of those with headaches and migraines may have histamine issues
  • Histamine causes GI dysmotility
  • Downstream effects of H2 blockers reducing stomach acid may lead to SIBO and other GI problems
  • DAO breaks down and removes histamine from food; histamine's vital counterpart
  • Low DAO correlates with poor mucosal integrity
  • DAO modulators: histamine in diet, DAO blockers (alcohol, OTC drugs, RX medications), antihistamines, host health (pregnancy, nutrients, inflammation) genetics, the microbiome
  • Food allergy is 1-2% of population; food intolerance is 20%
  • Some microbes produce histamine; even beneficial organisms
  • Histamine intolerance generally has lower diversity; low Bifido; higher Proteobacteria
  • LPS are produce in cell wall of gram negative bacteria that cause local and systemic inflammation
  • LPS lead to increase in histamine and mast cell degranulation
  • Research on Biocidin and GI Detox+; showed higher DAO and lower histamine and improvement of LPS antibodies
  • GI Detox+ binds histamine
  • Did testing to show that Biocidin does not negatively impact beneficial flora; actually improved in 69%; 73% showed increase in Akkermansia
  • Biofilms often contain histamine; must use binders
  • LPS is found in the oral cavity as well; P. gingivalis
  • The human mind cannot duplicate or improve upon what Mother nature can provide
  • Biocidin was developed in 1988 for the HIV patient population
  • Biocidin has been shown to be effective against biofilms
  • Liposomal Biocidin has 74% better cellular uptake

Nafysa Parpia, ND spoke on "Acute COVID: Diagnostics, Variants and Treatment" and shared:

  • Can be infected and spread to others prior to symptoms; up to 5 days
  • Most no longer contagious 5 days after onset of symptoms and have symptom and fever-free for 3 days
  • Omicron expresses symptoms more rapidly
  • Antibody levels are not required for immunity or predictors of outcome
  • Antibodies decrease 2-5 months after infection or vaccination
  • T-cell response may be more relevant to minimize sickness
  • S1 spike can persist in monocytes
  • Antibodies to N proteins means infection; the N protein antibodies are not found in vaccine responses
  • Reinfection is common and increasing; though less so for 1-3 months after infection or vaccination
  • No variants of interest at present
  • Variants of Interest become Variants of Concern when they start spreading and pose a risk to public health
  • Cases have risen since end of March 2022; hospitalizations have risen; deaths have declined; 52% increase in cases in past 14 days
  • Acute COVID testing: Nucleic Acid Amplification Tests and Antigen Tests
  • NAAT is highly sensitive; current or recent infection; not for diagnosis; not at home
  • Antigen testing is specific but less sensitive; done at home; with Omicron, home tests often continue to be negative 5 days after exposure even with symptoms
  • Even with positive tests, after 5 days and no fever, viral load is believed to be too low to be contagious
  • PCR can show positive results for 60-90 days
  • Cycle thresholds above 32 indicate low likelihood of being contagious 
  • Still supposed to quarantine for 5 days after exposure
  • Wear N95 mask and avoid susceptible people; responsible thing to do
  • Vaccinated still transmit after exposure though there is a decrease in transmission compared to unvaccinated
  • Should wear masks for 10 days after a positive test; do not travel
  • Antibody tests have to differentiate between S protein and N protein (only prior infection)
  • No direct correlation between antibodies and immunity
  • Vaccines have dropped in efficacy over time with Delta and Omicron
  • Data on heart attacks, strokes, hypercoagulation not well-understood
  • Has seen the vaccine save lives and seen others with injuries
  • Acute COVID Treatment based on FLCCC and Gordon Medical Associates 
    • Ivermectin, D, quercetin, melatonin, fluvoxamine, spironolactone, steroids, curcumin, Nigella sativa, and anti-androgen therapy have been found helpful
    • It will take months to years to reach herd immunity via vaccination
    • Vaccines may become less effective with mutations over time
    • COVID kills through cytokine activation and activation of clotting system; not from viral replication
    • Want to start antiviral treatment early; anti-inflammatory treatment day 7-10-12
    • Don't use steroids during the acute viral stage
    • Androgens make illness worse
    • Treat the sinuses early on; serve as site of viral replication
    • Antimicrobial essential oils, mouthwashes/gargles, lozenges

Pierre Kory, MD spoke on "Insights and Approaches to Long Haul and Post-Vaccine Injury Syndromes" and shared:

  • Has become an expert on multiple phases of COVID
  • Long Haul
    • Treating long-haul now for quite a few months
    • Long Haul in seen 20-80% to some degree
    • Some fall into a repeated illness cycle of acute care; one issue after another; for others, a prolonged recovery
    • Vast majority recover from outpatient illness and develop ongoing symptoms
    • Fatigue with COVID is profoundly different than other viral syndromes
    • Some recover, go back to life, and then have significant fatigue, concentration issues, and other symptoms
    • 30-50% of outpatients develop some degree of long haul
  • Post-COVID Vaccine Syndrome
    • Equally if not more debilitated patients
    • Vaccine injury is not an accepted reality
    • Many adverse events have not been documented
    • 1-1.5% of patients have some degree of injury; at least 2 million cases
    • VAERS is under-reported
    • German insurer found 2.5-3 million required medical treatment post-vaccine
    • Almost nothing published; no therapeutic studies
    • Healthcare system has completely failed
    • Academic medical centers have long haul clinics; absolutely worthless
    • Post-COVID vaccine injured patient is much worse
  • Spike protein is one of the most toxic proteins in history
  • Causes numerous mechanisms of injury
  • Could be reacting to mRNA, polyethylene glycol, lipid-nanoparticles
  • 900 recorded cardiac arrests in sports players in Europe
  • Myocarditis is consistent with high catecholamine surges, nor-epi/epi; compounds the injury and stress on the heart
  • Respiratory disease does not cause cardiovascular deaths
  • Mechanisms: S1-induced persistent monocyte-drive inflammation; autoantibodies; clotting cascade; secondary viral reactivation; MCAS
  • Spike protein causes molecular mimicry
  • Micro-clotting not seen in most conventional tests; may explain brain fog and headaches
  • Chronic Lyme, EBV, Herpes, Mycoplasma may worsen
  • Impacts any organ but primarily brain, heart, and endocrine organs
  • Autoantibodies can cause Guillain-Barre, Bell's Palsy, Transverse Myelitis, immune thrombocytopenia, and small fiber neuropathy
  • Numbness and pain syndromes
  • Anti-phospholipid syndromes, Lupus, RA
  • Spike protein is highly thrombogenic leading to clots; some large clots cannot be pulled out
  • Some patients have sky-high IgE with no prior allergic syndrome
  • Genetics appears to play a role; vaccine injury more common in family members and twins
  • 80% of vaccine-injured are female
  • Pre-existing conditions may have primed the immune system to be more reactive post-vaccine
  • Some lots seem to be more problematic than others
  • Many become so exhausted that they cannot leave the house; formerly very healthy
  • Long-Haul/Post Vaccine Syndrome
    • Fatigue, post-exertional malaise, cognitive dysfunction
    • Fatigue more in long-haul
    • Twitching, neuropathic, tinnitus more in vaccine injury
    • Insomnia, tinnitus, vertigo, dizziness, numbness, tingling, cold or pain sensations in extremities, weakness in extremities
    • Fasciculations, uncontrolled movements
    • Difficultly processing tasks/focus
    • Short and long term memory loss
    • Difficulty speaking
    • Headaches
    • Loss of taste and smell or everything tastes/smells rotten
    • Friends/family often do not recognize the loss of cognitive function
    • Anxiety/depression
    • Dysautonomia/POTS
    • Joint and muscle pain
    • Night sweats/hot flashes
    • Skin changes/sensitivity
    • Temperature lability; low temps down to 91F
    • Eye pressure, vision problems, redness
    • Menstrual changes
    • Urinary frequency
  • MCAS/Long COVID Symptoms
    • Abdominal pain, diarrhea, nausea, vomiting, bloating, food intolerance
    • Itching, redness, rash, dermatographia (eczema, psoriasis, rosacea)
    • Palpitations, vertigo, arrhythmia, hypotension, POTS, Kuonis disease
    • Running nose, sneezing attacks, asthma, shortness of breath
    • Headache, migraines, sweating, freezing, menstrual pain
    • Fibromyalgia, tingling sensations, brain fog
    • Anxiety, panic attacks, insomnia, fatigue, post-exertional malaise
  • Testing
    • CBC, chemistry, liver
    • D-Dimer
    • CRP
    • Cortisol
    • TSH
    • HbAC1
    • Troponin/BNP for hart
    • Viral reactivation for CMV, EBV, HSV
    • D
    • Autoantibodies
    • Live blood analysis 
  • Treatment must be individualized
  • Early treatment is essential
  • A focus on clotting issues often leads to improvement
  • Many protocols and approaches; no one way
  • Learning from patients and adapting
  • Backbone is Ivermectin, Ivermectin, Ivermectin
  • Ivermectin non-responders are harder to treat
  • Moderate to large benefit in Ivermectin responders
  • First Line Therapies
    • Intermittent fasting or water fasting (best); all mammals fast when they are sick; induces autophagy; Complete Guide to Fasting by Dr. Jason Fung
    • Ivermectin
    • Hydroxychloroquine
    • C (favors higher doses; powerful antioxidant; just below bowel tolerance; potentiator of Bifidobacteria)
    • D/K2
    • LDN
    • Melatonin
    • Magnesium
    • Quercetin
    • Pro/prebiotics (Kefir)
    • Omega 3
    • Aspirin, Lumbrokinase, Nattokinase
    • Nigella sativa
  • Early treatment is essential for every disease ever known to man
  • Second Line Therapies
    • IV C
    • Fluvoxamine
    • Mitochondrial support; PQQ; Life Extension Energy Optimizer, ATP 360
    • NAC
    • Low dose corticosteroids (has stopped and not found it to be a problem)
    • Sulforaphane
    • Mindfulness/psychological support
    • Suicide is a realm problem in vaccine-injured patients
  • Third Line Therapies
    • HBOT - may repolarize macrophages
    • Triple Anti-Coagulation Therapy
    • Maraviroc (astounding responses in a small subset, some nothing, some worse)
    • Pravastatin (has had good responses to statins for short period of time)
    • EBOO / apheresis
  • Potential Treatments
    • Valproic Acid
    • Sildenafil/L-arginine/L-citrulline
    • Vedicinals 9
    • C60
    • Cold hydrotherapy
  • Not clear that there is a detox for spike proteins; they persist inside of cells
  • Ivermectin has numerous mechanisms; anti-viral, anti-inflammatory, mast cell stabilizer; strongest binding medicine to spike protein
  • Fasting and ivermectin may liberate spike from monocytes
  • Loss of taste and smell can lead to disuse atrophy of the brain
  • Brain fog: LDN, Fluvoxamine/Fluoxetine; may be mediated by MCAS
  • Tinnitus: Tricyclic antidepressants, CBT, tinnitus retraining therapy, hearing aids, Clonazepam, benzos
  • Small fiber neuropathy: Tricyclic antidepressants, ALA, Gabapentin, Clonidine
  • IVIG is generally not recommended; improvement does not last; can be appropriate for specific autoimmune syndromes
  • MCAS: H1/H2 blockers, low histamine diet, vitamin C, rupatadine, ketotifen
  • Bell's Palsy: LDN, low dose corticosteroids, fluvoxamine
  • Getting more interested in ozone; lots of positive clinical experiences
  • Additional comments from Q&A
    • Life insurance companies are concerned about the all-cause mortalities never before seen in the history of their business
    • Some are beginning to believe that there is viral persistence in these patients; more research is needed
    • Always want to make sure that mast cell issues are explored; has not made a difference in tinnitus symptoms
    • For long-haul, may use: Ivermectin + LDN + C + D + nigella + lumbrokinase; then hydroxychloroquine for autoimmunity; layers by 4-5 days to observe benefits; then does MCAS regimens
    • Has started to use Maraviroc; hit or miss
    • Wants patients to try HBOT based on responses to date
    • Fatigue is pretty standard; post-exertional malaise related to inflammation; modulate activity; Ivermectin mitigates a lot for many; micronutrients, hydroxychloroquine
    • Thinks of clotting, autoimmunity, viral reactivation higher on the list if vaccine injury
    • If you don't recognize what helped initially, you may recognize what was helping as you start to stop the various treatments one by one

Bob Miller, CTN and shared "Epigenetic and Genetic Factors Contributing to Platelet Activation, Aggregation & Clots" and shared:

  • Platelets become activated and aggregated; good with injury; bad when resulting in thrombosis
  • Mycotoxins, COVID, Clostridia, and Borrelia stimulate TNF alpha
  • Nrf2 is inhibited by KEAP1
  • NADPH oxidase enzyme stimulates mast cells and histamine
  • Nitric oxide is stimulated by pathogens
  • iNOS activates platelets
  • All calmed down by Omega 3 oils; protectins/resolvins
  • RANTES or CCL5 is "Regulated upon Activation Normal T cells Expressed and Secreted"
  • RANTES produced by platelets, macrophages, epithelial cells, megakaryoblasts, T lymphocytes, eosinophils
  • RANTES stimulates histamine secretion by mast cells
  • Bruce Patterson shows Long haul COVID is a RANTES disease
  • High RANTES: liver injury, autism, histamine/serotonin generation, mast cells, chronic eczema, atherosclerosis, IBD, prostate cancer
  • Factors: Clostridia, Borrelia, LPS, mercury, COVID, glyphosate
  • Inhibitors of TNF-a: Nigella, curcumin, quercetin, milk thistle
  • SIRT1 is a marker of cell senescence; activity low due to low NAD+
  • Resveratrol, quercetin, and caloric restriction activate SIRT1
  • Histamine from mast cells enhances the production of RANTES
  • HDC SNP causes more production of histamine from histidine
  • Nitric oxide has been called "miracle molecule"; vasodilator
  • NOS2 or iNOS enzyme involved in immune defense; generates high amounts of nitric oxide to fight pathogen
  • Excessive nitric oxide has been associated with many health concerns
  • COVID increases iNOS to fight virus; going too far leads to severe lung inflammation
  • iNOS inhibits eNOS and leads to blood clotting
  • Running out of BH4 leads to NOS uncoupling; make superoxide free radicals instead of nitric oxide
  • iNOS stimulation: aluminum, mercury, uranium, BPA. EMF, HFCS, gluten, chlorine, fluoride, glyphosate, excess iron, homocysteine; serious inflammatory cascade
  • Gain of function mutations in NOS2 and other enzymes overstimulate iNOS along with environmental and endogenous stimulation which leads to : inflammation, excess superoxide, depletion of BH4
  • Arachidonic acid from PLA2 activating platelets and creating RANTES: superoxide, peroxynitrite, EMF, mTOR, mercury, smoking, ozone, allergens, bacteria
  • Increased thromboxane A2 cam be associated with heart attack, stroke, atherosclerosis, bronchial asthma
  • We do not get enough Omega 3s anymore; protectins and resolvins come from omega 3 and calm inflammation
  • Processed foods, canola oil, vegetable oils, lack of good fats and fish impact omega ratios; as do certain genetics 

Lara Adler spoke on "Environmental Toxins: Metabolic Disease, Autoimmune Disease, and Gut Health" and shared:

  • 350,000 chemicals and mixtures registered for production worldwide
  • Most never assessed for safety
  • Chemicals are innocent until proven guilty in the US
  • Safe Drinking Water act looks at ~90 contaminants; none added in 20+ years
  • In 2010, 45 states had perchlorate contamination in their water systems
  • Perchlorate inhibits iodine update in the thyroid
  • 100% of people have perchlorate in their urine; from food and water
  • Chemical mixtures are 1+1=5
  • Constant daily exposure does not always result in acute symptoms
  • Lifestyle changes will lower body burden
  • Metabolic, gut health, and autoimmune overlap
  • Metabolic issues impact 24-34% of the population: insulin resistance, abdominal obesity, dyslipidemia, hypertension, hyperglycemia, cardiovascular disease, type 2 diabetes, stroke, chronic kidney disease, NAFLD
  • Endocrine-disrupting chemicals can act as obesogens, diabetogens, and cardiovascular disruptors
  • NIH has a more restricted definition of endocrine-disrupting chemicals than The Endocrine Society; NIH requires adverse effects
  • Many pharmaceuticals work on same pathways as obesogenic chemicals to lead to weight gain
  • Some chemicals increase the number of fat cells as well as volume of existing fat cells
  • Many chemicals accumulate in adipose tissue
  • Enormous spikes in toxins in blood can be seen after gastric bypass and resulting weight loss
  • Gut microbiome and environmental chemicals influence each other
  • Some beneficial flora can be protective against exposures to chemicals
  • Strongly altering microbiomes: bisphenols, phthalates, pesticides, metals, persistent organic pollutants
  • Pesticide exposures can lead to intestinal inflammation and leaky gut resulting in autoimmunity
  • 30% of autoimmunity is genetic; 70% is environmental 
  • BPA found in polycarbonate plastics, lining of canned foods, thermal paper, and dental sealants
  • BPA plays a role in the pathogenesis of autoimmunity
  • Halogens interfere with thyroid function via competing with iodine
  • Goal is to minimize exposures in a daily basis
    • Open windows
    • Take off shoes
    • Eliminate fragrances
    • Wet dust and vacuum
    • Decline cash register receipts
  • Doing these minimizes exposures to:
    • Particulates
    • Pesticides
    • Heavy metals
    • BPA
    • Phthalates
    • PFAS
    • Flame retardants
    • VOCs
  • Next:
    • Organic produce, meat, dairy
    • Low food chain, wild domestic seafood
    • Eliminate canned foods
    • Minimize plastic contact with food
    • Avoid greaseproof paper products
    • Filter drinking water
    • Clean personal care products
    • Less toxic cleaners
    • Air filters
    • Avoid dry cleaning

 Lyn Patrick, ND spoke on "Chemicals & Environmental Toxicants in Chronic Illness" and shared:

  • NAFLD is now referred to as MAFLD (Metabolic-Associated Fatty Liver Disease) and MASH (Metabolic-Associated Steatotic Hepatitis)
  • TAFLD (Toxicant-Associated Fatty Liver Disease) and TASH (Toxicant-Associated Steatotic Hepatitis)
  • May or may not have an alcohol contribution
  • 40% of the general population has NAFLD or MAFLD
  • Toxicants are ubiquitous and are closely related to risk of fatty liver; PCBs, BPA, Phthalates
  • Vinyl chloride exposure in an industrial accident led to severe liver issues in 80% of workers; many developed cancer and died
  • PCBs, phthalates, PFOA, PFOS, dioxins, BPA, and others cause liver damage; work at nuclear receptors in hepatocytes and disrupt entire homeostasis of the liver
  • Chemicals involved: pesticides, solvents, PCBs, dioxins, phthalates, BPA, cadmium, PFOS/PFOA, chemotherapy
  • Effects of liver toxicants: increased AST, ALT, GGT, increase in triglyceride/HDL ratios in obese subjects; damage to SOD, catalase, and glutathione in the liver
  • Obesity cannot be explained by calories in/calories out theory
  • Metabolism disrupting chemicals may require a second hit: dietary sugar, trans fats, oxidative stress, endotoxemia
  • Vinyl flooring is the primary source of indoor air phthalate exposures
  • Any "fragrance" is equivalent of a phthalate
  • Phthalates are added to certain pharmaceuticals
  • Processed food is a common source of phthalates
  • Phthalates, like many other toxicants, are detoxified through glucuronidation
  • Appropriate intervention is avoidance, not detoxification; they are not stored in the body
  • Bisphenol exposure comes from water, canned foods, dermal absorption from thermal receipts; endocrine disruptors and kidney toxicants
  • Skin softening products in personal care products can be a source of BPA exposure
  • BPA can be associated with breast and prostate cancer, PCOS, diabetes, obesity, kidney damage
  • Dioxin has a half-life of 7-10 years; most toxic chemical on the planet; contaminant in Agent Orange
  • Forest fires generate dioxin
  • Dioxin leads to an increase of TGFb1; not just mold
  • 95% of exposure comes from fish, meat, and high-fat dairy products
  • TCE commonly used in dry cleaning; the most common groundwater contaminant in US of organic chemicals; leads to autoimmune diseases
  • TCE sored in adipose with majority to liver, non-viral hepatitis, breast cancer in men, and many other symptoms
  • Understanding drinking water and what's in it is incredibly important
  • Million Marker Lab resulted from UCSF Reproductive Medicine department
  • BPS and BPF are being substituted for BPA in products; as bad or worse
  • Great Plains, Vibrant, Biotek, Doctor's Data, Vista Analytical, LabCorp have various testing options
  • PCBs taken out of use in 1979; carcinogens; persistent; half-life 21-133 years; in over 90% of American population; now found mostly in diet; removal via sweat, feces, and breast feeding
  • Ochratoxin is bound tightly to albumin; same for PCBs
  • PCBs come from farmed fish, fish from the Great Lakes, beef, dairy products, butter, cheese, mother's milk, canned sardines, fish oil
  • PCBs damage the gut, liver, immune system; lead to metabolic disease; impact bile acids and SCFAs
  • Significant markers for liver disease: HOMA-IR, fasting insulin, fasting triglycerides, MCP-1, PAI-1
  • Serum triglycerides has a high correlation with liver disease
  • HOMA-IRis fasting glucose times fasting insulin divided by 22.5; want fasting insulin around 5
  • Carbohydrates and HFCS will lead to high triglycerides
  • Suspect TASH with proinflammatory cytokines (MCP-1, PAI-1), insulin resistance, hypertriglyceridemia, CK18 M65 elevation
  • Butter is not something our ancestors ate
  • Men more more likely to be impacted by endocrine-disrupting chemicals
  • Support PCB Metabolism: B complex, NAD, NAC, glutathione, ginger, garlic, eggs, broccoli sprouts, onions, B2, dandelion, rooibos tea, honeybush tea, rosemary, soy, ellagic acid, ferulic acid, curcumin, astaxanthin, C, fiber
  • Omega 6 fatty acids worsen PCB while polyphenols and Omega 3 improve inflammation
  • Pectin, Konjac mannan, chitosan, CSM, rice bran fiber, Cinnamaldehyde, Scutellaria baicalensis, Perilla frutescens stimulate Nrf2
  • Sauna can help reduce PCB, PBB, chlorinated pesticides, hexachlorobenzene, phthalates, cadmium, mercury, BPA, toluene; not PFOA/PBDE
  • Prebiotic fiber promotes beneficial microbes; pre/probiotics have been helpful in NAFLD
  • Colon hydrotherapy improves bile flow to the common bile duct

Mark Su, MD spoke on "The ISEAI Framework: Applications to Patient Care with Case Studies" and shared:

  • When do you continue to treat the diagnosed problem?  When do you look elsewhere and diversify thinking?
  • How much penetration do pathogens and toxicants from the external environment (or exposome) have on the self as a result of weakened interfaces?
  • How do you support the immune system?  Enhance it?  Regulate it?  Peptides?  IVIG?  Fish oil, curcumin, turmeric? SPMs? Pectasol-C? Perilla?  D?  LDN?  Turkey Tail?  How do you decide?
  • Other questions
    • Innate vs. adaptive immunity?
    • Th1/Th2/Th17/Treg?
    • TGFb1 cytokines or inflammatory signaling?
    • Membrane/ATP management?
    • Combination of factors in the 3 part model?
    • Hormones?
    • Methylation?
    • Micronutrients?
    • Neurotransmitters?  Neuroplasticity?
    • Mitochondria?  PC?
  • What testing correlated with phases of the Cell Danger Response?
  • If we can set the immune system back into balance, perhaps the exposome profile may not matter; maybe eradicating and killing microbes is not the solution
  • The immune system is synonymous the the mitochondria in his model; how much are the stressors from the exposome impacting the immune system and mitochondria
  • "Inflammaging" looks at non-self, self, and quasi-self (interfaces); chronic inflammation leads to aging; immune system is core
  • Can we fix the immune system and let the immune system drive the response to microbes and toxins?
  • Exploring Th1/Th2/Th17/Tregs and tools like Cyrex Lymphocyte Map can show unexpected patterns and identify potential treatment options; some have Th1/Th17 dominance when Th2 dominance better fit the clinical presentation
  • Better understanding the immune balance may lead to new thoughts on potential factors influencing the immune shift and this new treatment options
  • The immune system can shine a light on where to put the focus in terms of the exposome
  • Has found the Cyrex Lymphocyte Map to be clinically helpful; has been as helpful as he could have imagined
  • Different treatment options are often needed based on whether or not a person is Th1, Th2, or Th17 dominant

Werner Vosloo, ND spoke on "Cellular Impact of Environmental Toxins: Epigenetics of Chronic Disease" and shared:

  • Focuses on epigenetics and DNA adducts in those with complex, chronic illness
  • IGL testing is for research purposes only
  • DNA adduct is a chemical that is covalently bonded to DNA; usually a carcinogen
  • Can be exogenous or endogenous chemicals
  • DNA adducts have been studied since the 1960s; larger context of genetic toxicity
  • In modern times, DNA adducts are of considerable interest
  • Important to consider genetic integrity in reproductive health; can play a role in infertility
  • Polycyclic aromatic hydrocarbons (PAH) have been found as DNA adducts in human sperm
  • Important to prepare the body for pregnancy via pre-conception focus and removal of DNA adducts
  • Impacts reproductive capacity but also health and well-being of the offspring
  • DNA gene regions are transcribed and translator to a protein
  • Chemical damage to DNA is a key initiator of adverse biological consequences due to disruption of faithful reading of the genetic code
  • Chronic diseases encountered today are resistant to good, comprehensive treatments; may be unable to respond due to upstream corruption at the genetic code due to environmental chemicals
  • DNA adducts are involved in many chronic diseases
  • DNA adducts trigger a multi-step pathogenic cascade
  • DNA adducts are involved in localization of chronic degenerative lesions in multiple sites; lung, liver, heart have been studied
  • If clinically detectable manifestations of chronic disease is the tip of the iceberg, studying DNA adducts is an important aspect of studying the interaction of the submerged basis of each iceberg
  • Hierarchy: adducts, SNPs, transcriptomics, proteomics, metabolomics
  • There are ten million SNPs in the human genome
  • DNA adducts are not the same as SNPs
  • Transcriptomics is the study of the pattern of gene expression; can help to diagnose CIRS, Post-Lyme, COVID-19, etc.
  • Corruption of DNA by DNA adducts affects everything downstream
  • Proteomics is the study of proteins that are expressed in a specific cell, tissue, or organism
  • Metabolomics is the study of intermediates and products of metabolism in body fluids
  • DNA adducts are chemicals covalently bonded to DNA gene regions
  • Adductomics is the study of DNA adducts of the entire genome
  • Can have DNA adducts on SNPs like CBS, etc.; the SNP is less relevant than the DNA adduct that may be impairing its function
  • Stabilize the patient, enhance the mitochondria. balance hormones, treat the infections, address unique etiologies, maintenance; this approach often works
  • Incorporating treatment on DNA adducts and corruption of the code leads to longer-term health improvement, fewer supplements
  • IGL testing can provide information about corruption of DNA gene regions which then results in incorrect expression of the DNA and leads to multi-symptom, multi-system condition that is resistant to otherwise robust treatment options
  • When zinc is low, there is less effective removal of DNA adducts
  • IGL testing looks at level of LPS in blood; also looks at histamine intolerance
  • Treatment may include IV: butyrate, PC, glutathione, B12, folinic acid, biotin, B complex, minerals, amino acids
  • Cell stabilizing therapy can lead to exiting of the Cell Danger Response
  • Want to focus on optimizing elimination of fat-soluble chemicals and consider bile reabsorption and elimination
  • Mandatory to to closed system colonic hydrotherapy; shunts the bile towards elimination and decreases reabsorption of bile
  • Zinc level at the nucleus allow the cell to better maintain DNA integrity
  • Cells can regain ability to create NAD; without supplemental NAD
  • Restoring cellular structures and enzyme systems leads to regaining of the ability to perform normal cellular housekeeping
  • IGL testing has shown silicone in those with breast implant illness
  • Adduct levels vary with:
    • Stopping smoking
    • Reduction in air pollution
    • Occupational exposures

Dayan Goodenowe, PhD spoke on "Measuring and Restoring Peroxisomal and Mitochondrial Health for Neurological Diseases" and shared:

  • Mitochondrial and Peroxisomal health are critical for good health
  • Created plasmalogen restoration technologies
  • Ignorance and inaction are the causes of all death
  • Author of "Breaking Alzheimer's"
  • Redox failure is mitochondrial and peroxisomal failure
  • First sign of failure is the inability to utilize the electrochemical energy stored in NADH
  • When a cell cannot process NADH, electrons are spit out via NOX enzymes
  • Intracellular and extracellular environment has capacity to neutralize superoxide via SOD into hydrogen peroxide and molecular oxygen
  • An unhealthy cell is identified by presence of peroxidation
  • Maintaining electrochemical balance is a core requirement of life
  • Chronic imbalance results in high energy electrons spilling out of the cell and oxidation of lipids and proteins
  • Peroxidation of membrane lipids is the signal to the immune system that the cell is near death
  • Inflammation is the natural mechanism to destroy damaged cells and allow new cells
  • Inflammation creates energetic stress to surrounding cells
  • If cells become damaged and become inflammation stimulators, this is the mechanism of autoimmunity
  • When oxygen is bound to a carbon or hydrogen, oxygen is "happy"; when bound to another oxygen, both are "unhappy"
  • We run on Acetyl-CoA; from sugars and fats; mitochondrial fuel
  • Energy created by NADH is used to charge the battery/electron transport chain
  • CoQ10 becomes used up and acts like a hot potato; does not neutralize a free radical; it is a storage molecule, not an antioxidant
  • Good oxygen is a life giver; body uses oxygen to burn and release energy
  • Failure to maintain mitochondrial function is death
  • Longevity begins with oxidatively balanced cells and ends with oxidatively imbalanced cells
  • NADH is the electricity of the body; electrons cannot be stored, they must be used
  • Low iron anemia is a bad problem
  • Bad oxygen #1 is superoxide
  • When NADH is in excess of what the electron transport chain can handle, it will create superoxide
  • Excess NADH ends up as lactate, superoxide, or nitric oxide
  • Bad oxygen #2 is hydrogen peroxide
  • Hydrogen peroxide removed by catalase, glutathione, plasmalogens; covert to water
  • One plasmalogen molecule can neutralize two reactive peroxides into non-oxidative products
  • When control mechanisms get overwhelmed or impaired, you get membrane peroxidation and immune response
  • If hydrogen peroxide does not get neutralized, microglia may become activated
  • DHA is very susceptible to oxidation
  • Uncontrolled immune response may lead to neurodegeneration, demyelination, and reduced brain function
  • Plasmalogens are critical for memory structure
  • Goal of mitochondria is to create energy; catabolic
  • Peroxisomes are anabolic; make membranes
  • Mitochondria have DNA; peroxisomes do not
  • Myelin may be restored with combination of Cuprizone (demyelinates) and Plasmalogen Precursors
  • Exogenous plasmalogens directly support remyelination
  • Parkinson's can be induced with mitochondrial toxicity
  • Plasmalogens can halt neurodegeneration
  • Inflammation should be attracted to damaged cells
  • Immune system is not attracted to healthy cells
  • Autoimmunity is really mitochondrial insufficiency
  • All oxidative stress is an imbalance in the creation of NADH and inability of the electron transport change to neutralize electrons into water using oxygen
  • Excess NADH electrons are transferred to lactate, superoxide, nitric oxide
  • Superoxide is neutralized by SOD
  • Hydrogen peroxide is neutralized by multiple enzyme systems and plasmalogens
  • After these mechanisms fail, lipid peroxidation occurs
  • Biomarkers
    • Plasmalogen levels
    • Adrenic acid; if elevated, mitochondria not processing Acetyl-CoA
    • Fasting triglycerides over 100 suggest insufficiency of mitochondria or peroxisomal function
    • Total cholesterol under 200, cellular insufficiency state; 220-250 is optimized; under 200 increases all cause mortality; most neurological disease patients have low cholesterol
    • HDL should be above 50; ideal 60-70; low = peroxisomal or PC insufficiency 
    • Too much uric acid reflects excess NADH; over 6; below 4.5-5, NAD/nicotinic acid deficiency
    • hsCRP
    • Homocysteine, PC/PE ratio, sphingomyelin/ceramide ratio, Creatinine
  • Mitochondrial and peroxisomal function should be optimized

A few items from the Q&A:

  • Membrane support: plasmalogens (intermittent fasting/resistance training can help; want precursors), PC (pancreatic cancer and liver disease will have PC deficiency), methytransferase system (lipids in blood do not reflect cells in the brain; methylfolate, B12, creatine, homocysteine)
  • If trouble getting homocysteine down, creatine will often drop homocysteine
  • Creatine frees up methyltransferase activity; tangles in the brain represent insufficient methyltransferase 
  • Homocysteine is a marker for methyltransferase activity
  • Plasmalogens work in peripheral nerves as well as central nerves
  • Autoimmune disease often considers anti-inflammatory omega 9 plasmalogens
  • Creatine stressing the kidneys is generally not a concern 
  • TMAO is cardio-protective; biomarker of abnormal gut microbiome activity on dietary PC consumption; a valid biomarker; not the same TMAO that is associated with cardiovascular outcome
  • Carnitine, NAC for restoring mitochondrial strength
  • Rare to see multi-system, multi-symptom presentations that does not have multiple DNA adducts
  • What you see in a patient is an adaptation to a given stressor and their best-case adaptation to the stressor
  • When antimicrobial treatment does not work in "Lyme", it may be a different set of circumstances that are now preventing healing; non-responsive patients may have a cellular lack or loss of ability to respond to the invitation to healing; focus more upstream on the ability of the cells to re-acquire ability to regulate

Bob Miller, CTN spoke on "Functional Genomic Analysis" and shared:

  • Measures 260,000 SNPs and runs through his software, Functional Genomic Analysis, to analyze SNP patterns
  • Can create custom formulas through Compounded Nutrition
  • Looking at genetics to identify impacts in optimal function
  • Has built a holistic framework including a focus on the terrain into the interpretation of the SNP results
  • Software suggests specific nutrients/supplements to optimize unique issues 

Lawrence Afrin, MD spoke on "Mast Cell Activation Disease: Current Concepts" and shared:

  • Similar talk to the ILADS talk here
  • MCAS can be at the root of polycythemia vera, pure red cell aplasia, and Burning Mouth Syndrome; many different types of conditions that may present
  • Allergic disorders rarely lead to loss of life; but do lead to loss of quality of life
  • Mastocytosis is an increase in the number of mast cells
  • MCAS may be a mutation-driven disease; KIT genes
  • Mastocytosis is rare; MCAS is prevalent - may be 17-20% of the population
  • Stress is a major trigger for mast cell activation
  • Mast cells release more than 1000 mediators
  • Not a new disease, but a newly recognized disease
  • MCAS = inflammation +/- allergic phenomena +/- aberrancies in growth/development from chronic inappropriate expression of mediators
  • Most become symptomatic at or before adolescence but may not have recognized
  • Multisystem; inflammation is universal constant; wax/wane
  • Tryptase is a poor markers of mast cell activation; better for mastocytosis
  • Odd and prolific sensitivities to drugs, foods, environment; fillers, binders, dyes, preservatives, not the medication itself generally
  • Autism has been described as brain on fire; no one has been thinking about mast cells
  • Autism has a 10-fold rate of prevalence in mastocytosis population; not yet recognized commonly in MCAS
  • Not being able to catch a breath can be MCAS
  • Traditional desensitization therapies have a role
  • Neural retraining may have a role
  • MCAS may underlie MCS and TILT
  • Antigens from microbes in the environment may serve as triggers; such as mold
  • MCAS plays a role in COVID illness; the 20% that have a severe course may have MCAS; may also play a role in long-haul COVID
  • Treatment
    • Avoid triggers; desensitization, low histamine diet, DAO
    • Inhibit mediator production; steroids, NSAIDs, C
    • Inhibit mediator release; Cromolyn, Pentosan, tyrosine-kinase inhibitors, Interferon, Omalizumab, Azathioprine, Benzodiazepines, Imidazopyridines, cannabinoids, LDN
    • Block actions of released mediators; H1/H2
    • Cytotoxic and cellular therapy for aggressive cases
    • Treat secondary issues and co-morbidities
  • Complementary treatments: C, D, ALA, NAC, PEA, CBD, flavonoids, stilbenoids (resveratrol), alkaloids (berberine), Lion's mane, elderberry, Omega 3, white willow bark, turmeric/curcumin, green tea, Pycnogenol, Boswellia, cat's claw, capsaicin, ginseng
  • Heparin may play a role in osteopenia/osteoporosis
  • Likely a small proportion of the mast cells in the body that are misbehaving
  • Most patients, sooner or later, identify a cocktail of treatments that lead to significant improvement the majority of the time
  • Has not found a more complex disease yet

A few items from the Q&A:

  • For MCAS, may start with H1 blockers Zyrtec, Claritin, Allegra, Xyzal trying each for 1-2 weeks to see what improves symptoms; then layer in H2 blockers such as Pepcid; Cimetidine can have other interactions
  • Benadryl and Hydroxyzine can be fantastic
  • May need 2-3 times a day dosing
  • Compounded versions may be needed: Loratadine, Cetirizine, Levocetirizine
  • Quercetin, Peremine, AllQlear can be helpful
  • Cromolyn works for some, not others; Ketotifen, LDN
  • Luteolin is in celery and parsley in high amounts
  • NeuroProtek tends to be a favorite
  • Hydrating with electrolytes can stabilize mast cells
  • PEA is a mast cell and cell membrane stabilizer; can also be helpful for pain; combined with CBD; Metagenics PEA Relief for pain and mast cell stabilization
  • PEA and PureLut (luteolin) are generally well-tolerated even in more sensitive patients
  • May start with compounded RX options like Ketotifen and Cromolyn; many don't tolerate herbs initially
  • Ketotifen can help with mast cells but also with sleep; also helps some with interstitial cystitis and brain-related symptoms
  • Perilla and AllQlear ca be helpful
  • For Benadryl, get dye-free
  • Oral KPV or compounded Amlexanox can be helpful for MCAS
  • Fluvoxamine can help with COVID and is also a mast cell stabilizer; can help with OCD
  • LDN may be helpful in those with long haul COVID
  • Neuropeptides are best used after infections and toxins have been addressed
  • Nortriptyline is an H1/H2/H3 blocker
  • Mirtazapine can be helpful for those with bad food reactions
  • Seroquel is anti-histamine; Trazadone is anti-histamine
  • Clonazepam can stabilize mast cells, but CBD is a better option; using benzodiazepines may lead to later issues
  • Stress is a major contributor to turning on the mast cells
  • GABA can decrease glutamate and may help to stop producing stress hormones that trigger MCAS
  • Using peptides from various online sources is a risk; some have been found to be contaminated with mercury and other contaminants; peptides should be obtained through a doctor and compounding pharmacy
  • THC is not a good option for developing brains
  • Need a refrigerated centrifuge for many of the MCAS/histamine tests
  • Tryptase, Chromogranin A, Histamine available through LabCorp/Quest
  • CD117 staining of the gut biopsy can be helpful for exploring mast cell issues; > 20 is technically positive
  • Infections and toxins are drivers of MCAS; a therapeutic trial is often helpful and insightful

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.   

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  BetterHealthGuy.com is intended to share my personal experience in recovering from my own chronic illness.  Information presented is based on my journey working with my doctors and other practitioners as well as things I have learned from conferences and other helpful resources.  As always, any medical decisions should be made only with the guidance of your own personal medical authority.  Everyone is unique and what may be right for me may not be right for others.   

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