ISEAI 2022: Cultivating Resilience: The Environmentally Acquired Illness Framework

Details: Created: May 20, 2022; Last Updated: May 28, 2022

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.