On August 5-7, 2022, GPL Academy hosted the Mitochondria and Toxins: Advanced Strategies & Protocols in Chicago and live-streamed online. The following Q+A is a grouping of responses from the workshop presentations.
The material contained within this article is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the following portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.
Kurt Woeller, D.O.
Kurt N. Woeller, D.O. has been an integrative medicine physician and biomedical Autism specialist for over 20+ years. He is an author of several health books including Autism – The Road To Recovery, Methyl-B12 Therapy For Autism, Methyl-B12 for Alzheimer’s Disease and Dementia, and 5 Things You MUST Do Right Now To Help With Your Rheumatoid Arthritis. He is an international speaker, educator, and practicing clinician offering specialized interventions for individuals with complex medical conditions. His health consulting practice for Autism alone is multinational with families from various countries. Dr. Woeller serves as a clinical and lab consult for Functional Medicine Clinical Rounds, as well as provides educational seminars for Great Plains Laboratory. He is co-founder of Integrative Medicine Academy (www.IntegrativeMedicineAcademy.com), which is an online training academy for health practitioners learning integrative medicine.
Q: How much more is covered in your Advanced OAT Mastery Course?
A: We go over every marker on the Organic Acids Test from Great Plains, as well as certain other markers commonly seen on other OATs.
Q: Do you ever delay addressing the bacterial/fungal dysbiosis to gently detox the patient first so that the removal of the biofilm is more effective and is only done once?
A: Yes, this can be done for some people.
Q: I have a patient who gets recurrent vaginal yeast infections monthly. She is told by her gynecologist that it’s hormonal. Could it be from a yeast/mold issue within the gut and environment? Should I run an Organic Acids Test on her?
A: Absolutely run an OAT.
Q: Do you typically avoid fungus plants in mold/mycotoxin patients? Do you use saccharomyces boulardii?
A: I use this from time to time. It can be helpful overall, but some people are sensitive to it.
Q: If the test shows candida or mold does that mean it is currently active?
A: On the OAT its active.
Q: Or could it be showing that you did at one time have candida and there are antibodies or organic acids still present?
A: The IgG Food MAP can indicate past problems, but the OAT is current and active.
Q: Once you see the clostridia markers high on the OAT, do you run a stool test to confirm Clostridia presence before treating?
A: No, only unless they have significant bowel problems and want to rule out C. difficile with toxins and A and B.
Q: Polyethylene glycol is used widely in nursing homes for older people with constipation. It is also a component in some drugs and foods, how much of a health risk is this?
A: It’s a risk and certainly not ideal to use. There are many other options for constipation in the natural medicine world worth looking into.
Q: I understand, from other information I've viewed, that the OAT test can be hit-or-miss for oxalates because of cyclical excretion. Are you familiar with this phenomenon or its implications?
A: Yes. It’s called dumping. However, most of the time it is picked up on the OAT.
Q: For patients taking high doses of quercetin ascorbate (i.e. 2-8g/day) for mast cell hyperactivity, do you think there is a high probability of oxalate issues from such high doses of Vitamin C? Would a downward taper be a good idea, to avoid possible dumping when coming off it again?
A: Yes. Oxalates can manifest through this. For people who are very sensitive this would be a good idea. Not necessary for many people though.
Q: I've heard of good results with AURO topical glutathione. Your thoughts? Have you used it? vs Tri Fortify?
A: I have not used it.
Q: Would ADD medication affect the HVA value on the OAT?
A: Anything that drives up dopamine can affect the HVA value.
Q: What D-lactic free probiotics do you use/how do you know if the probiotic is D-lactic free?
A: It has to do with the type of bacteria in the probiotic. You will need to do some research on which bacteria produce D-lactic.
Q: Which marker on the OAT could indicate a coinfection of virus interfering with mitochondria function or getting damaged inducing the cell danger response?
A: There is no specific marker for viruses and no markers per se specific to the CDR.
Q: Do you have any thoughts or preferences on the form of CoQ10 to use, ie. Ubiquinol or Ubiquinone?
A: Ubiquinol.
Q: Do you have any thoughts on supplementing with Calcium Citrate for Oxalates and K2 amounts to address uptake? Does it matter if the Calcium is getting bound with the oxalates?
A: Vitamin K helps with bone mineralization so less availability for oxalate binding. It is a good idea to use too.
Q: Do molds that are known to be toxic that show up on the OAT not always produce toxins that would show up on the MycoTOX Profile?
A: Correct. There may not always be mycotoxins present, but they often are.
Q: Is Gliotoxin just produced by fungus or also candida?
A: There seems to be controversy around it, but it appears more likely that Candida can produce it too.
Q: Do you avoid using saccharomyces boulardii as an antifungal in those with fungal or mold related illness due to it being in that family of organisms, or do you find it still beneficial?
A: I do not use SB a lot. It can be helpful for some people, but watch out for reactions in people with inflammatory bowel disease.
Q: Can colonized molds create mycotoxins?
A: Yes
Q: Does the nephrotoxicity associated with ochratoxin, etc, tend to reverse once the detoxification has been done?
A: It should if the problem has been more of a recent onset.
Q: Any experience using modified citrus pectin?
A: Some. It is another type of binder.
Q: At what level of a positive MycoTOX Profile do you treat mycotoxins?
A: Any level outside the green. If its in the green than I mostly leave it alone unless the patient has known exposure and there is a high suspicion of mold/mycotoxin exposure.
James Greenblatt, M.D.
A pioneer in the field of integrative medicine, James M. Greenblatt, M.D., has treated patients since 1988. After receiving his medical degree and completing his psychiatry residency at George Washington University, Dr. Greenblatt completed a fellowship in child and adolescent psychiatry at Johns Hopkins Medical School. He currently serves as the Chief Medical Officer at Walden Behavioral Care in Waltham, MA and serves as an Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College Geisel School of Medicine. Dr. Greenblatt has lectured internationally on the scientific evidence for nutritional interventions in psychiatry and mental illness. He is the author of seven books, including Finally Focused: The Breakthrough Natural Treatment Plan for ADHD. He is the founder of Psychiatry Redefined, an educational platform dedicated to the transformation of psychiatry, which offers online CME-approved courses, webinars, and fellowships for professionals about functional and integrative medicine for mental illness. jgresources@gmail.com www.PsychiatryRedefined.org www.JamesGreenblattMD.com
Q: Do you think that the safety profile differs much between lithium carbonate, lithium citrate, and lithium orotate or are they all primarily dose-dependent?
A: I believe that the side effect profile is most often due to the amount of elemental lithium not the carrier model (i.e., Carbonate, citrate, or orotate). It is important to remember 150 mg of lithium carbonate only has 28 mg of elemental lithium.
Q: For patients with brain fog associated with long COVID, have you found Lithium helpful? Any protocols specific for long COVID?
A: Other than “the basics,” the most effective supportive supplements for long-haul COVID involve the use of lithium and OPC’s. Lithium (Lithium (Orotate) 1mg | Pure | Doctors and Patients Access (pureencapsulationspro.com) and Lithium (Orotate) 5mg | Pure | Doctors and Patients Access (pureencapsulationspro.com)) is recommended for patients with starting dose at 1-2 mg and titrate up if tolerated or needed to 5-10 mg. The OPC product is usually 2-3 times per day and we use the Curcumasorbmind (Cognitive Support Supplement* | Pure | Doctors and Patients Access (pureencapsulationspro.com)
Q: What kind of doses of lithium (or lithium levels) show the greatest effect on inflammation?
A: Using nutritional lithium for irritability, prevention of dementia, and neuroinflammation, we often use dosages that do not result in blood levels. There is very little research correlating blood levels with efficacy on any disorder except for bipolar disorder.
Q: It looks like some studies were done in the 90s showing “no effect” in OCD, but theoretically lowering neuro-inflammation would improve OCD. Have you seen any benefit of low dose lithium on PANS/PANDAS/OCD? How long would you trial it for in a pediatric patient before concluding it has no effect on them?
A: I have seen tremendous benefit in patients with PANS/PANDAS/OCD. I think the problem in our field is that we oversimplify our treatment response and simply assume every PANS/PANDAS/OCD patient with respond. As you know, there are multiple genetic and environmental factors that contribute to these illnesses and the exacerbation of symptoms. Lithium often plays a critical stabilizing role but without adequate testing and targeted treatments for the infection and other drivers of inflammation, lithium by itself is usually not enough.
Q: Is low lithium excretion on the urinary essential elements test equivalent to low lithium on hair mineral analysis?
A: I am not familiar with urine tests and am not convinced of utility of urine tests for assessment of lithium status. I know a few labs have developed these very quickly. I have not yet found them useful in clinical practice.
Q: Who offers lower than 5 mg dose in supplement form for Lithium?
A: Pure Encapsulations offers a 1 mg lithium orotate.
Q: What is the appropriate dosage for a suicidal person in an emergency and how soon will it calm the patient?
A: Any patient that is suicidal should be in an emergency room and low dose lithium is not an agent that is used for acute suicidal behavior.
Q: With the 1-2mg dosing in irritable children, is that 1-2mg of Lithium Orotate, or elemental?
A: Both. They should be the same. It should be elemental lithium, most commonly found as lithium orotate. For younger children under 6 years of age, I would recommend to start with 500 micrograms.
Q: How does lithium impact the Orotic marker on the OAT?
A: Lithium orotate simply will raise Orotic acid.
Q: Would there be any value in administering Lithium via IV?
A: I have not investigated IV lithium and, since lithium is so easily absorbed, it likely won’t be significantly advantageous.
Q: Can stress from living in a low social economic environment deplete lithium and require higher need?
A: Stress is unlikely to deplete lithium directly but all the related inflammatory markers and disruption in neurotransmitter utilization will likely require higher lithium.
Q: What are the parameters for dosing carbonate, as well as orotate in adults and then for children?
A: I can only share 150 mg lithium carbonate and 28 mg of lithium orotate. These should be dosed according to a physician’s clinical experience based on symptoms and underling diagnoses.
Q: What is the dosage range of lithium for generalized anxiety disorder?
A: I would recommend sticking to lower doses 1-5 mg.
Q: Which SNPs are related to higher lithium needs?
A: There are SNPs associated with lithium but not well understood. The only SNP that I consistently look at is BDNF.
Q: Would low dose lithium be acceptable for patient with Hashimoto’s and elevated levels of TSH when patient has Lithium deficiency?
A: I have utilized low doses of 2-5 mg with patients with thyroid disorder with good success, but this should be done carefully by monitoring thyroid function.
Q: Do you suggest Lithium carbonate or Lithium orotate with patient who is deficient?
A: Based on the dose, I usually use 1-20 mg lithium orotate. If I am looking for 30 mg or higher, I use lithium carbonate.
Q: What is dosage for adult female 115 lbs.?
A: Lithium is not dosed per body weight. We always start with 1-2 mg and titrate as we monitor symptoms and possible side effects.
Q: Would a thyme supplement be an alternative for lithium micro dosing?
A: I have not found that for any patients with clinical symptoms that herbal supplementation is sufficient.
LEARN NEW WAYS TO HELP PATIENTS WITH DIFFICULT-TO-DIAGNOSE AND CHRONIC HEALTH ISSUES.
The tests discussed throughout each workshop are all used to help identify exposure sources and biochemical imbalances in individuals with chronic health conditions. The Organic Acids Test (OAT) contains multiple markers which may be influenced by environmental and mold toxins. Often, the combination of the OAT, MycoTOX Profile, and GPL-TOX Profile can be used to help identify how a patient might be getting exposed, as well as assist with correlating their symptoms back to these sources. Determining the underlying causes of chronic illnesses for patients is the key to integrative medicine, not just treating the symptoms. The Great Plains Laboratory continues to find new ways to detect these causes of many illnesses and study the correlations between the results and conditions.
Registration includes:
Ability to purchase GPL tests discussed throughout the program at special workshop-only discounted rates.
60-day access to the full conference recordings.
Permanent PDF access to each speaker’s slides.
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An interactive Workshop Hub website where you can live chat and network with attendees and ask questions to the speakers.
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