Detoxification

Workshop Q+A Part 2 - Mitochondria and Toxins

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.


Joseph Pizzorno, N.D.

Joseph Pizzorno, ND is a world-leading authority on science-based natural medicine, a term he coined in 1978 as founding president of Bastyr University. A naturopathic physician, educator, researcher and expert spokesman, he is Editor-in-Chief of PubMed-indexed IMCJ, Chair of Board of IFM, board member of American Herbal Pharmacopeia, and a member of the science boards of the Hecht Foundation, Gateway for Cancer Research and Bioclinic Naturals. Author or co-author of six textbooks and 7 consumer books (Encyclopedia of Natural Medicine, The Toxin Solution), he has been an intellectual, political and academic leader in medicine for four decades.

Q: What was the supplement you recommended when using NAC for a patient?   

A: N-acetylcysteine is readily available from many good companies. I use Natural Factors/Bioclinic Natural since I am a scientific consultant for them. I like adding fiber to help bind the toxins that NAC helps excrete. 

Q: How do you detox arsenic? What nutrients or binders do you use to detox arsenic?  

A: The best detox for arsenic is avoidance. Its half-life is typically 2-4 days, so avoidance is effective. The rate of detox can be increased by consuming dietary folates, not folic acid, and flavonoids such as phloretin.  

Q: What are your thoughts on NAD and Glutathione IV therapy?  

A: IV therapy can be helpful but should only be done by those who are very skilled and when the safer oral interventions are not adequate. Before giving anyone IV glutathione, be sure the blood is cleared of mercury. 

Q: For someone with deletions in glutathione-S-transferase, what is the best way/form to increase GSH?  

A: This is really two different issues. Glutathione-S-transferase uses glutathione, does not produce it. Oral NAC and liposomal glutathione increase GSH. 

Q: With a sulfa allergy which is directly correlated with that deletion, is glutathione supplementation not recommended or cautioned?  

A: I am not aware of sulfa allergy being a contraindication for glutathione. 

Q: Is there any connection between the malate you are speaking about in your lecture and supplements with malate, such as calcium and magnesium malate?  

A: Same molecule. Several minerals have been bound to Krebs cycle intermediates, supposedly to improve absorption and utilization. 

Q: Do you have data on the effects of Metformin on Cplx 1 - causing acidosis?  

A: Yes, Metformin does indeed cause pericellular acidosis. Anything which increases lactic acidosis causes acidosis, such as biguanides (metformin), antiretrovirals, statins, many more. 


Elena Villanueva, D.C.

Dr. Elena Villanueva, producer and co-host of the 5 Part Series Mental Health Masterclass, the 5 Part Series Inflammation Masterclass, and The Leaky Brain Summit, is an internationally recognized crusader for ending the global chronic illness & mental health crisis by educating both the public and health professionals that mental health & other chronic illnesses are actually a body or brain health issue and not a disease. Elena has been featured on multiple occasions on FOX news, MSN, Healthline, Houston Chronicle, Anxiety and Depression Secrets Docu-Series, and several other documentaries. Dr Villanueva teaches on stages around the globe on evidence-based approaches for finding the underlying causes of chronic illness and brain-related conditions and how to use holistic and 'whole person' approaches to restore brain-related disorders and other chronic diseases.

 

Q: Do you have any experience with devices such as the NanoVi, to assist with mitochondrial function and proper folding of proteins? 

A: I do not. I do however have experience with bioenergetics and how that shows improvement of mitochondrial function. In fact, a recent study was just completed by a university out of California showing the biological improvements in mitochondrial function and replication with the use of bioenergetics. 

Q: What is your glyphosate protocol? 

A: Glyphosate has a short half-life and is one of the toxins that can leave the body without help of added supplementation. However, the client must discover and stop his/her exposure to the glyphosate for levels to come down. When we detox, our protocols are designed to detox ALL toxins, chemical, myco, and HM’s… this simplifies the protocols (and reduces the costs) for patients/clients and makes them much more compliant and with that compliance you and your patients/clients will see more consistent positive outcomes. 

Q: Are you concerned when toxins don't increase on testing between months 4-6 indicating they are not coming out as much? 

A: Not as much of a concern as it is an indicator that the client/patient is not compliant with the protocols. By month 4-6, if they are compliant with reducing their exposure and taking their recommended supplements and food protocols, you will see one of the following two scenarios: 

  1. Their toxins will show higher indicating they are releasing toxins from their body 

  2. Their toxins will show lower because they have already released a good portion of their toxic load quickly. 

If they are still showing the same levels after 3 months on deep detox, they are either still exposing themselves, not taking their protocols as recommended, or both. Keep in mind this is reflective for the protocols in our practice and may vary based on the protocols you establish. 

Q: For a colonized fungal infection in the gut do you cycle, rotate, or use one over-the-counter anti-fungal at a time? 

A: It depends. If the client/patient is not showing symptoms directly related to the fungal infection I focus instead on the broader picture with my deep detox protocols which also address fungal infections. If they are having considerable symptoms from the fungal infection, then yes, I put them on a fungal protocol first to mitigate their symptoms. Then I resume with my 12-month protocol system. 

Q: I have a 34-year-old female with extreme CFS, ADHD and depression for 12 years. Organic Acids Test results are within normal limits except for borderline high arabinose and low Vitamin C. MycoTOX Profile results are positive for ochratoxin A, citrinin, and chaet (from previous home). Dealing with severe debilitating brain fog, memory issues, poor executive function. She wants to go back on Adderall but worried that it will affect mitochondria/adrenals. Any insight on the negative effects of psychostimulants on CFS? 

A: We prefer to avoid those at all costs because of the negative side effects and potential damage they can have. If you are using effective protocols your client should be able to detox her mold toxins in an average of 9 months and you can include added brain and energy support during this time to help her… that could look like added high dose DHA, phospholipids, AA therapy, adrenal support, or even addressing vitamin and /or mineral deficiencies (according to labs) because those are common and can exacerbate brain fog, memory, etc. 

Q: Can you comment on use of Vitamin D with Vitamin K? Why do you use Vitamin K? 

A: High level overview on this: there are a percentage of people who have the VDR taq genetic variant and need Vitamin K to process their Vitamin D. Also, it simply ensures that the Vitamin D has the best chance at being utilized by the body. So, we are covering the bases without having to add more costly testing like genetic testing to their overall costs.  

Q: Just wondering the rationale for doing just the methyl B12/folate vs. a good B complex with activated forms? How do they replete the other B vitamins if given just the folate and B12? 

A: We do like using a good B complex with the methylated B12 and folate. However, at this time we have not found, nor have we been able to formulate a B complex that has the high therapeutic grade doses of methyl B12 methyl folate we prefer to use… therefore we use just the Methyl B12 and Methyl folate that we created in our brand at BioOne Sciences. There are some clients that we will put on additional B Complex. And all our clients that go into a year 2 program with us (which is most of them), get switched over to a B Complex (with the methylated B12 and Folate). We haven’t had an issue with repletion of the other B’s. 

Q: Could we get your pdf form for patients to record their lab results and significance? 

A: Please reach out to us at info@modernholistichealth.com We will be emailing our practitioners who are interested in learning our systems with information on our first live, in person training that we want to do and from that training we will share all our forms and protocols with you. 

Q: What is in your tox bundle? OAT, MycoTOX Profile, Heavy Metals and what else?  

A: Yes, those plus the environmental toxins and Glyphosate

Q: What was the biofilm agent you said you used?  

A: It’s our TCG Activation product that is humic/fulvic based.  

Q: Is it normal for a patient to get full body edema during a detox? 

A: No, it is not normal. It sounds like their detox pathways are not open and you should have your patient stop immediately. Be sure you check their blood labs for kidney and liver function, make sure they are having full evacuation bowel movements, and check for methylation challenges with some genetic testing. You might also get a history on any issues with their lymphatic system as well and determine if they have any allergies or sensitivities to any of the ingredients in the supplements you have them on. 


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:

  1. Ability to purchase GPL tests discussed throughout the program at special workshop-only discounted rates.

  2. 60-day access to the full conference recordings.

  3. Permanent PDF access to each speaker’s slides.

  4. The option to purchase continuing education credits (5 credits per day), whether you attend in-person, watch Live Online, or watch the conference recordings at a later date! See detailed information about credits.

  5. An interactive Workshop Hub website where you can live chat and network with attendees and ask questions to the speakers.

  6. And last, but most certainly not least, qualified practitioners will receive a free OAT.

Workshop Q+A Part 1 - Mitochondria and Toxins

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:

  1. Ability to purchase GPL tests discussed throughout the program at special workshop-only discounted rates.

  2. 60-day access to the full conference recordings.

  3. Permanent PDF access to each speaker’s slides.

  4. The option to purchase continuing education credits (5 credits per day), whether you attend in-person, watch Live Online, or watch the conference recordings at a later date! See detailed information about credits.

  5. An interactive Workshop Hub website where you can live chat and network with attendees and ask questions to the speakers.

  6. And last, but most certainly not least, qualified practitioners will receive a free OAT.

Kidney: The Often-Forgotten Part of Detoxification

Quick glance

  • Toxicants can be absorbed via three main pathways: respiratory tract via inhalation, integumentary system via direct skin contact, or gastrointestinal tract (GI) via consumption (2).

  • Chemical toxicants passing through the kidneys can be measured in urine.

  • Included are recommendations that can be put in place to ensure your patients’ kidneys function well and are prepared to do the work of detoxification of any type of toxic intruder.

By: Lindsay Goddard, M.S., R.D.N., L.D.

Too often the liver and the GI tract are the first two organs that spring to mind when the word detoxification is mentioned.  Granted, these two systems do a lot of important work in removing toxins from the body, but another vital organ that detoxifies the body are the kidneys.

The kidneys are instrumental in detoxifying a wide range of end products of metabolism. Toxins which have gone through phase II liver detoxification or direct excretion, and excess water-soluble nutrients such as B vitamins and Vitamin C are also filtered out by the kidneys (1). The kidneys allow these compounds to be removed from the body via urine, which along with stool, is the major pathway of elimination. Sweat, tears, saliva, hair, nails, and milk, all are a part of elimination as well, but to a lesser degree (2). In this blog we will discuss the kidneys and the roles they play in elimination of toxins, especially ones found on the MycoTOX Profile and the GPL-TOX Profile.


How the Kidney Works

Let’s first review the kidney and its function. It is a complex, and sophisticated organ that is so important, nature felt two were necessary. These bean shaped organs have many functions, but one of the major roles is filtering out excess water and cleaning the blood from toxins. They are so efficient, they can clean all the blood in the body in just under an hour on average (3).

The three layers of the kidney are the cortex (outer layer), medulla (inner part), and the central pelvis. Unfiltered blood travels through the cortex via the renal artery into the nephron. The nephrons are basically the blood filtering units composed of bundles of blood vessels called glomerulus, within the Bowman capsules.

When the blood passes through the glomeruli, within the medulla, waste and excess water diffuse into the capsule. The excess is then carried away by tubules to form urine, while useful substances that can be recycled are absorbed by the capillaries. The filtered blood is sent back to the heart via the renal vein. The urine is then carried through the tubules to the central pelvis, which is then emptied into two tubes called ureters, ultimately going to the bladder (2).

To be fair, the kidneys have other notable functions as well, such as release of certain hormones, stimulation of red blood cell production, and supporting fluid homeostasis within the body, but those details are outside the scope of this blog.

Figure 1: Basic Structure of the Kidney. Adapted from the University of Michigan. http://websites.umich.edu/~elements/web_mod/viper/kidney_function.htm (4).


Eliminating Toxicants

How do toxicants enter our systems? Toxicants can be absorbed via three main pathways: respiratory tract via inhalation, integumentary system via direct skin contact, or gastrointestinal tract (GI) via consumption (2).

The pulmonary route of absorption can be quite significant as the lung tissue is highly vascularized and has a larger surface area. The GI tract also has a larger surface area, but pH has a greater influence on this systems ability to absorb.

The skin isn’t as permeable (unless there is an opening), and it’s mainly the lipid-soluble compounds that are the most worrisome, as they can be absorbed more efficiently via passive diffusion. In a very, very simplistic view, once the toxicant is absorbed via the skin or respiratory tract, it ultimately ends up in the blood where it can travel throughout the system.

The GI tract absorption is different in that if it passes through the membranes, it will likely pass through the liver before it enters general circulation. Ultimately, the body’s goal is to eliminate toxicants. As noted previously, urinary excretion via the kidney is an extremely important mechanism for this to occur.

When toxicants enter the kidney, a large amount are filtered across the glomerulus with relative ease if they are not protein bound in the plasma and/or are relatively small. Ionized toxicants tend to remain in the urine, while toxicants that are more lipophilic can re-enter renal circulation through reabsorption (2). This is the case with Ochratoxin A (OTA) from Great Plains Laboratory’s MycoTOX Profile.

OTA is quite nephrotoxic, and this is likely because as it is going through organic anion transport in the tubules of the kidney, it is actively being reabsorbed. It is also transported with smaller carrier proteins, allowing the compound to pass through the glomerular membrane at an increased rate (5-7). Other than OTA, there are other mycotoxins that can impact the kidneys while they pass through it.

Other Ochratoxins, particularly C, can be damaging to the kidney, though the direct mechanism of action is still being investigated (8). Mycotoxins from Fusarium and Aspergillus, particularly some of the aflatoxins (B2, G1, M1 and M2), and the T2 toxin have all been documented in literature to influence the kidneys during excretion (9-12).

Evidence also indicates that Gliotoxin has cytotoxicity to renal epithelial cells, even at lower concentrations (13). Verrucarin A and Roridin E have both been found to be highly absorbed into the kidneys, even more so than the liver or lungs (14, 15).

Mycophenolic Acid (MPA) goes through glucuronidation in the kidneys, and is mainly eliminated via urine by active tubular secretion and glomerular filtration (16-18). These mycotoxins are all measured on the GPL’s MycoTOX Profile, and can be a helpful clue into what assaults are occurring on the kidneys, along with the other added benefits of running a MycoTOX Profile.



Eliminating Chemical Toxicants

Chemical toxicants passing through the kidneys can be measured in urine. The structure of the chemical compound has a large influence on its excretion through the kidneys. The more lipophilic the compound, the more likely it will be reabsorbed, or in other words, have a difficult time eliminating. The more hydrophilic compounds are, the easier they are to eliminate (1,2).

Please do not think of chemicals that are easy to eliminate as not as toxic as others. Though they may not bioaccumulate as well, the damaging effects they can have while in the system prior to elimination are still of concern, especially with chronic exposure.

Saturation plays a factor in the kidney’s ability to eliminate, meaning it only has a certain capacity it can filter. Mitochondrial function can also be a factor since the ATP generated from the citric acid cycle can help actively move the toxicants out (1).

When you look at toxicants on the GPL-TOX Profile, one can get an idea of the more water-soluble compounds by the metabolite name. If the metabolite is the same name as the parent compound, then it did not have to go through much metabolism to be eliminated. Toxicants such as Diphenyl Phosphate, Perchlorate, and 2,4-Dichlorophenoxyacetic Acid (2,4-D) all fit that description. The others are more complex, and it gets even more complex with heavy metals, but we can save that for another blog.

How to Support the Kidneys

So, we now know what the kidneys do, and what assaults can negatively impact them, the next question  is how can I support it? How do we take care of the kidneys so they can do their job(s) well?

If you have been looking into the world of environmental toxins, it is abundantly clear that the most important thing to do is remove/reduce the toxicant loads. That is a whole other topic, and some really great blogs/webinars have been produced that already delve into mold testing for your body and your home as well as identifying toxins in your environment. If you don’t remove the source, no matter what you do, the problem will persist.



Additional Recommendations

Below are some additional recommendations that can be put in place to ensure our kidneys function well and are prepared to do the work of detoxification of any type of toxic intruder.

  1. Drinking enough clean water. Keeping fluid moving through the body and the kidneys will help them run efficiently and get the toxicants out quicker. There is no specific amount, as everyone is different, but a good general guideline is half the body weight in ounces (e.g. a 120lb person should consume around 60oz of water, minimum). Also, check the urine color to help. Too yellow means more water, clear urine means too much water, as it should have a tinge of yellow to it.

  2. Decrease Sodium and Phosphorus Intake. Sodium and Phosphorus in excessive amounts (not the kind in natural foods, rather the kind in processed foods) can cause imbalances in the kidneys and put additional strain on them, causing them to work harder.

  3. Movement. Improving blood and lymph flow through movement can help the kidneys function optimally. Walking, Yoga (added bonus with the breathing - that’s a part of detoxing too believe it or not!), bicycling, etc. Whatever movement brings joy, it will help.

  4. N-acetyl Cysteine (NAC). NAC has been known to protect kidneys from various assaults. A meta-analysis found that supplementation with NAC improved glomerular filtration rate and serum creatinine, indicating supportive effects (19).

  5. Functional Foods. Various foods can have direct effects on kidney improvement. Beets can support better blood flow throughout the system, in particular the kidneys (20). Blueberries and cabbage have been shown to help with reducing inflammation in the kidneys (21, 22). Curcumin has evidence suggesting it can be helpful in protecting the renal mitochondria (23). Cinnamon, although the effects are not directly towards the kidneys, can help control blood sugar which in turn helps support the kidneys (24).

  6. Be aware that some herbals can be toxic for the kidneys, while other herbs may have influences on kidney function, if the kidney is already in distress. Be mindful with herbal tinctures depending on the current state of the kidney (25).

There are other supports for the kidneys out there, but these should at least be a good start.

The kidneys are incredibly important in helping with the elimination of toxicants, and it is important to support them with lifestyle and diet. We need to support our bodies for the environment in which we live and take care of our systems to ensure they can work properly to withstand the challenges.

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Lindsay Goddard, M.S., R.D.N., L.D.

Lindsay Goddard is a Registered Dietitian, with a Master’s Degree in nutrition. She has been involved in integrative and functional nutrition for over 10 years. She has worked in a variety of specialty areas such as genetic and metabolic disorders along with NICU and pediatrics. She also had a private practice where she specialized in gastrointestinal disorders. Lindsay now works as a GPL consultant and is currently earning her graduate certificate in Toxicology through The University of South Florida.


References: 
  1. Pizzorno J. The Kidney Dysfunction Epidemic, Part 1: Causes. Integr Med (Encinitas). 2015 Dec;14(6):8-13. PMID: 26807064; PMCID: PMC4718206.
  2. Richards I and Bourgeois M. Principles and Practice of Toxicology in Public Health. 2014. ISBN: 9781449645267
  3. A, Fardon J, Friend J, Temple N, Routh, K. et al. The Amazing Body. Smithsonian. 2017. First American Edition. Pg. 154-155. ISBN: 978-1-4654-6239-8
  4. University of Michigan. Kidney Function. http://websites.umich.edu/~elements/web_mod/viper/kidney_function.htm
  5. Khoury A and Atoui A. Ochratoxin A: General Overview and Actual Molecular Status. Toxins. 2010. 2(4): 461-493. PMID: 22069596
  6. Gupta, Ramesh C. Veterinary Toxicology. Basic and Clinical Principles 3rd edition. 2018. 
  7. Plumlee KH. Mycotoxins Toxicokinetics. Clinical Veterinary Toxicology. 1st Edition. 2004
  8. Abramson D. MYCOTOXINS Toxicology. Encyclopedia of Food Microbiology. 1999. Pages 1539-1547. ISBN 9780122270703. https://doi.org/10.1006/rwfm.1999.1150.
  9. Mohan J, Sheik Abdul N, Nagiah S, Ghazi T, Chuturgoon AA. Fumonisin B2 Induces Mitochondrial Stress and Mitophagy in Human Embryonic Kidney (Hek293) Cells-A Preliminary Study. Toxins (Basel). 2022 Feb 25;14(3):171. doi: 10.3390/toxins14030171. PMID: 35324667; PMCID: PMC8954924.
  10. Coppock RW, Dziwenka MM. Mycotoxins. Biomarkers in Toxicology. 2014. Pages 549-562.ISBN 9780124046306. https://doi.org/10.1016/B978-0-12-404630-6.00032-4. https://www.sciencedirect.com/science/article/pii/B9780124046306000324. 
  11. Nassar AY, Megalla SE, El-Fattah HM, Hafez AH, El-Deap TS. Binding of aflatoxin B1, G1 and M to plasma albumin. Mycopathologia. 1982 Jul 23;79(1):35-8. doi: 10.1007/BF00636179. PMID: 6811900.
  12. Adhikari M, Negi B, Kaushik N, Adhikari A, Al-Khedhairy AA, Kaushik NK, Choi EH. T-2 mycotoxin: toxicological effects and decontamination strategies. Oncotarget. 2017 May 16;8(20):33933-33952. doi: 10.18632/oncotarget.15422. PMID: 28430618; PMCID: PMC5464924.
  13. Gayathri, L., Akbarsha, M. & Ruckmani, K. In vitro study on aspects of molecular mechanisms underlying invasive aspergillosis caused by gliotoxin and fumagillin, alone and in combination. Sci Rep 10, 14473 (2020). https://doi.org/10.1038/s41598-020-71367-2
  14. Amuzie CJ, Islam Z, Kim JK, Seo JH, Pestka JJ. Kinetics of satratoxin g tissue distribution and excretion following intranasal exposure in the mouse. Toxicol Sci. 2010;116(2):433-440. doi:10.1093/toxsci/kfq142
  15. Amuzie CJ, Islam Z, Kim JK, Seo JH, Pestka JJ. Kinetics of satratoxin g tissue distribution and excretion following intranasal exposure in the mouse. Toxicol Sci. 2010;116(2):433-440. doi:10.1093/toxsci/kfq142
  16. Food and Drug Association. Mycophenolic acid (Myfortic). https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/050791s002lbl.pdf
  17. Lamba V, Sangkuhl K, Sanghavi K, Fish A, Altman RB, and KE.PharmGKB. Mycophenolic Acid Pathway. Pharmacogenetics and genomics.2014. PMID:24220207. https://www.pharmgkb.org/pathway/PA165964832
  18. Hooijmaaijer E, Brandl M, Nelson J, Lustig D. Degradation products of mycophenolate mofetil in aqueous solution. Drug Dev Ind Pharm. 1999 Mar;25(3):361-5. doi: 10.1081/ddc-100102183. PMID: 10071831.
  19. Ye M, Lin W, Zheng J, Lin S. N-acetylcysteine for chronic kidney disease: a systematic review and meta-analysis. Am J Transl Res. 2021 Apr 15;13(4):2472-2485. PMID: 34017406; PMCID: PMC8129408.
  20. Kolluru GK, Kevil CG. Beets, bacteria, and blood flow: a lesson of three Bs. Circulation. 2012 Oct 16;126(16):1939-40. doi: 10.1161/CIRCULATIONAHA.112.136515. Epub 2012 Sep 19. PMID: 22992323; PMCID: PMC4078643.
  21. Nair AR, Masson GS, Ebenezer PJ, Del Piero F, Francis J. Role of TLR4 in lipopolysaccharide-induced acute kidney injury: protection by blueberry. Free Radic Biol Med. 2014 Jun;71:16-25. doi: 10.1016/j.freeradbiomed.2014.03.012. Epub 2014 Mar 19. PMID: 24657730.
  22. Asiwe JN, Kolawole TA, Anachuna KK, Ebuwa EI, Nwogueze BC, Eruotor H, Igbokwe V. Cabbage juice protect against lead-induced liver and kidney damage in male Wistar rat. Biomarkers. 2022 Mar;27(2):151-158. doi: 10.1080/1354750X.2021.2022210. Epub 2022 Jan 3. PMID: 34974788.
  23. Trujillo J, Chirino YI, Molina-Jijón E, Andérica-Romero AC, Tapia E, Pedraza-Chaverrí J. Renoprotective effect of the antioxidant curcumin: Recent findings. Redox Biol. 2013 Sep 17;1(1):448-56. doi: 10.1016/j.redox.2013.09.003. PMID: 24191240; PMCID: PMC3814973.
  24. Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003 Dec;26(12):3215-8. doi: 10.2337/diacare.26.12.3215. PMID: 14633804.
  25. National Kidney Foundation. Use of Herbal Supplements in Chronic Kidney Disease. 2009. https://kidneyhi.org/use-of-herbal-supplements-in-chronic-kidney-disease/

Advanced Organic Acids Testing: Q&A With Bob Miller, CTN, Joseph Pizzorno & Kurt Woeller, DO

On June 10-12, 2022, GPL Academy hosted Beyond the Basics: Advanced Organic Acids Testing Strategies live-streamed online. This three-day event focused on advanced Organic Acids topics. Those who attended the summit learned how to use effective diagnostic and treatment protocols for their patients to help get them on the road to recovery.

The following Q+A is a grouping of responses from the Day 2 workshop presentations. Click each presentation title to expand the answers from each speaker.

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.


Day 2 Q+A: Advanced Organic Acids


Kurt Woeller, DO

Mitochondrial Dysregulation: Factors that Adversely Affect Energy Production | The Organic Acids Test and Neurochemical Imbalances That Every Practitioner Should Understand | Panel Discussion

Q: I seemed to have a lot of adverse die-off reactions when using nystatin for candida in my patients, even when starting with the lowest dose and which does not alleviate much even with toxin binders like GI detox. Do you see those reactions in your patients, and if so what would you do for it? Sometimes I add in liver support too but the die-off reactions are also very severe to the extent that they have to give up the protocol.

A: You might try some individual botanicals first, e.g., goldenseal for a few weeks, then switch over to low dose Nystatin. These are difficult situations so starting with single botanical remedy may help.


Q: Which markers are an indication of SIBO? Which markers are associated with aspergillus? How do you test for SIBO in children?

A: The bacterial markers in the bacterial section page 1. But the Organic Acids Test is not definite on SIBO. Markers associated with aspergillus are #2, #4, #5 and #6. I typically do not recommend SIBO testing in kids because it is too difficult. 


Q: Have you used SB before in candida treatment protocol?

A: Yes, but not as single therapy. It would be used along with other probiotics and/or botanicals.

 

Q: I’m treating a patient with nutrient deficiencies and candida/ bacterial dysbiosis, which is causing mitochondria impairment. If the candida and bacterial dysbiosis has not been resolved, will providing and compensating nutrients alone alleviate the symptoms?

A: Resupplying nutrients often helps a lot, but will not completely resolve the problem if mitochondrial dysfunction is being caused by bacteria and yeast toxins.

 

Q: How do you explain to a patient who has normal vitamin levels on blood tests that they need vitamins based upon their Organic Acids Test results?

A: Blood testing is just one view of nutrients and does not always pick up or reflect what may be occurring at a cellular level. Therefore, indirect markers like Pyroglutamic and Methylmalonic acid are indicators of what’s happening within the cell.


Q: Can mold exposure (as evidenced by the MycoTOX Profile) without mold colonization (as evidenced by Organic Acids Test) still create an oxalate problem?

A: Not that I am aware of. It’s the mold producing the oxalate and not the mycotoxin.


Q: What is the significance of low aconitic?

A: According to the lab, there is no known clinical significance. 


Q: How is NAC compared with glutathione in combating oxidative stress in mitochondria?

A: It works, but it needs to be converted into glutathione. I still prefer the end product of glutathione in most cases oxidative stress affecting the mitochondria. The problem is the cost and NAC is typically less expensive.

 

Q: Do PPIs for GERD affect the mitochondria?

A: Good question. I am not sure, but know that PPIs alter the gut and increase the risk of vitamin and mineral deficiencies. Other alternatives exist and should be explored first.


Q: How does PQQ and lithium orotate cause mitochondrial biogenesis?

A: I have not studied the mechanism involved. I know PQQ has an antioxidant effect. This would be a good research project.


Q: Mitochondria are said to come from the mother's side of the family. So, if your mom had good energy, you would also have good energy. Why is that? 

A: Our genetics certainly play a role, but even more important moving forward in our lives are epigenetic factors affecting cellular function, including mitochondria.


Q: What if any reservations do you have with prescribing SAMe?

A: Bob Miller discussed this in-depth in his talk. I have seen some over-methylated special needs kids get hyper and emotional on SAMe. This may happen with sensitive adults too.


Q: Is there a way to test for the genetics of dopamine elevation? Or is it a diagnosis of exclusion?

A: GPL at one point had a DBH activity test. At this point, it just needs to be tested through genetics. Bob Miller’s genetic test is the most comprehensive.


Q: Should minor elevation in a clostridia marker always be treated?

A: Yes. I feel they should be.


Q: What is the dose for PTERIDIN-4?

A: I start with 2.5mg (one tablet) twice daily and progress from there. Typically, for most people 2.5mg to 5mg twice daily is enough.


Q: I have an adolescent patient with chronic depression who I measured Vitamin D and it was approximately 25. I know low D causing depression, which I find curious since the a child is outside a lot. I did rapid bolusing and remeasured. Vitamin D went down to 22. So, I thought maybe high dose bolus caused the increased breakdown. I increased slower, same levels. I could not get the child's Vitamin D up. What would you suggest looking for?

A: Look at his genetics. Also, it may be more advantageous to get natural sunlight activated Vitamin D over supplement D.



Q: Is there any role for the Organic Acids Test to assist with weight loss along with lifestyle changes.  

A: Absolutely. Stressors of various kinds can alter metabolism and effect weight, mitochondrial function, etc.


Q: Thoughts on ingesting elemental silver 2.7 mg with peppermint oil to eliminate bacterial and fungal infection.

A: I have patients where colloidal silver helped a lot. I have not combined it with peppermint oil.


Q: What are your thoughts on using low-dose naltrexone for treating chronic inflammation, particularly in autism or even other conditions (like Down syndrome).  

A: I like LDN a lot. Personally, I have never worked with a Down’s individual.


Q: Do you see this Quinolinic elevation is cases with chronic pain too?

A: Most definitely. One of things that can increase quinolinic is stress.


Joseph Pizzorno, ND

The Link Between OAT, Mitochondria, and Environmental Pollutants, Including Phthalates and Bisphenols | How to Practice Environmental Medicine | Panel Discussion

Q: What are the symptoms of sulfur metabolism problems or what alerts you to sulfur metabolism problems? For those people, would an epsom salt bath 2 or 3x weekly aggravate the situation?

A: The symptoms I have seen of sulfur metabolism problems are allergies, GERD and IBS. I think magnesium deficiency very common and regularly recommend Epsom salt baths. However, I do not see a direct connection with sulfur metabolism.


Q: Would it be a reasonable option to use the GGTP and/or liver enzymes first before proceeding with toxic chemicals analysis?

A: Yes. I know patient funds are limited, GGTP can tell you if it is worth spending their resources on toxin testing.


Q: What are your DMSA dosage to chelate lead/ mercury in children? If you do not use DMSA, what do you do for children with heavy metals toxicity? Do you recommend using safer compounds like spirulina, fiber, and supporting the liver?

A: For younger people, I modify dosage according to the standard weight-based drug formulas. I believe it is fine to use these other approaches. They will simply be slower.


Q: How is arsenic getting into the water? Is natural spring water a better source of water or can natural springs also have arsenic contamination?

A: Arsenic in naturally present in many rock formations. So the amount of arsenic in the water is randomly depended upon the geology. However, arsenic has been used a lot in manufacturing and for wood preservation. Natural springs are only safer if far from industrial contamination and if the source is not naturally contaminated with arsenic. Some wells in the US, especially in Maine, have very high levels of arsenic. The only way to know if the water is safe, is to test.


Q: How reliable or effective would aqua foot detox foot baths be in removing heavy metals and how many treatments do you believe it would take to see results?

A. I am not aware of any convincing research.

 

Q: What is the best testing protocol for heavy metal detoxification for chemical-sensitive patient? What is the best heavy metals detox protocol for a chemical sensitive patient? I suspect high levels of mercury and multiple high chemical exposures.

A: If a person is sensitive to sulfur-containing chemicals like DMSA, I would only use first morning urine. I would still expect GGTP to be a reliable indicator of chemical as well as metal exposure. ALT is better for just chemicals, but not all chemicals increase ALT.


Q: Is it safe to give a child (a 3-year-old) NAC to boost immunity? If yes, how much? If no, what can I use?

A: Yes, but modify the dosage according to weight. Let’s say the child weighs 15 kg. The dosage would be 500 mg * (15/70) = 100 mg


Q: For post Covid, long-term effects, what mechanisms are at work and what botanicals are helpful to return the sense of smell and taste?

A: We’re working on that issue now. It looks like mitochondrial damage is a major factor.

 

Q: On the study showing that a high-fat diet reduces mitochondrial activity, did the study indicate the type of fat consumed and how does this apply to people on a ketogenic diet? Were they eating unhealthy polyunsaturated omega-6 fats?

A: Unfortunately the study did not specify so I assume the standard unhealthy fats. A different study, but in animals, showed that arachidonic acid specifically was damaging to mitochondria. So quite possible this is more an arachidonic acid problem rather than fat in general. More research is needed.


Q: For arsenic, what is better: quercetin or luteolin?

A: Intriguing question. Both are beneficial. However, not enough human research on luteolin to quantitatively compare. There is encouraging research showing that an increased intake of flavonoids increase the rate of conversion of inorganic arsenic to the safe DMA.


Q: You mentioned lactate as a test for mitochondrial function. What range do you use? Is there an optimal range different than the lab range? Do you shoot for >50% of the lab range?

A: I use the conventional ranges. I am not aware of research suggesting an optimal range for lactate.


Q: Does the product Mito Q from New Zealand work better than US brands? If so, why?

A: Looks like an intriguing supplement. Not complete, however, and I do not see any reason why it would be better than a good quality US version.


Bob Miller, CTN

Using the OAT to Understand Methylation and Glutathione in Our Patients | Panel Discussion

Q: What dosage of riboflavin has been found to reduce hypertension?

A: In the report that I read, I did not see any specific dosage. Keep in mind, we can’t assume that riboflavin will always lower blood pressure because there are many factors that lead to hypertension and there are probably unique situations that riboflavin is helpful for.

Q: Is it a good idea to just throw in an activated B complex to fill in all gaps instead of just giving a certain B vitamins?

A: In my clinical experience, many times an activated B complex can cause problems as many times as it can be helpful. As we discussed, both folate and B12 can stimulate the HNMT enzyme which will create more N-methyl histamine. If the MAO enzyme is not working properly because of mutations in MAOA, mutations in SIRT1, or lack of riboflavin, the folate and B12 can make the situation worse. Additionally, if someone has overstimulation or gain of function on HDC (histidine decarboxylase), the B6 can stimulate more histamine as well. Finally, folate does stimulate mTOR which can weaken autophagy. In this time of COVID, it has been found that COVID uses mTOR for replication, so I am a little bit cautious in wanting to overstimulate mTOR. Of course, the exception is pregnant women who need the folate to stimulate mTOR for a healthy pregnancy.

Q: How to decide which forms of folate to give patients, like Folinic acid, methyl folate, etc?

A: I am not sure there is a tried and true formula, however it is best to determine if the person has adequate methyl groups. If someone for some reason may have high levels of methyl groups which could be related to genetic mutations in the using of SAMe for making creatine, methyl folate can be contraindicated. A simple test is 50-100 mg of niacin on an empty stomach. If the person flushes and has a horrible histamine reaction, they may do better on methyl folate. If they feel nothing or feel better, folinic acid may be a better choice.

Q: Would you ever advise anyone to avoid methionine-enriched baby foods?

A: I am not familiar with how methionine can impact a baby. Theoretically, if anyone has difficulty converting methionine to SAMe either by genetic mutations, lack of ATP, or hydroxyl radicals, high methionine could be contraindicated.

Q: Would you recommend taking creatine as a supplement for intense resistance training?

A: I am a big fan of moderation in everything, and keep in mind that if you take creatine, it could spare SAMe. If someone is already overmethylated, it could be contraindicated. I think your best bet is to check your methylation status or start out with small amounts and see how it is tolerated.

 

Q: How do you determine the dosage of SAMe and adverse reactions? Is SAMe safe to use on infants/ toddlers?

A: Since SAMe stimulates mTOR, and I believe that we are already due to exogenous factors have a high mTOR and low autophagy, I am very cautious. I usually never start out with more than 50-100mg, although there are some sold at 200mg. As we discussed earlier, SAMe will stimulate HNMT. If someone already has a histamine problem, SAMe could make it worse. In regard to infants/toddlers, I really don’t know the answer to that, but I would be extremely cautious.

Q: Can we supplement with too much glutathione or any other antioxidants?

A: First, keep in mind that although we think of free radicals as being bad, they do play a role in killing pathogens. In theory, you could take too many antioxidants, but with all the oxidative stress going on that might be very difficult to do. However, it is easy to backfire with glutathione. As we discussed in the presentation, weakness in NRF2, gain of function on KEAP1, weakness in GSR, lack of NADPH, or lack of riboflavin, can create a situation where oxidized glutathione does not turn back into reduced. Consequently, when someone is supplementing with glutathione, if it becomes oxidized and does not turn back to reduced, that oxidized glutathione can combine with oxygen to make superoxide and as ironic as it may seem, too much glutathione can make free radicals and deplete your glutathione.

Q: Which test do you use to identify SNPs? What is the best genetic test to add for a further deep dive for patients with multiple chronic disease issues?

A: I may have a conflict of interest/prejudices here, but I believe Functional Genomic Analysis is the best bet to look at function. If you are looking at disease SNPS then this would not be your choice, but if you are looking at function, this is your best bet. Contact us at functional genomic analysis and we can send you a video that demonstrates how this works.

Q: Do you have general dosing guidelines you recommend for B2 when you see very high glutaric levels indicating a very moderate/severe B2 deficiency?

A: I generally start out with around 37-40 mg and then double it if needed.

 

Q: Dr. Ben lynch mentions that GUT inflammation inhibits the many GSH synthesis pathways. Have you seen this happen? He recommends PQQ. Have you used PQQ to support glutathione?

A: I never correlated gut issues with glutathione synthesis, but I am sure Dr. Lynch has a reason. I am a big fan of PQQ as it relates to energy production, but I am not aware of the mechanism that would allow it to support glutathione, but there likely is one.

 

Q: It seems like some people with mutated SNPs react adversely with the use of glutathione only without supporting other nutrients. In your clinical experience, what is the approximate percentage of patients having adverse reactions to using glutathione without testing for the various relevant SNPs? Is it necessary to test for the relevant SNPs before giving glutathione?

A: In our health consulting, we see a unique client base of people with chronic Lyme, extreme mycotoxins, and for these individuals, the reason traditional things are not working for them is often they do have difficulty recycling their glutathione. With that skewed database, I would say 60-75% of the people I see have difficulty converting their oxidized glutathione back to reduced, but again that may be due to the uniqueness of the customer base here. I don't know that it is always necessary to test for relevant SNPS, but if the individual is extremely sensitive, has had negative reactions to glutathione in the past, then I believe checking is very important.

Q: What are some of the possible causes of high NAC without supplementation and normal pyroglutamic levels?

A: There are enzymes GCLC and GCLM that convert cysteine into glutathione that could be mutated. Mycotoxins also inhibit the conversion and weakness in NRF2 and/or gain of function in KEAP1 that inhibits NRF2 may cause the NAC not to turn into glutathione. Keep in mind that NAC that is not turned into glutathione may go down the transsulfuration pathway, stimulating sulfites, which by itself can be a problem, but if combined with weakness in SUOX turning sulfites to sulfates can be very pro-inflammatory.



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:

  1. 60-day access to the full conference recordings.

  2. Permanent PDF access to each speaker’s slides.

  3. The option to purchase continuing education credits (5 credits per day), whether you attend in-person, watch Live Online, or watch the conference recordings at a later date! See detailed information about credits.

  4. An interactive Workshop Hub website where you can live chat and network with attendees and ask questions to the speakers.

  5. And last, but most certainly not least, qualified practitioners will receive a free OAT.

Workshop Q+A: Mold and Toxins: Integrative Strategies & Protocols

On March 25-27, 2022, GPL Academy hosted the Mold and Toxins: Integrative Strategies & Protocols live-streamed online. This three-day event focused on the epidemics of toxin exposure, including both toxic chemicals in our environment and mycotoxins from mold. These toxins can cause symptoms of many acute and chronic health disorders. Those who attended the summit learned how to use effective diagnostic and treatment protocols for their patients with toxin exposure and get them on the road to recovery.

The following Q+A is a grouping of responses from the workshop presentations. Click each presentation title to expand the answers from each speaker.

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.


Day 1 Q+A: Organic Acids

Click each presentation title to expand the answers from each speaker.

Introduction to the Organic Acids Test | Kurt Woeller, DO

Q: Rhizopus is used for tempeh, but Aspergillus is used to make miso and soy sauce. Just curious if furan-2,5-dicarboxylic acid might also be in those foods & thus be high in the OAT test?
A: Good question, but I do not know specifically.




Q: When we first use the OAT is there someone at the lab that will help us with understanding/interpreting it?
A: Yes. Great Plains Laboratory has lab advisors available.




Q: If arabinose is "elevated 80% of the time" and the reference range is +/- 2 standard deviations, why isn't the reference range higher? Or is it that of the types of patient’s functional medicine clinicians see, 80% have high arabinose?
A: The 80% is my impression. Something I have seen over the years in my practice. It is an approximate percentage.




Q: I often do OAT and NutrEval by Genova. When I compare nutritional markers, OAT rarely finds abnormalities in nutrients, but NutrEval very often finds abnormalities in nutrients status. Please offer an explanation.
A: I would recommend speaking to one of the biochemists at the Great Plains Laboratory about this observation. They might be able to provide more insights from a laboratory standpoint.




Q: I hear mixed things about fungal link to oxalates. Why is there such a wide discrepancy in opinions on this?
A: There is a wide discrepancy about a lot of things in medicine, science, and nutrition. From my experience and research (and I know Dr. Shaw’s too from Great Plains Laboratory) there is a strong correlation.




Q: Will the nutrients that are low (CoQ10, B2, b12, etc.) get better when you treat the mold/candida/etc.?
A: Sometimes.




Q: Should we give them those nutrients while fixing the underlying issue?
A: I like to in most circumstances.




Q: Or will they not absorb those nutrients because of the overgrowth?
A: They should still get absorbed.




Q: Is DOPA altered with Parkinson?
A: It can be.




Q: How come my sample test I got before showed Arabinose normal level is < 29 instead of <50? data-preserve-html-node="true" data-preserve-html-node="true"
A: The reference ranges changed based on age and sex. The sample I showed was just a sample from my practice.




Q: Do you know what may cause burning mouth syndrome in a patient? She has mild white coat of tongue; do you think this is candida or nutrient deficiency?
A: Very likely Candida. Research mineral deficiency linked to this condition too.




Q: If a client’s marker is between the first and second deviation but not necessarily “high”, do you still treat if client has symptoms? (Examples would be in the case of 4-cresol or arabinose being in between the first and second deviation.)
A: Yes. This is reasonable to do if you suspect there is a developing problem.




Q: Oxalates appear to be a sensitive, but very nonspecific test. What is the purpose then of testing it?
A: Some people are extremely sensitive to oxalates. Like any marker, it is always important to correlated to a patient condition.




Q: Emphasis is on elevated levels of different markers. What about negligible to low levels of different markers? Speaker addressed negligible levels of amino acids as being normal, what about other biomarkers. When should we be concerned?
A: For most things, low values have no known clinical significance. This changes though when looking at neurotransmitters. The amino acid metabolites are not the same things are directly assessing amino acids. When neurotransmitter metabolites are low that can be significant, as well as certainly nutrients such as Ascorbic Acid and Vitamin B6.




Q: What is the significance of very low metabolites in mitochondrial markers?
A: No known clinical significance according to Great Plains.




Q: Can you see mild elevations in fatty acid oxidation markers in people who are carriers for some of the inborn errors of metabolism in fatty acid metabolism?
A: This may be possible from my understanding.




Q: Is aspartame high from eating a meal the night before testing? Or is it only high if someone regularly eats aspartame?
A: It could be high ikf ingested the night before.




Q: If #28 marker is just slightly low, Aconitic - what does this indicate?
A: No known significance according to the lab.




Q: There are cases of asymptomatic positive stool test for C diff toxin. Do we need to treat it?
A: I would, at least with some probiotics.

Invasive Candida and Various Health Issues | Kurt Woeller, DO

Q: Is burning mouth syndrome candida?
A: Yes. It could be. Do some research on nutritional imbalances that could cause this too.




Q: Do edible mushrooms increase fungal levels in the body?
A: Not that I know of.




Q: Is Biocidin useful for Lyme dx?
A: There are many practitioners who have used Biocidin for Lyme. The company at BioBotanical Research would have more information on this.




Q: Do you use the biofilm busters for a time before starting the antimicrobial?
A: Typically, not with a new patient who is new to integration and functional medicine. I often rely on the botanicals first and then graduate to biofilm busters as needed.




Q: Any recommendations for fungal sinus infections?
A: Compounded nasal Amphotericin B or Itraconazole. Biocidin LSF can be used intranasally too. Contact BioBotanical Research as if they have additional information.




Q: What was the article that was recommended re invasive candida?
A: Candida Pathogenicity Mechanism - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654610/




Q: Can an elevated arabinose indicate conditions other than candida? Or is it specific?
A: It can be elevated from diet. So, it is critical people follow the instructions on the test collection form.




Q: You mentioned the connection between candida infection and the potential for leaky gut. I'm curious, are there any markers in the OAT test that may indicate that leaky gut could be an issue?
A: There is not a specific leaky gut marker. The Arabinose is about as close as a marker comes on the OAT for this condition.




Q: Could you deduce that a persistently high homocysteine on blood testing should prompt OAT testing looking for metals/chemicals?
A: I do the OAT for everyone that comes into my practice. However, regarding homocysteine/metals, etc. there are other tests to look for too such as environmental chemical exposure.




Q: You mentioned that organic acid markers for mold can be negative, but mycotoxin results can be high for past mold exposure. Why is this?
A: The mycotoxins are different chemicals from the organic acids. Therefore, the MycoTOX profile needs to be looked at as a separate test.




Q: Is there any evidence of Lyme in the OAT test?
A: Not specifically.




Q: Again, please explain the difference between the OAT mold markers and mycotoxin test. Which one is indicative of current mold exposure verses past exposure?
A: If an OAT mold marker is high that is active exposure (most likely) or at least lingering mold colonization (active) in the body from previous exposure. However, the organic acids linked to mold exposure as completely different chemicals from mycotoxins. It is possible to have a mycotoxin stored in the body for months even though someone is no longer being exposed to mold spores. It would also be possible to have mold colonization in the gut if the mold just continues to replicate itself without being treated. The bottom line is do not rely on the OAT to diagnose mycotoxin exposure.




Q: Can candida cause an elevated serum myeloperoxidase level?
A: Most likely if the level is serious enough and there is highly active neutrophil activity. I have not done this type of testing though.




Q: So, are you saying we should use manuka honey to break up biofilms? Or how was manuka honey relevant to candida?
A: I was only using those slides as a point of discussion about botanicals in general having anti-biofilm properties.




Q: Regarding Nystatin, can you please comment on Nystatin resistance and Botanicals for Aspergillus?
A: Nystatin will have some affect on Aspergillus, but Amphotericin B orally seems to work better. But there is literature out there indicating the liposomal Nystatin is a treatment option for Aspergillosis.




Q: If using Nystatin to treat candida will that help a suspected candida/fungal caused rhinitis?
A: Not likely, unless it was compounded into a nasal spray. At least this has been my experience with Nystatin orally is that it seems to have little effect on yeast outside the GI tract.




Q: If you have a patient that has candida issue and you have addressed the root cause as to why will the candida correct itself since root cause gone? or will the patient still have to be treated for candida?
A: Working on root cause is always the best overall approach to take. But they still may need to treatment to bring the levels down and make it easier for the microbiome to regain control.

Clostridia Bacteria Toxins and Various Health Issues | Kurt Woeller, DO

Q: Since Biocidin has echinacea in it, does not exclude patients with auto immune disorders from taking it?
A: I have never seen Biocidin at the dosages recommended by the company exacerbate an autoimmune problem.




Q: Can you touch on Clostridia spp on the OAT vs a stool test when the results do not match up?
A: The OAT markers are more specific to various clostridia bacteria. Stool testing for Clostridia difficile is specific for toxins A and B. These are often not present even in people dealing with bowel problems, but this test should be done if a serious C. diff. infection is suspected. However, the OAT overall is more sensitive to of clostridia bacteria infections.




Q: What about spore-based probiotics to deal with clostridia?
A: This can be helpful. I personally use a lot of Core-Biotic from Researched Nutritionals and Proflora 4R from BioBotanical Research.




Q: At which point is a stool test also indicated?
A: This can be done at any point, particularly if you want to assess digestive function overall or identify other pathogens. Consider a stool analysis to be complementary to the OAT and an often-necessary test on its own.




Q: Can the posting method be used with Biocidin and other herbals as well?
A: Yes. Pulsing could be done with other botanical supplements too, not just Biocidin.




Q: Why are some people so prone to having recurrent clostridia infection?
A: This likely has to do with many factors such as overall microbiome status, the presence of toxins such as chemicals and mold, and poor immune function.




Q: When you used Biocidin for 6 weeks, when was the binder used in relation to the dosing of Biocidin, and how many times was Biocidin used on daily basis? I dose Biocidin three times daily.
A: A binder can be used in between dosing of the botanical at least twice daily. Best to take away from other supplements by at least 90 minutes to 2 hours.




Q: When you believe a person has clostridial challenges, but the markers are normal, what would you use to begin excretion of clostridial?
A: You could use the same things discussed with regards to active clostridia such as the spore probiotics, e.g., CoreBiotic, as well as botanicals.

High Oxalate and Various Health Issues | Kurt Woeller, DO

Q: Rather than discourage a diet of healthy foods, wouldn't it be more ideal to focus on the reason for elevated oxalates like dysbiosis/leaky gut?
A: I never discourage a healthy diet, but for some people they do need to reduce high oxalate foods (even some of the healthy ones) for a while to get their levels down, and at the same time as addressing underlying gut problems and dysbiosis. There are plenty of healthy foods that are not high oxalate.




Q: Could high oxalates also lead to interstitial cystitis?
A: Yes, from my understanding high oxalates can be linked to this condition.




Q: Sally Norton talks about yeast as protective against dietary oxalates. Have you heard this?
A: I have, but I do not know the specifics.




Q: I'm curious if you consider Blastocystis hominis to be a problem always. Microbiome research is coming out now that it is associated with better metabolic health and discourage its eradication.
A: B. hominis is a problem for some people. However, I have seen it show up in random stool testing where the primary reason for the test was not anything specific to parasite analysis. https://pubmed.ncbi.nlm.nih.gov/33432175




Q: Patient with good response to a low oxalate diet but shows no oxalates or yeast on OAT. She still has body pain which increases noticeably when she eats more oxalates. Is it possible that she does not release oxalates well?
A: Yes. There can be stored oxalate that either are not be released or dissociated into soluble forms in body fluid.




Q: Should a person take vitamin K 1/2 with calcium/magnesium prior to oxalate meal?
A: Vitamin K has a complementary effect on calcium regulation by assisting in its storage into various body tissues.




Q: Can oxalate level be confirmed on 24-hour urine collection?
A: Yes.




Q: Can you expand on the lung CT scans, why were those ordered? Was that showing oxalates in the lungs? Was that patient having respiratory issues due to high oxalates. Simply curious about how/why that patient had a CT and didn’t know it would show up.
A: That was a paper looking at Aspergilloma infection and associated calcium oxalate crystallization. My recommendation is to look up the article and read it for more details.

Neurochemical Imbalances and Quinolinic Acid Toxicity | Kurt Woeller, DO

Q: Do keto diets increase LPS then?
A: From my understanding they can be associated with increased LPS.




Q: Is there another method to measure lithium levels other than hair analysis?
A: Blood levels are typically used for people on lithium medication. There may be a lab that does intracellular analysis of lithium.




Q: What would you think when someone responds badly (anxiety type symptoms) to 5 mg lithium orotate?
A: I have seen this too, but not very common. I would start looking at other mineral imbalances.




Q: Have you been seeing elevated quinolinic acid in patients with long covid? Or any other markers that may help explain common long covid symptoms? Thinking about the implications of neuroinflammation in this population.
A: Not yet, but I have not had a lot of long covid patients at this point.




Q: Do you see elevation of neurotransmitter markers in patients on SSRI or dopamine agonists or similar? Also is there a negative side to super dosing glutathione-2000mg plus?
A: Yes, this can happen. There is a negative feedback mechanism on glutathione production. High dose could also increase detoxification affects which a patient may not tolerate.




Q: Can you please clarify what you mean by resveratrol "decreasing microglia"? thanks.
A: It helps to decrease microglia activation. Therefore, Resveratrol can be helpful for brain inflammation and oxidative stress.




Q: L-cysteine can substitute for NAC as a useful precursor to glutathione, since I believe, NAC is converted to L-cysteine anyway? And if NAC is banned soon as a supplement, a substitute may be necessary in some cases.
A: Correct.

Additional Case Studies: Lab Reviews and Treatment Options | Kurt Woeller, DO

Q: Do you see die off reactions / Herx type reactions with Biocidin? Do you ever titrate up on it, or do you just start at full dose?
A: Depends on the sensitivity of the patient. Starting at a lower dose and titrating is certainly appropriate to do. Herx does not always happen, but more so in the sensitive patient. In my experience, it occurs about 30% of the time.




Q: How often are you using toxin/mycotoxin binders using only OAT tests showing positive yeast/clostridia markers?
A: Often. In general, I use binders about 80% of the time, but in some of the kids I treat it is difficult to do.




Q: I use soil based probiotic same as spore-based probiotics. Can you stay on spore-based probiotics for chronic use?
A: I do not like to use them for extended periods of time, but instead use them strategically as highly needed for certain patients. For example, 60 to 90 days for most clostridia problems.




Q: How long after a 14-day round of rifaximin would you recommend retesting (Dx: SIBO)
A: Two weeks




Q: Can you treat clostridia and a presumed yeast overgrowth at the same time? Put a patient on Biocidin and nystatin for example for a couple of months? Would doing a SIBO protocol help with both clostridia and yeast (using botanicals to treat SIBO)?
A: Yes, yes, and yes, most likely.




Q: I am not sure that I understand why you prefer daily dose of Biocidin for 3 mo. instead of daily for 3-6 weeks and then pulse as it seems that combination worked very well for you?
A: Depends on the patient and I have used multiple methods. The pulsing is generally used for recurrent issues. I have had some situations where I was daily dosing, check the MOAT at 6 weeks and the clostridia is still present. Then switch to a pulsing method, rechecked the markers and things had normalized. During my talk my goal was to show various options with the understanding that there is no single way that is going to work for all people.




Q: If succinic is high but your TOX test is not remarkable, mold not an issue and you still suspect a chemical, is there another chemical testing method/direction you have done?
A: This could be from Glyphosate too. I just came across this information in Stephanie Seneff’s book called Toxic Legacy. Can you discuss low Aconitic marker? According to GPL and the lab report it has no known clinical significance. I am looking into more as ongoing research.




Q: Do high thallium levels have any impact of concern?
A: Yes. Thallium has similar toxicities to Mercury. I see high Thallium in about 5 to 10% of hair metal tests that I do.




Q: Can you share some sources / reference for low cholesterol as risk factor for mental health doze?
A: There is so much information on the Great Plains Laboratory website. Go to their Resource section and look for past webinars and articles on this topic.




Q: At what level of cholesterol (for adults) would you consider low and decide to supplement?
A: Levels below 160 are considered not ideal. Mostly in my practice, when I look to supplement with Sonic Cholesterol, is levels around 120 to 130.




Q: Is presence of enterotoxigenic E coli going to show any abnormalities on OAT?
A: This would likely show up in the Bacterial Markers section.




Q: Do you recommend activated charcoal during the protocol?
A: It is okay but can be constipating. I prefer the GI Detox+ from BioBotanical Research.




Q: In your experience, is a low oxalate diet required for life or is that a temporary change when working through issues?
A: Some people will do it for life, particularly if they have struggled significantly with oxalates before. However, if the oxalate is mostly coming from fungal sources than a lifelong low oxalate diet is not necessary if the fungus is treated. Depends on the patient scenario, but typically it is not need lifelong for some people.




Q: Some patients with glutathione deficiency, are sensitive even to small dose of glutathione replacement. Are there markers that can indicate reaction to glutathione or is that just indicative of high toxicity? What do you recommend for them?
A: There are no markers that would indicate a tendency towards individual reactions. Every person is different with regards to their individual reactions. For many sensitive people, you have to dose things at a very low level. Start low and go slow is always a good method for sensitive patients.




Q: How long do you use the binder like GI Detox?
A: Typically for the duration of treatment of the candida, bacteria, and mycotoxins.


Day 2 Q+A: Hidden Threat of Mold and Mycotoxins – Testing and Treatment Protocols

Click each presentation title to expand the answers from each speaker.

Organic Acids and Mycotoxins: Correlations With Mold in Various Chronic Illnesses | William Shaw, PhD

Q: GPL recommends NOT using glutathione prior to testing however, I have seen that without glutathione many tests are negative, and the patients have a lot of s/s of mold toxicity.
A: To my knowledge, there is no published or unpublished study that this is true. Also, it goes against the scientific fact that glutathione reacts with mycotoxins to form large adducts that will be invisible to a mass spectrometer. Show me your before and after data (at least 10 cases) and I will publish it.



Q: Is Gliotoxin also an environmental mycotoxin or is it primarily thought to be due to candida?
A: Gliotoxin is due to both Candida and mold.



Q: I have a current client with high levels of Citrinin, and I'm curious whether this would primarily come from diet or due to a GI infection of an organism like Aspergillus?
A: High levels of mycotoxins in the USA are almost all due to water damaged buildings but the mold from such buildings often may colonize the lungs, sinuses, and GI tract.



Q: How do we tell whether mycotoxins are present in the environment and are showing up on a mycotoxin test or if they are present due to fungi in the gut? Am I correct in thinking that if the OAT shows fungal markers, the gut is to blame?
A: The presence of mold markers in the OAT test can indicate both the presence of mold in a water damaged building and the presence of mold in the GI tract.



Q: What makes the difference between responses between two people exposed to the same mold? can you be exposed and not be affected? is there a way to make yourself resistant to mold illness?
A: There are many genetic factors that influence response to mold infections and mycotoxins including many glutathione and cytochrome P450 factors.



Q: Clarify my Question: 'urinary mycotoxin testing vs. serum mycotoxin antibodies...'
A: Vodjani reported that there was a significant relationship between mold antibody levels and mycotoxin antibody levels, so mycotoxin antibodies are an indicator of mold allergy, not mycotoxin toxicity. Urine mycotoxins are the best indicator of non-allergic mold toxicity. There are hundreds of articles on urine mycotoxins and their clinical effects by a number of independent researchers but only a handful of articles on mycotoxin antibodies, all written by employees of the companies selling those tests.



Q: How do you get for sinus fungal colonization?
A: Mayo clinic published a study indicating that fungi are the main source of sinus infections which almost always are due to inhalation of mold spores in a water-damaged building.



Q: How did you clear the Zearalenone from your dog? did you use binders?
A: The dog went from near death to completely well after switching to a grain-free dog food in about one day. I did no other treatment. I had spent thousands of dollars on vet visits and lab tests that were zero benefit. Our vet continues to recommend dog food with grains. Contaminated dog food from moldy grains is probably the most common reason for vet visits for your dog. Completely ignore your vet’s bad advice on dog food.



Q: If someone only has one mold show up on their test, is it really that concerning? And do patients really have to give up the foods the molds are found in? Is that a strong source of mold for most people?
A: The most important factor is the amount of mycotoxins found, not the number of mycotoxins. Food is not a major source of mold in the USA. If the mycotoxin is double the upper limit of normal, I think the person has a significant problem.



Q: How long would a patient have to be off Mycophenolic drug in order to be tested?
A: The half-life of mycophenolic acid is 17 hours. In 5 half-lives (85 hours or 3.5 days), 97% would be eliminated. To be safe, it might be better to say 4 days off the drug.



Q: To help diagnose whether mycotoxins are causing or contributing to patient's illness, how helpful would it be for them to simply live somewhere else for a week or two? (Assuming they could find a mold-safe house)
A: Unfortunately, if the patient is colonized, they would be taking their mold with them to their new home. Testing is better than guesswork.



Q: How did you treat mold in your car?
A: The dealer (Hyundai) had a procedure. I don’t know how it was done, but it seemed to clear up the mold.



Q: Will you be covering anything on what antifungals to use when?
A: Itraconazole (Sporanox Brand Name) is effective against most molds and is reasonably priced. Voriconazole is thought to be more effective against more molds but is pricier. Nystatin and Diflucan are not nearly as effective.



Q: How long do you typically use binders to help mycotoxins? What would be the average time?
A: I would recommend one month. I do not think formal studies have been done.



Q: Do you recommend pulsing binders?
A: I see no benefit in pulsing.



Q: OAT mold metabolites are indicative of growth in GI exclusively?
A: I suspect that the markers are mainly of GI origin since the markers decreased following the use of nystatin which only kill yeast/fungi in the GI tract. The GI tract provides all the nutritional factors required by mold in abundance. I don’t think that would be true of sinuses or lungs.



Q: When someone goes on vacation or gets out of the house (or source of mold if it is at work or a school), will a lot of their symptoms get better? And how quickly?
A: Getting out of the moldy environment is always helpful but the colonized person is taking the GI mold with them wherever they go.



Q: What supplements / medicines should a patient take while mold remediation is being done? (I'm sure best is moving out but if cannot how to treat to avoid more future problems?)
A: If remediation is not done, the person will have to be treated again and again with antifungals and binders.



Q: So just to confirm, if you are positive on urine mycotoxin test, it means ACUTE exposure? How do you determine long-term exposure?
A: Long-term exposure is determined by clinical history of symptoms and knowledge of the mold in the home/office/school. For example, when did the flooding of the house first happen? When did the water pipes first develop a leak?



Q: Do you recommend treating with medicated nasal spray in cases of positive mycotoxins and upper respiratory symptoms?
A: I think that the standard treatment with antifungals and binders will clear up respiratory symptoms as well if systemic antifungals like Sporanox are used.



Q: So positive results on urine MycoTOX panel mean ACUTE exposure?
A: I would say that the presence of mycotoxins indicates current exposure which can be from moldy buildings and/or previous colonization.



Q: I have a male patient who keeps getting acute pancreatitis, for no reason; could this be mold?
A: Yes, there are a number of articles relating pancreatitis to mold and even pancreatic cancer. Aykut, B., Pushalkar, S., Chen, R. et al. The fungal mycobiome promotes pancreatic oncogenesis via activation of MBL. Nature 574, 264–267 (2019). https://doi.org/10.1038/s41586-019-1608-2 Firsova VG, Parshikov VV, Kukosh MV, Mukhin AS. Antibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review). Sovrem Tekhnologii Med. 2020;12(1):126-136. doi: 10.17691/stm2020.12.1.15. PMID: 34513046; PMCID: PMC8353699.



Q: Assuming you are not a dog, how contaminated are cereals, peanuts, coffee, etc with mold in the USA? Are legumes a significant source of mycotoxins?
A: In the United States, most foods are checked for mycotoxins. Any food may have mycotoxins.



Q: Do frequent rounds of antibiotics increase the risk of mold and mycotoxins to spread in the body?
A: I know of no studies but suspect the normal flora keeps molds in check.



Q: Do you think it is worth doing a MycoTOX test in patients who are in hospice with hepatocellular carcinoma? Is it too late to do anything at that point? I have so many patients with HCCA, one is a husband and wife:( thank you
A: Aflatoxins from mold-contaminated food and moldy buildings are a major cause of hepatocellular carcinoma. I could find no reports of diminishing the cancer once it has developed but it might be worth a try. If certain foods or building are suspect, mycotoxin results could be used to build a lawsuit case for the family of the couple.




Q: Would an isolated elevation of 14 in marker #6 on OAT, with high (98 oxalic) , and high HVA in a cancer patient, be concerning for aflatoxin or ochratoxin tox ? or maybe just a food exposure prior to testing? this is the conclusion of the staff.
A: Mold such as Aspergillus is common in cancer patients treated with chemotherapy. Many hospitals administer antifungals prophylactically with chemotherapy to prevent systemic fungal infections. High HVA may be due to certain tumors like neuroblastomas.



Q: What is a typical antifungal that is used, Diflucan or nystatin?
A: Not nearly as effective as itraconazole for mold. Voriconazole more effective and more expensive.



Q: Regarding the fibromyalgia patient treated for mold, that had reduction in mold furans in OAT, was she given Nystatin or a systemic anti-fungal?
A: I think both.



Q: When using binders for mold are there specific binders recommended for specific mold mycotoxins?
A: I would recommend GI detox for all since it has both clay and charcoal (NBNUS.com).



Q: Can you explain why some of the "oxalate" experts discount the mold connection to oxalate?
A: I suspect they have had minimal experience and access to OAT and Mycotoxin testing and the appropriate research papers.



Q: What are your thoughts on the GPL urinary excretion test vs ones that test antibodies? Wondering if more sedentary patients with depleted glutathione may not show as much mycotoxin exposure.
A: I suspect the opposite is true. When glutathione covalently bonds to mycotoxins, the altered mycotoxins are a much higher mass than cannot be detected by the mass spectrometer.



Q: How long was the Sporanox treatment regimen for the 3-year-old with Autism treated by Dr Baker thanks
A: The child recovered completely after 6 weeks of the antifungal, but the treatment was continued for a much longer time period. The child continued on Sporanox at lower doses for about 3 years.



Q: 3-year-old child that was switched to Sporanox from itraconazole, Were there less herkzheimer reactions on Sporanox?
A: The switch was made because the parent thought the Sporanox was more effective.



Q: I thought Sporonox is the brand name of itraconazole. Yet your slides make it sound like two different drugs (the 3-year-old with autism slide). Am I missing something?
A: Many physicians suspect that generic brands of drugs are of lower quality or less potent than brand names. The parent thought the child’s progress was better on the brand name Sporanox. The Sporanox brand of itraconazole has been developed and marketed by Janssen Pharmaceutica, a subsidiary of Johnson & Johnson. The three-layer structure of these blue capsules is complex because itraconazole is insoluble and is sensitive to pH. The complicated procedure not only requires a specialized machine to create it, but also the method used has manufacturing problems. So there may be real differences in the 2 products.



Q: Have you seen higher incidence of kidney stones in patients with high oxalate?
A: I have encountered several patients who developed kidney stones after starting diets with frequent spinach salads or spinach smoothies. Spinach is the food with the highest oxalate content.



Q: Is there a plan from the GPL Lab to expand the MycoTOX Profile to include other mycotoxins?
A: Yes.



Q: Can you discuss sinus colonization and how to test?
A: If there is sinus colonization, GI colonization will follow shortly as sinus leakage goes into the esophagus and GI tract. X-rays of the sinuses can be helpful to look for oxalate stalactites formed by colonizing molds. Mold cultures of the nose and urine mycotoxins also helpful.



Q: Do you need to do provocation (i.e. glutathione or EDTA) prior to doing the MycoTOX Profile?
A: No.



Q: Do you need mycotoxin testing and OAT to exclude most mold infections or is one test adequate as a screen?
A: The OAT only screens for Aspergillus and Fusarium so both are needed.



Q: Pulmonary aspergillosis (farmer's lung) treatments?
A: Remove from exposure, then treat with Sporanox. If severe, surgery may be needed.



Q: How does markers such as Melanocyte Stimulating Hormone, antidiuretic hormone or MMP-9 compared to the mycotoxin urine test?
A: None of these markers are specific for mold. These markers may sometimes be useful in patients with confirmed mold diagnosis



Q: If the OAT finds mold like aspergillus, is it assumed that the patient must be ill affected? or can you have mold in the OAT and have no issue or reason to treat?
A: I have recommended treatment in every case that the OAT mold markers were elevated.



Q: Can a mold toxicity situation produce a raised ferritin situation? I have a 50-year-old male with this situation (not hemochromatosis).
A: Many mycotoxins, especially aflatoxins, are harmful to liver. Ferritin is raised in liver toxicity.



Q: What is the best way to treat ochratoxin?
A: Ochratoxin is treated like all mycotoxins. Remediate moldy living spaces, treat with antifungals, then follow with one month of binders (GI detox, NBNUS.COM has both charcoal and clay).




Q: I see moderately high MPO on many labs but too high for heart disease and no apparent Infection? Can elevated MPO by from stealth gut infection be caused by fungus?
A: Mold fungus can indeed cause heart disease. Here is a resource.



Q: Why do mycotoxins often rise after starting treatment?
A: As molds are killed, they will release all mycotoxins that are stored intracellularly which are then absorbed and excreted into the urine.



Q: If patient can’t move or get away permanently from the exposure or remediation hasn’t quite been a success, can you perhaps pulse antifungals or herbal antimicrobials ongoing for long term?
A: You can do this, but you run the risk of drug resistance if you use this approach too long.



Q: If the mold is in hollow spaces like lung or sinuses does the antifungal treat that effectively?
A: Antifungals will treat any area of the body that has a blood supply. Lobectomy is commonly done when the infection of the lung is severe.



Q: If someone has known lung colonization, home tested positive, awaiting results, am I to assume this would be a patient who most likely would require stronger antifungal treatment, ie Sporanox and not as likely to respond to herbal therapies?
A: Yes.



Q: Can you speak to which probiotics specifically can help?
A: Lactobacillus plantarum and rhamnoses have been shown to degrade aflatoxins.



Q: Can carbon c60 be used as a binder?
A: Carbon 60 is a molecule made up of 60 carbon atoms. The layout of the atoms forms a molecule shaped like a soccer ball. Carbon 60 was first used in nanotechnology and electronics. Charcoal is very cheap and effective. Why not use charcoal?



Q: I know MMS is controversial, but I use it a lot with patients, and it is miraculous. Have you any thoughts on MMS and mold?
A: Miracle Mineral Solution is an oral liquid solution also known as "Miracle Mineral Supplement" or "MMS." The product, when used as directed, produces an industrial bleach that can cause serious harm to health. The product instructs consumers to mix the 28 percent sodium chlorite solution with an acid such as citrus juice. This mixture produces chlorine dioxide, a potent bleach used for stripping textiles and industrial water treatment. High oral doses of this bleach, such as those recommended in the labeling, can cause nausea, vomiting, diarrhea, and symptoms of severe dehydration. Since this substance is a powerful oxidizing agent, it is mutagenic and carcinogenic. I personally communicated with a woman who developed GI cancer after its use. Another parent had her child taken away by government child protective services after using it on her child. It undoubtedly is a potent antimicrobial but there are so many safer things, why take the risk?



Q: How long should someone be off Glutathione prior to testing?
A: Two days.



Q: I have a patient with moderately advanced Parkinson’s with moderate amounts of mold. When I put him on binders, regardless of the time of day, it decreases/binds his medical prescribed dopamine. As his L dopa is prescribed 4x/day. Other suggestions?
A: Use antifungals for a month before any binders. Then retest. If mold is gone, don’t use binders. If binders are used, use them 3 hours after L-DOPA.



Q: How would you explain increase in urinary mycotoxins after glutathione provocation compared to the urinary mycotoxin test done on the same individual without glutathione provocation prior?
A: To my knowledge, there is no published or unpublished study that this is true. Also, it goes against the scientific fact that glutathione reacts with mycotoxins to form large adducts that will be invisible to mass spectrometer.



Q: How do you time treatment of Mold in a patient with SIBO?
A: I would say exactly the same as a non-SIBO patient.



Q: Do molds have any impact on MS?
A: I have found mold involvement in virtually every neurological disease: MS, autism, ADD, Parkinson’s, Alzheimer’s, and ALS.



Q: I have three clients with mold exposure in the same household. Two out of three showed high levels of mycotoxins but the one that was immune compromised barely showed up on the MycoTOX Profile. Any reason why would one not excrete metabolites?
A: The big suspicion is that the person with the lowest mycotoxins spent less time in the moldiest parts of the house. That has been the reason in other cases I am familiar with. I doubt it is due to immune system compromise.

Mold and Alzheimer’s: An Unacknowledged Pandemic | Dale Bredesen, MD

Q: Amyloid plaque is misfolded fibrinogen from excess iron and low Vitamin C per Dr Robert Thompson. Does this fit into your management?
A: That is incorrect—amyloid plaque has many components, but the major proteinaceous component is the beta-amyloid peptide (of varying lengths, mostly 40 and 42 amino acids).



Q: Can you repeat what you said about low Triglycerides and low zinc? How does this link to Alzheimer’s?
A: This is simply an observation: many of the patients with type 3 (toxic) Alzheimer’s have low serum zinc and low triglycerides. Therefore, if you notice this in the setting of other features of type 3, it supports the diagnosis. We do not yet know the mechanism for these phenomena.



Q: How do you recommend testing for glutathione levels? Is whole blood via LabCorp sufficient?
A: Yes.



Q: In treating patients with cognitive decline and mycotoxin issues, do you find any contraindications in using ketosis as a therapeutic option?
A: Great question; we have not found this to be a problem, but please avoid stress to the extent possible, since patients with mycotoxin-associated cognitive decline are often hypersensitive to stress.



Q: Are we still able to become Bredesen certified? If so, how?
A: Yes, ReCODE 2.0 training is available via Apollo Health. https://www.apollohealthco.com/practitioners/



Q: What would a "cognoscopy" entail at age 45?
A: 3 parts: (1) Blood tests (you can get directly via mycognoscopy.com); (2) on-line cognitive assessment (freely available as CQ test; (3) MRI with volumetrics (optional if you are asymptomatic).



Q: Can you comment on long history of benzodiazepines use and AD and antihistamines use and AD?
A: Yes, both of those have been associated with increased risk for cognitive decline. Anticholinergics, benzodiazepines, PPIs, antihistamines, etc. There are numerous epidemiological studies on this.



Q: Do you test extensively first, then apply appropriate measures, or can one apply some measures without testing, and what are the priorities Dr Bredesen recommends?
A: Best to test first, but you can apply some measures, and then test if/when the measures are unsuccessful. The protocol is detailed in the book, The End of Alzheimer’s Program, and also in The First Survivors of Alzheimer’s.



Q: Have you seen high quinolinic acid for most of the Alzheimer’s participants in the study?
A: Good point. We did not measure this in the study.



Q: Which exogenous ketone do you use? brand name?
A: KE1 is a good one, from KetoneAid. Perfect Keto also has a range of products.



Q: Thoughts about Microwaves, e.g. 5-G, Satellites?
A: It’s concerning. We need a better clinical test to determine who is suffering from this exposure.



Q: What is your preferred source for exogenous ketones?
A: Ketone Aid or Perfect Keto, to name a few. I like KE1. However, if LDL-p is normal (800-1200), you can use MCT oil.



Q: Have you seen burning mouth syndrome, sore tongue/teeth be associated with mold illness?
A: No. Most of the patients we see with cognitive decline associated with mold do not have peripheral CIRS manifestations, although some do.



Q: Do you recommend intranasal antifungal spray, how do you treat?
A: We typically follow the recommendations from Dr. Neil Nathan, detailed in his book, Toxic: Heal Your Body.



Q: Do you think Coenzyme Q10 can help to reduce cognitive impairment?
A: It’s part of the approach to improve mitochondrial function, so it has a role, especially in those with reduced mitochondrial function.



Q: Is there a place for Hyperbaric Oxygen in MCI/Alzheimer's?
A: Yes, especially for those with vascular or traumatic contributions.



Q: How does this tie in with the work of Prof Exley and his findings of aluminum in the brain?
A: Yes, aluminum can be one of many contributors, and amyloid is a metal-binding peptide.



Q: Do you use Cyrex labs Lymphocyte Map to evaluate immune system phenotypes?
A: We have used Cyrex testing (Arrays such as 2, 3, 4, 5, 11, 12, etc.) but not the lymphocyte map—have you found it useful?



Q: What are CNS vital signs?
A: CNS Vital Signs is an on-line cognitive assessment: https://www.cnsvs.com/



Q: What role would intermittent fasting play in therapeutics?
A: Yes, it can be very helpful—helps both to create insulin sensitivity (and metabolic flexibility) and ketosis. There are several other advantages, as well.



Q: Do you think that the treatment protocol works for most other neurological conditions as well such as MS, neuropathy, autism, Restless legs, etc.
A: The protocol is designed for the pathophysiology or pre-AD and AD. It is modified for the different pathophysiologies of these other conditions, and of course it is also personalized so that each person’s optimal protocol will be slightly different.



Q: How can we find clinics and practitioners that are willing to follow your approach in treating Alzheimer's patients?
A: Yes, we’ve trained over 2000 physicians in 10 countries and all over the US. You can check on drbredesen.com or contact Apollo Health staff for a practitioner in your area.



Q: Can you please repeat the name of the person who is utilizing this approach to MCI in San Diego?
A: Several: Dr. Heather Sandison, Dr. Wes Youngberg, and others.



Q: What is the name of the assisted living facility in San Diego that you mentioned is treating Alzheimer's pts with your protocol?
A: Marama (in Vista, just outside San Diego): https://www.maramaexperience.com/



Q: What is the definition of organic toxic buildup? Does he mean metabolic waste that isn't flushing through the drainage pathways?
A: Organic toxins such as toluene, benzene, formaldehyde, and glyphosate can contribute to cognitive decline, in part by reducing glutathione and in part through their effects on mitochondria and other cellular components.



Q: Can you give a link for the ARK Project?
A: No link to this yet; we are still treating the first group—patients with age-related macular degeneration.



Q: 2.0 Bredesen Protocol Health Coach here! Are any practitioners utilizing health coaches with the Bredesen Protocol?
A: Great point. Have you talked with Christine Coward or Valerie Driscoll from Apollo? They may be helpful. Also, most of the practitioners do work with coaches (Drs. Ann Hathaway, Kat Toups, Deborah Gordon, Kristine Burke, Craig Tanio, and many others).



Q: When is he talking about "organic toxins" do you guys think he is referring to metabolic waste buildup?
A: Toluene, benzene, acrolein (see the GPL organic toxins test), formaldehyde, glyphosate, and many other organics. These are also important in Parkinson’s (e.g., TCE, PCE, paraquat, rotenone, etc.).



Q: How can we find a provider using the Bredesen CODE in our area? Thanks.
A: Drbredesen.com or apollohealthco.com



Q: How do you convince someone to start addressing contributors to dementia if you notice MCI, but that person doesn't acknowledge any deficits?
Great point. This is relatively common. Getting all of the family members to have a “cognoscopy” is one way to get people evaluated (therefore the person with MCI does not feel singled out). Good for everyone who is 45 or over to be evaluated and begin active prevention. However, there are some people who simply do not want to admit decline, and it is very hard to treat someone who simply does not want to get better.



Q: Can you provide information about how to learn more about your physician training program?
A: Sure — please check https://www.apollohealthco.com/practitioners/

Increased RANTES, sCD40L and Platelet Aggregation from Genetic and Epigenetic Factors | Bob Miller, CTN

Q: So boosting NO if someone has clots would be bad because it would decrease eNOS and cause further clotting?
A: eNOS (endothelial nitric oxide supports healthy circulation and lowers the risk of clots while iNOS (inducible nitric oxide) creates very large amounts of NO to kill pathogens and inhibits eNOS, thus increasing the chance of clots. For a deep dive into eNOS and iNOS, watch my iNOS interview with Dr Jill Carnahan on her YouTube channel.



Q: How are you measuring thromboxane a2?
A: It’s a urine test from a company called Chronic Inflammation. (www.chronicinflammationtest.com) I’m encouraging Great Plains to try to get back PLA2 and add thromboxane. I believe these two measures, along with checking Omega 3, 6 and AA are very helpful tools.



Q: Do you have an opinion on how the mRNA/lipid nanoparticles may have role in this (vegf maybe) and how those with the vaccines can help supplement to decrease their risks of these long-term effects? Your opinion so far?
A: This is totally speculative and hypothetical, but it would seem reasonable to think any vaccine will stimulate NOX to create immunity. If this stimulates mast cells, histamine and iNOS, this has the potential to activate platelets and VEGF.
To potentially reduce the platelet activation, finding which step in the process may be most active and trying to lower it may be helpful.
I recently did an interview with Dr Jill Carnahan on her YouTube Channel on platelet activation. You may find this useful.



Q: In patients with limited means, is a hsCRP and sed rate enough to rule out systematic inflammation?
A: Its useful, but I have clinically observed individuals with systemic inflammation with normal hsCRP and sed rate, but it can be useful.



Q: What is the easiest way to determine maybe through testing to suspect if a patient has uncoupled eNOS and should not take arginine/citrulline?
A: I am not aware of any specific testing, but clinical observations would be Raynauds or chronic cold hands and feet, high blood pressure (low eNOS) and genetic testing with down regulation of eNOS and gain of function in eNOS or potential mutations in BH4 production.



Q: Can CDP Choline raise TMAO?
A: I’ve seen this happen, so I always combine CDP Choline with Grape Seed Extract.



Q: Do you know about the "omega check" serum test via LabCorp and Quest. If so, do you recommend target levels for protection?
A: Yes, excellent way to see levels. Omega 3 – 8 to 12%. Omega 6 to 3 Ratio 3.1 to 5.1. AA to EPA 2.5-11.1.




Q: If you have SNPs on both FADS 1 & 2, is increased omega 3 supplementation useless; is it better to do Omega 3,6,9?
A: What we are finding to be most useful is oils like Calamari that are higher in DHA, Algae based DHA or if needed, some of the newer supplements that are Protectins and Resolvins. Omega 6 uses FADS first, and can further weaken Omega 3’s turning into Protectins and Resolvins.



Q: Can you expand on why someone with mutations in FAD enzymes can't tolerate intermittent fasting?
A: This has been a clinical observation and we are hypothesizing that since they are not effectively using fats, they need carbs on a frequent basis.



Q: What genetic/epigenetic tests are you using to find the sap's you discussed?
A: We use Functional Genomic Analysis (www.functionalgenomicanalysis.com).



Q: What if you calm the TNFa down with these supplements but the reason that its high isn't removed? Does it cause more damage?
A: Excellent question, as TNF-a is needed to fight off pathogens, so theoretically it could be lowered too much. This is an emerging field, with much to be learned. What we are doing, is trying to lower it when there is a gain of function of TNF-a or excess Iron stimulating. LDN lowers TNF-a so it’s done regularly.



Q: Are you measuring VEGf? What is your opinion of an optimal level?
A: Just started by doing the Covid Long Haul test and considered high when > 12.3



Q: How much resveratrol do you recommend for pathway 1?
A: 250 mg



Q: Can you clarify a few symptoms patients would have with pathway 1, 2, 3?
A: 1 - Possible excess mast cells and histamine, potential inflammation from RANTES. 2 - #2 Hypertension from higher thromboxane, pain and inflammation and activated platelets and ANTES. 3 - Mast cells, histamine.



Q: Thoughts on NAD+ IV for iNOS/eNOS balance and general endothelial function?
A: Here’s a speculative hypothesis. NAD+ creates NADPH that recycles glutathione. If inadequate glutathione, which is needed to clear Peroxynitrite, the Peroxynitrite may lower BH4 which increases NOS uncoupling.



Q: Have you seen low AA on testing? What are your thoughts about this lab finding?
A: Yes, but I am not aware of why or the potential impact.



Q: For people trying to self-regulate blood pressure with diet, would daily consumption of beets be sufficient to over activate the iNOS pathway? Top 3 tips to balance overactive iNOS pathway? What about SOD supplementation to balance the superoxide?
A: 1 - Beets have nitrates that turn into Nitrites that may create nitric oxide that improves the eNOS for healthy blood pressure. 2 - Balance Homocysteine and Iron, reduce histamine. 3 - Avoid Glyphosate as much as possible. 4 - Avoid and clear mycotoxins. <>br>I use SOD quite a bit, but balance with Catalase, or the SOD can make too much hydrogen peroxide. Catalase clears the hydrogen peroxide.



Q: Preferred means of measuring NOX enzyme activity?
A: I am not aware of any lab testing testing that would measure NOX specifically, however the Functional Genomic Analysis software looks at them. Clinical observations may be excess mast cells and histamine. Also, Homocysteine stimulates NOS, so high Homocysteine may be a useful indicator.



Q: How do we get the software he's talking about to use as practitioners?
A: You can get a free trial at www.functionalgenomicanalysis.com

Managing the Complex Patient: Using the GPL-TOX and OAT in Clinical Practice | James Neuenschwander, MD

Q: RE-bone marrow, I have not heard much about using this as a food (lightly roasted for example, from grass fed organic cows) to support patient's own bone marrow function. I read these ages ago, used in childhood leukemia especially. Any thoughts?
A: The issue with bone marrow is that it tends to be high in heavy metals (like lead) even if the animal is raised organically. You would need to use a product that is tested for this. Bone marrow was probably the first animal product humans ate—we were scavengers originally and the only thing left after the lions and the hyenas were done with the animal, was the bone marrow. It is a great source of multiple nutrients if you can find something that is not toxic.



Q: You recommended to continue a long-term detox regimen due to daily exposures. Beyond sauna are there any continued long-term supplementation you suggest?
A: I recommend regular liver detox support (NAC, glutathione, milk thistle, etc.).



Q: Regarding sauna - What about those who react to a sauna or even a hot shower. Do they need to take other steps before they can do a sauna?
A: That reaction is usually from autonomic dysfunction. If it is a detox reaction, then start with binders or Epsom salt baths first.



Q: How do you determine thyroid receptor disruption? Clinically, and check organophosphates?
A: Most toxins will disrupt thyroid function, so that is a given. There is no test I know of to test thyroid receptor function—a patient would have a low basal body temperature with normal thyroid numbers and no other explanation.



Q: Can toxins be the cause of burning mouth syndrome? Painful throbbing teeth? Thanks so much.
A: Burning mouth is an autonomic dysfunction along with some type of neuropathy. You have to figure out why. Toxins are always on the list for this.



Q: Can toxins affect free testosterone levels, as well?
A: They will affect production of testosterone. The amount of free testosterone is so miniscule, I am not sure if they will affect this directly outside of affecting total testosterone. I do not know if toxins impact albumin or sex hormone binding globulin (I have not read anything on this)—these are the two proteins that bind testosterone.



Q: I have a patient with elevated MTBE #1 on GPL tox - drinks only bottled water, lives in rural suburb near pond. Any recommendations on looking for source? Any other ideas on detox other than liposomal glutathione and NAC? Thanks.
A: MTBE is ubiquitous. Have they checked the bottled water? None of that is regulated — I can fill a bottle from the tap and sell it with any label I want. If there is not obvious source, work on the liver.



Q: Do you recommend IV chelation? or use of binders?
A: I do IV chelation for heavy metals—this was not covered in my lecture. I use binders—that was part of my lecture.



Q: What reference range do you use for reproductive hormones? As you know, reference ranges vary from test to test. Also, hormone levels vary depending on where patient is in their menstrual cycle, or arguably even time of the day.
A: I would recommend doing a course in hormone replacement for this answer. Ranges completely depend on where a patient is at in life, their menstrual cycle, and where their base line was. It is usually a range of okay along with managing patient’s symptoms.



Q: What do you say to a patient that won't change the exposure? Do you still treat them? Can treatment compound the problems they have?
A: Unless it is a temporary situation, I won’t treat them. It is like treating a patient with cardiovascular disease or diabetes that won’t change their diet or lifestyle. That is why we have traditional physicians—they would be more than happy to prescribe drugs for the rest of their lives. I don’t waste my time. If someone doesn’t want to get better, you can’t make them. Move on.



Q: If it’s determined that a patient has low glutathione recycling due to SNP and this likely the cause of presence of toxins-can they take glutathione long term without negative consequence?
A: Be careful with SNPs—there are very few that are determinate. Low glutathione has many causes, one of which is recycling. If you are going to use SNPs, you better have the entire glutathione/sulfation/uric acid/methylation/ammonia cycle SNPs laid out to see the entire pattern. Using a precursor (sulforaphane and/or NAC) first will tell you if you need to use glutathione itself. If those two do not increase the level, then I will use glutathione chronically.



Q: Toxicity of microwaves how significant is this? Seems to be coming way too high.
A: EMFs are a topic all by itself. I am not an expert on this, but the literature I am read suggests that it is a problem.



Q: What do you think about silicon rich water to reduce aluminum levels?
A: The problem with products like Fiji water is that come in plastic bottles and are shipped from Fiji. I typically use a supplement for this (like BioSil).



Q: Any specific suggestions to help detox glyphosate?
A: Binders are an effective way to detox glyphosate as are saunas.



Q: Do you think mitochondrial nutrient support is helpful, at the same time as detox?
A: Yes, most of our chronically patients have mito issues. The ultimate solution is to eliminate the cause of the cell danger response.



Q: Are saunas safe for kids? what age?
A: Yes, I reserve the lower age for children that can express their needs (usually around age 3). Things like headaches or dizziness are signs that they are not tolerating. Start low and go slow.



Q: Do you have a supplement recommendation for blood sugar dysregulation due to toxins for someone who eats clean, has mold, and still needs help getting A1C normal again? Is it just a matter of time?
A: Detox the mold first to see where the patient is at before working with other medications or supplements for the sugar.



Q: Can NAC or glutathione be used long term?
A: NAC - yes, Glutathione — usually, but not something that I like to do.



Q: Do you believe after filtering water through zero water you need to replenish with minerals?
A: That would be ideal, but I tend to take and recommend mineral supplements

The Clinical Approach of a GPL Consultant on GPL Testing | Jasmyne Brown, ND

Q: Dificid is recommended first line therapy for C diff with fewer side effects than Flagyl or Vancomycin. What are your thoughts?
A: do not have much experience with that antibiotic and how it influences the clostridia markers on this test. However, the OAT does not necessarily differentiate between the pathogenic clostridia species. There are a number of pathogenic clostridia species, and by measuring various metabolites produced by these organisms, you can cast a broader view of pathogenic clostridia that would otherwise not be identified on a stool test. With that said, the intervention is dependent on how aggressive you as the practitioner see fit. Interventions vary from high dose (generally between 10-12 billion) spore- based probiotics to botanicals to pharmaceuticals.



Q: Is GPL Labs doing DBH testing? if not which lab provides the testing for copper- polyuria?
A: GPL is not currently measuring DBH. The best way to assess it, at this time, is either through genetic testing or a spinal tap. We do measure copper (along with ceruloplasmin and zinc) via serum https://www.greatplainslaboratory.com/copper-test-1 and via urine through the heavy metal urine test https://www.greatplainslaboratory.com/metals-urine-test.



Q: How do you time your treatment of a patient with mold, SIBO, IMO, Candida, dementia, and oxalate kidney stones? What is your protocol including prescription medications and supplements?
A: This is highly dependent on the patient, and multiple other factors.



Q: Do you recommend to-do DMSA and Glutathione provocation prior to ENVIROtox?
A: DMSA provocation is only necessary for a heavy metal urine test. Glutathione is not recommended for any of the test on the ENVIROtox (Glyphosate, GPL-TOX, and MycoTOX Profile) as the ranges are based on people not provoking.


Day 3 Q+A: Health Implications of Mold, Environmental Toxin Exposure, and More

Click each presentation title to expand the answers from each speaker.

Environmental Toxins and Prenatal Care | Joseph Pizzorno, ND

Q: How do you approach patients with abnormally low GGT who may have difficulty recycling glutathione?
A: Very good question! And one I have been thinking about and have not figured out a good answer. At this time, I recommend topical or liposomal glutathione.




Q: What are some safe brands for cooking pans?
A: I have not independently evaluated specific brands so can’t make an informed recommendation. We use the new ceramic cooking ware. Appears to not leak toxins and is reasonably easy to clean.




Q: How long do you need to eat organic/limit exposure to see a change in blood work or on other toxin screening tests? / How long would you wait until retesting?
A: Remarkably, blood and urine pesticide levels drop dramatically—75-90%--after just 4 days of eating organically. The problem, of course, is that most are fat-soluble, so they accumulate in the fat. Since blood and urine change so quickly, I recommend testing 2 weeks after the patient tells you they have been eating organically.




Q: If I wanted to grow my own organic garden, where do you get seeds? Are the seeds in a typical store organic?
A: Happy to report there are a lot of good sources! I prefer the seeds to be both organic and heirloom. I like most of the food produced by the seeds I get from Uprising Seeds in Bellingham, WA.




Q: What natural sequent do you recommend?
A: All food-sourced fibers. Unfortunately, very little objective research. The little that is available is mostly wheat and rice fibers. Considering that most people react adversely to wheat, I suggest rice. And yes, good idea if you can get the manufacturer to document arsenic free.




Q: How does exercise with sweating compare with sauna for excreting toxins? Do you recommend red sauna or the blankets?
A: I asked the great researcher Steven Genuis, MD this question. His response is that it doesn’t matter. All that matters is the sweating.




Q: Is NAC ok for pregnant women?
A: I believe <1,001 data-preserve-html-node="true" data-preserve-html-node="true" mg/d should be safe for everyone. The only reactions I have seen are in a very small percentage of people who have a sulfur metabolism problem. Watch for IBS, acid reflux and/or allergies as an indication of sulfur overload.




Q: I'm working in community that has several paper mills. What toxic burden does that present to the people?
A: Highly dependent upon the source of the materials used. Unfortunately, trees will incorporate toxins they are exposed to. For example, if grown in an area with mercury contamination, the trees will be high in mercury which is released if there is a forest fire. The only way to be sure is to go to the US Geological Service website (www.usgs.gov). they’ve a large number of maps by county of the many toxins in the environment. Also, the Environmental Working Group has a website where a Zip Code can be entered to determine the toxins in the area.




Q: What is the half-life of PBDEs? How can we get them out of the house/off the floor?
A: I have not been able to get a good answer on this. Appears to be months, but I am not sure. The research does show that the more brominated the PBDE the longer the half-life.




Q: Do you have a resource on the half-lives of specific toxins? Thanks
A: I found a great paper that has many of them, but not all. Also includes a lot of drugs. Therapeutic (“normal”), toxic, and comatose-fatal blood-plasma concentrations (mg/L) in man. 150 pages and almost 1,000 references. Very useful.




Q: What is the most reliable test for metals if you cannot do provocation before testing?
A: Depends upon the toxin (lead—blood, cadmium—urine, arsenic—urine, mercury—urine.). But must recognize the “safe” standards are way too high. Urines should all be first morning.




Q: Dr. P, What about a low GGT? Does this mean liver needs more support?
A: They likely need glutathione. Measure their RBC glutathione.




Q: Doesn’t ggt also assess gallbladder function? In the ICU, we used to check ggt when we suspected gallbladder disease, which makes sense that it’s elevated when they are not detoxing well d/t gallbladder disease...
A: Yes, there are several causes of elevated GGT. Need to determine the full context.




Q: Is GGTP the same lab test as GGT?
A: Yes. The same test but labs use both abbreviations.




Q: Can you repeat the name of Doc in Northern CA who follows the GGTP?
A: Alan Goldhamer, DC measures GGTP in his fasting clinic.




Q: Does 8-ohdg also measure damage from mitochondrial dan?
A: Good question! And one I have wondered about. 8-OHdG has been used for both nuclear and mitochondrial DNA damage but I have not been able to quantify the differences. We do know that mitochondrial DNA suffers a lot more damage and does not have the repair mechanisms of nuclear DNA. So, I would not be surprised if the urinary markers are dominated by mitochondrial damage markers.




Q: Do you think the Big Berkey water filter is enough? Or what about distilled water, with adding minerals?
A: I do not at this time have enough data to compare manufacturers. Distilling water and adding minerals is a good strategy.




Q: Do you think fiber in food is enough, or do you recommend fiber powder?
A: Hard to get enough fiber from diet unless eating primarily vegetarian and primarily high fiber foods. Supplemental fiber seems a good idea to me.




Q: A great resource for parents is Lead Safe Mama website https://tamararubin.com/ information on lead in children's toys, dishes, etc.
A: Great! Thanks for sharing.




Q: How long should a gal wait to get pregnant following removal of amalgams by an environmental dentist?
A: Assuming active efforts to avoid all other mercury sources and active facilitation of excretion, 6 months will get rid of most of the mercury.




Q: Can you comment on what pollutants we should be concerned with near a landfill in US?
A: Not being facetious — all of them.




Q: What key lab tests should a woman who has had 3 miscarriages in the first trimester have done before getting as part of her prenatal and fertility care?
A: Homocysteine, methylmalonic acid, GGTP, 8-OHdG, blood lead, and urinary mercury.




Q: How do you filter outside air? Isn’t that where your furnace and AC gets the air?
A: Depends upon the installation. The furnace typically recirculates the air of the house and has a separate intake to bring in outside air for the burning. Opening a window lets in outside air. If heavily polluted area, then should consider clearing outside air before it enters the house.




Q: Please tell us some of the toxin-absorbing plant names?
A: Moss case, Pot mum, Gerber daisy, Warneckii, and Ficus.




Q: With use of plants do you increase exposure to soil spores?
A: Probably, likely.




Q: What do you do when people are non-sweaters?
A: More fiber and glutathione.




Q: Does sweating from exercise and/or hot tub excrete these toxins as well?
A: Yes. Note that hot tubs and steam baths recirculate toxins unless removed by a filter.




Q: I have patients who barely sweat, they go in sauna and don't sweat until have been in there for at least an hour...thoughts on this?
A: Trickly. I can’t recommend specific protocols without knowing more about the patient.




Q: Do you have a recommendation for trace mineral supplementation?
A: Eat organically grown foods. No specific supplement recommendations.




Q: Do you recommend drinking alkaline water while in the sauna?
A: Theoretically, yes. But I’ve no research. The sauna drink I make for myself is slightly alkaline.




Q: Are saunas safe for kids? what age and time limit?
A: Yes, and a bigger question than can be answered here.




Q: What are your thoughts/recommendations for those that don't tolerate sauna (or even hot showers/baths) without feeling ill?
A: Primarily Red face, elevated heart rate and dizziness. Is it possibly related to histamine intolerance? This question has come up a lot. I will give it more thought.




Q: Is there an optimal reference range for GGTP?
A: My best estimate at this time is 15-20.

Non-Metal Toxic Chemicals and Their Effects on Health: Glyphosate and Beyond | William Shaw, PhD

Q: How toxic is weed/cannabis these days? I got a feeling it's loaded with metals and chemicals with cadmium leading the way. Does excess weed-smoking keep the copper/Dopamine high?
A: Acetaldehyde, ammonia arsenic, benzene, cadmium, chromium, formaldehyde, hydrogen cyanide, isoprene, lead, mercury, nickel, and quinoline are common in cannabis. Those who exclusively smoked marijuana had higher blood and urine levels of several smoke-related toxic chemicals such as naphthalene, acrylamide, and acrylonitrile metabolites than non-smokers. Metabolites of the last 2 chemicals are tested in the GPL-TOX test.




Q: Does your lab offer any tests for toxicities of chronic Lyme disease?
A: No.




Q: Do touch screens on electronics increase risk of exposure to chemicals?
A: Triphenyl phosphate is a significant hazard on computer screens, touched or not.




Q: Which brand of household cleaners would you recommend?
A: Don’t have one.




Q: Any suggestions on best ways to detox patients who are getting significant number of IVs? Or for anyone getting IVs - should they be taking binders for a particular amount of time before/after? any suggested protocols to detox the plastics?
A: Plastic IVs are all potentially hazardous. Request glass containers instead. Sauna is the best treatment.




Q: 1-bromopropane could be used for foam gluing. Is foam mattress and foam pillows for sleep also big source of? Are older foams better or worse?
A: Good question but don’t know.




Q: Dr. Shaw mentioned that glutathione will detox many toxins. If we start a patient in which we suspect a heavy toxic load on glutathione, are we in danger of seeing a large enough dump to see a severe herx reaction?
A: Most glutathione adducts are less toxic than the original toxic chemical not attached to glutathione. There are exceptions so there could be an occasional toxic reaction. Since there are tens of thousands of toxic chemicals there is no comprehensive source of this information.




Q: How does urine neurotransmitters rate to brain levels? Do they correlate?
A: Urine neurotransmitters correlate to brain levels since the same enzymes are present in both central and peripheral nervous systems for dopamine, epinephrine, and norepinephrine.




Q: Dr Shaw which supplements. do you take?
A: CDP choline, lithium, vitamin C, B6, methyl folate, methyl cobalamin, carnitine, biotin, Vitamins A, D, and K.




Q: What brand of air filter system do you use in your home?
A: None right now.




Q: What other techniques other than supplements and air filtration do you do to keep your toxins low?
A: The main thing is organic food and reverse osmosis water.




Q: Any suggested brands of sauna? Red sauna or blanket?
A: The only sauna not recommended are those made of pine which off-gas terpenes when heated.




Q: Will water distillers remove the vinyl chloride from the PVC in nearly everyone's home and workplace?
A: Reverse osmosis systems are the only systems that remove almost all chemicals.




Q: When you mention acrylic fibers being carcinogenic-does that include clothing-so much is made from acrylic?
A: Yes, if the person is exercising, the chemicals may off-gas and enter the skin.




Q: I am now wondering how many crafters who are big into the yarn arts are at risk, since there are many yarns that contain acrylic. It would be difficult to do yarn arts wearing gloves. Any advice?
A: Acrylics and other synthetic fabrics would be most toxic when wearing them while hot so they might off-gas.




Q: Can people with a sulfur allergy take glutathione?
A: A sulfur allergy would have to be defined. Virtually no one except industrial chemists are exposed to pure elemental sulfur. Two sulfur-containing amino acids found in almost every protein are cysteine and methionine. Virtually every normal person has high amounts of sulfur containing glutathione. I don’t think someone who is severely allergic to these amino acids could be alive. Some people mean they are sensitive to sulfur containing antibiotics. I seriously doubt that anyone is allergic to glutathione since it is present in virtually every cell in the body. If unsure, put a drop on the skin and see what happens.




Q: Is there an exhaustive list of where each of the environmental toxins are found? if so, where? i.e., work exposure with certain chemicals....
A: The Great Plains website is a good place to star. In this brochure, pages 10-15 are fairly good sources.




Q: Did any ALS patients who you highlighted in the lecture improve with removing exposure, sauna and NAC/Glutathione treatments?
A: Haven’t had time for follow-up. Biggest impediment is that family members consider ALS incurable so don’t want to treat.




Q: Many students are now using iPads that you can write on. Do you feel that the coating on the screen is being absorbed into the hands while writing or is the risk more with inhalation from off gassing?
A: Don’t know.




Q: Are latex gloves without powder toxic?
A: The latex allergy is to the gloves themselves not the powder.




Q: Are you of the opinion that glyphosate is one of the main causes of the rise in autoimmunity, due to alterations in protective microbiome? It's been sprayed on wheat/oats for 25 years and gluten is proven autoimmunity trigger.
A: Yes. Many articles on this. Wu HJ, Wu E. The role of gut microbiota in immune homeostasis and autoimmunity. Gut Microbes. 2012;3(1):4-14. doi:10.4161/gmic.19320




Q: Thoughts on the use of fermented foods such as sauerkraut packaged in plastic?
A: Plastic packaging is a big problem for all foods.




Q: A lot of people get Culligan water delivered to their home in big plastic jugs.... would it be better for them not to do this?
A: I am one of these people and need to ask what type of plastic is being used.




Q: Please can you repeat and expand on how Norepi influences in immunity after vaccination?
A: Clostridia bacteria phenolic metabolites inhibit the conversion of dopamine to nor-epinephrine by dopamine beta-hydroxylase. Since nor-epinephrine is needed to mount an immune response, the vaccinations don’t work if norepinephrine is deficient. Alaniz RC, Thomas SA, Perez-Melgosa M, Mueller K, Farr AG, Palmiter RD, Wilson CB. Dopamine beta-hydroxylase deficiency impairs cellular immunity. Proc Natl Acad Sci U S A. 1999 Mar 2;96(5):2274-8. doi: 10.1073/pnas.96.5.2274. PMID: 10051631; PMCID: PMC26773.




Q: Can you comment on cancer chemo / immuno drugs and chemical type of toxicity? At what point is it appropriate to test?
A: Many chemotherapy drugs are mutagenic. Organic acid testing might be useful to assess negative effects of chemotherapy.




Q: Not classical toxicity, but what evidence do we have of the biology of intense sensitivity to minute quantities of, salicylates, terpenes, non-pigment pill fillers...doesn't seem like histamine or IgE related? Hard to use herbals in such patients.
A: Many pharmaceuticals use phthalates as a time release agent. Not a good thing to do.




Q: What is the half-life of xylene?
A: Based on the rate of elimination of m-xylene in expired air, the half-life was 0.8 hours for the initial phase, 7.7 hours for the intermediate phase, and 17.7 hours for the slowest elimination phase. Overall, the elimination half-life of m-xylene from subcutaneous adipose tissue has been estimated to be 58 hours in a man.




Q: How long after painting your inner house are toxins reasonably less to live there?
A: I would say when the odor is no longer offensive. Or use “green” brands of paint.




Q: Why do so many supplements come in plastic bottles, eg the GSE of New Beginnings?
A: Glass would be better, but it breaks in shipping.




Q: Are phthalates what are off gassed in new cars and what would you recommend for people who have a new car and therefore continuously exposed besides binders and NAC/glutathione?
A: The chemicals of the new car smell are ethylbenzene, formaldehyde, and toluene.




Q: Are you aware of any water filtrations systems for the home that would filter out vinyl chloride?? Many newer homes are plumbed with plastic now, no longer copper.
A: You would likely need reverse osmosis.




Q: Can you comment on what toxins you see with vaping?
A: A vape website lists the following: Diacetyl: Inhaling diacetyl has been linked to irreversible lung damage in factory workers, according to the National Institute for Occupational Safety and Health (NIOSH). Heavy metals: Exposure to heavy metals may cause flu-like symptoms, lung damage, and even cancer in some cases. Ultrafine particles: If inhaled, ultrafine particles may damage the respiratory and cardiovascular (heart) system and other parts of the body. Volatile organic compounds: These compounds including acetaldehyde, formaldehyde and acetone may put people at risk for many health problems, such as cancer and heart damage.




Q: How were the percentile data derived? From NHANES or from GPL? Do the percentiles relate to a "healthy" population (however that's defined!) or a general population? If the latter, how was referencing based on a biased population avoided?
A: 3The percentiles were directly taken from NHANES which attempts to provide data on a normal population. They are not gathering data from patients in hospitals or clinics.




Q: What about toxins in tattoos?
A: 3A consumer group warned of the "the presence of carcinogenic, neurotoxic or highly allergenic products" in three-quarters of inks most used by French tattoo artists, French newspaper Le Monde said in a report. Colored inks can contain lead, cadmium, chromium, nickel, and titanium. These metals can trigger allergic reactions and potentially lead to disease.




Q: When GPL-TOX levels are not elevated greater than 75%tile or 95%tile, but many or some markers are less than or equal to the 75%tile does synergy does take place? Does this suggest increased toxic body burden?
A: 3You are right. Multiple exposures below the 95th percentile might be as hazardous as a single chemical above the 95th percentile.




Q: Can you comment on 3M claims they have a replacement for 1-bromopropane and TCE?
A: 3M™ Novec™ Engineered Fluids are non-flammable fluids used in a wide variety of industrial applications, including vapor degreasing, solvent cleaning of industrial parts, and thermal management of electronics. Claims have been made for better safety for this product. Time will tell.




Q: What are the major differences between Glutathione vs. NAC?
A: NAC is a precursor of glutathione and may be absorbed from GI tract more readily than glutathione although liposomal glutathione is well absorbed.




Q: Do these pathogens show up on stool studies that are designed to find them such as those from Genova Diagnostics or Doctors Data? I’ve rarely seen these pathogens on those studies.
A: The OAT test of the Great Plains Laboratory is the best (and only) test for detection of Clostridia bacteria that inhibit dopamine beta hydroxylase. It is better to ignore the Clostridia sections of other labs,




Q: How much of an influence does glyphosate/toxins have on MS and autoimmunity in general?
A: See question 22. Many patients with MS have high toxic chemicals.




Q: What is the half-life of 1-bromopropane? What is the half-life of 3-HPMA (acrolein)? Can we have the half-lives indicated on the GPL-TOX reports? That would help us tremendously!
A: Wistar male rats were exposed to 1-bromopromane (1-BP) vapor for 6 hours a day, 5 days a week, for 3 and 4 weeks (1500 ppm) and 1 day, and 4 and 12 weeks (700 ppm). ... 1-BP in blood decreased rapidly to the detection limit within 0.7 hr. On the other hand, bromide ion persisted longer in both blood and urine; the biological half-life of bromide ion was 4.7-15.0 days in blood and 5.0-7.5 days in urine. : Urinary 3-HPMA levels from acrolein were increased after 2-hr consumption of fried food with an elimination half-life of 10 hr. Human data are not available for 1-bromopropane. I will start looking for the other compounds. PMID:12191883 Ishidao T et al; Toxicol Lett 134 (1-3): 237-43 (2002)




Q: Can an OAT test's results be within normal ranges and the GPL-Tox or MycoTOX Profile have elevated values?
A: Yes.




Q: Do more "clean" tobacco sources, such as American Spirits, offer much improvement to the multiple toxicities associated with tobacco exposure?
A: American spirits do not contain glyphosate but its smoke has all the same harmful chemicals as any other cigarette.




Q: Which type of sauna do you recommend for most effective treatment in removal of toxins?
A: Any except those made from pine.




Q: Have you seen increased toxic load in your patients who have received the Covid vaccine?
A: I haven’t analyzed the data.




Q: What is the scientology sauna protocol?
A: The protocol can be accessed at the following link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259397/pdf/10.1177_0300060518779314.pdf

The Role of Other Toxicants in Mold Patients – How to Assess and Treat | Lyn Patrick, ND

Q: Do air pods emit EMF's? Kids wear them all day long.
A: Yes, they do.




Q: Can Dr Patrick repeat the suggested dose for NAC? Thanks!
A: I mentioned this during the talk so it will be on the recording- adult dose is 1800-2500 mg contraindicated in peptic ulcer.




Q: Will an air filtration machine with a Hepa filter remove aerosolized printer ink?
A: Depends on unit look for the filtration capacity- ultimately you want a unit that filter down to .003 microns




Q: Do we presume, or is there evidence, that all people with positive mycotoxin tests are colonized and/or have biofilms?
A: No evidence UNLESS there is no obvious sign of exposure meaning (home/workplace/school tests negative for mold and mycotoxin yet symptoms persist. My colleague Neal Nathan who knows much more about this than I do does not recommend nasal washings for culture due to false negative findings and recommends treatment in the above case.




Q: What about PEMF use? Can it mitigate EMF effect?
A: I would ask you to think about EMF/EMR like you think about tobacco smoke- would you recommend a vit. C therapy for smoking patients and not also intervene w cessation strategies? PEMF is helpful but mitigation involves remediation (hard-wiring, avoidance of Wi-Fi, keeping phone away from body or off, etc.).




Q: Do you recommend any of the protective EMF wearable devices?
A: Clothing that is penetrated with silver wire is protective, if you mean a device like a magic dot or other applications, no evidence.




Q: Vitamin E- do you recommend taking just tocotrienols or the full spectrum with tocopherols? There are some good literatures about benefits of just tocotrienols for cell membrane health and oxidative stress.
A: Vit. E, like vit. C is a complex of related compounds: gamma, alpha, beta, delta tocopherol and all four tocotrienols are necessary.




Q: Are using traditional headphones or Bluetooth headphones just as damaging as putting your phone to your ear?
A: Don’t know what you mean by traditional headphones, there are air gapped external earbuds that are OK to use but anything that allows a signal to go to your ear/skull/brain is damaging.




Q: You mentioned high prolactin as being from pesticides? How would you manage this in your pt?
A: The actual data on this comes from pesticide applicators who are occupationally exposed- treatment for OP toxicity involves B complex and high levels of antioxidants (C, E, Se, Zn, ALA, GSH, NAC, melatonin especially). OPs have short ½-life in body so further avoidance is crucial. Of course, other psychologic stressors can also raise prolactin so that must be addressed as well.




Q: Can Ozone break down the forever chemicals?
A: No, the fluorine/carbon bonding is the problem not vulnerable to ozonation.




Q: Does putting a device on airplane mode reduce EMFs?
A: Yes, it does there is still some small residual exposure but most of it comes from the phone searching for a signal.




Q: What is your opinion about using alkaline water in machines (such as "Kangen" machines) to remove pesticides from vegetables or using as drinking water? Would this result in removing beneficial bacteria from the gut?
A: I thought the US Consumer Protection Agency made Kangen illegal to import into the US I didn’t think they were still available. Water cannot hold an alkaline charge, it’s the minerals in the water that determine pH. Cheaper to just add mag glycinate to your water, no? Vinegar is highly effective at removing pesticide residue from fresh fruits and vegs, Dr. Pizzorno had an entire slide on that protocol. Cheaper as well.




Q: How about glass IV bottles from McGuff pharmacy?
A: We used to all our IVs in glass bottles in the old days, I do disagree w Dr. Shaw about phthalate contamination from IV bags, I think they have to be heated to contaminate IV w phthalates.




Q: I heard an ND say that toxins are stored in the bones too and not just fat tissues, but I have never heard that before - Is that true?
A: Depends on toxin- lead, cadmium, per fluorinates are stored in bone, the science on that is clear.




Q: I heard from a mold specialist that some 'mold' (Penicillium) is only introduced from Pharmaceuticals - Is this true?
A: No, look at my slide from EPA identifying molds commonly found in buildings.




Q: Thank you for bringing up EMFs!!! How about the recent satellite launches since 2020?
A: See this article that was just published a few weeks ago- measuring ground level EMF/EMR from small cell towers- they are source of the radiation not satellites: https://www.spandidos-publications.com/10.3892/wasj.2022.157.




Q: Do Sleep number beds increase your risk of EMF exposure significantly?
A: I had to look this one up (LOL). Obviously if you can program them remotely they are receiving a signal. You would have to use an EMF meter to quantify the v/M or microwatts/cm2. (Safe Living Technologies has a good meter.




Q: Do you think using a keyboard and mouse is safer than touching the IPAD itself?
A: No same exposure, safest is a hardwired external keyboard and mouse a few feet away from computer




Q: Where can we get more training on how to evaluate patients on EMF exposure and possible treatments for them?
A: We have a free lecture on our training website: emeiglobal.com and the emfconference2021 has CME courses as well.




Q: Could we get the name of the EMF study that Dr. Patrick is referring to in her lecture?
A: PMID: 32168876 let me know if this isn’t the one you wanted




Q: What is the best way to protect against EMF? Do you recommend products from Aires Tech or similar companies? NO please go to EMFConference2021 and see CME education courses for doctors as well as my course at emeiglobal.com
A: There is no magic pill for this- sorry. All of the Aires Tech “scientific papers” were peer-reviewed in house, and none were published in actual peer-reviewed journals. Grounding and PEMF helps but does not substitute for remediation.




Q: Regarding covid, anxiety, and EMF, both can stimulate mast cells, NO/ONOO activity, kynurenine, NMDA activity, etc. How relevant do you feel this has been over the past 2 years, even though everything is being blamed on covid?
A: I am very concerned about EMF hypersensitivity which has many of the same symptoms as Covid-19. Please follow Dominique Belpomme MD, a French oncologist who has published clinical data on this in his patient population of electrosensitive/chemically sensitive population.




Q: How do you propose we evaluate someone's EMF sensitivity?
A: Here is a free YouTube by a physician from the UK- Erica Mallary-Blythe MD, who covers how to diagnose during an office visit: https://youtu.be/_iP-Zv3VLV4.




Q: Should the router be turned off at night?
A: Yes, if not hard-wired it is important to turn off the router at night.




Q: Is there any research showing that cellphones used in the car have stronger negative effects?
A: Cars act as small Faradays cages catching and holding in EMF, especially signal cell phone generates so yes exposure is worse in an automobile.




Q: Can you comment on how to protect from EMF exposure with hearing aids?
A: Turn off Bluetooth that connects hearing aids to your phone.




Q: EMF question- Are wireless headphones a big source? More dangerous due to proximity to brain?
A: Yes, Bluetooth is more exposure than regular headphones, air gapped headphones are best, easily available through online vendors.




Q: Can you comment on urine iodine testing? Endocrine tells me that neither serum or urine iodine testing is accurate. What reference range should we target?
A: Depends on reason you are testing, anything less than 200 mcg in urine is deficiency according to standard medicine.




Q: What are the ways to support the body & or reverse these effects of EMF for our children?
A: 1 - Cell phones should be kept 3 feet away from body (use speakerphone). 2- No devices in bedroom at night. 3 - Turn off router at night. 4 - Deal directly with internet and device addiction in children.




Q: Do you have any Canadian sources for labs that test for PFAS?
A: Sorry, I do not- use the PFAS sites I talked about for resources.




Q: What labs companies that will check my water that also includes MTBE?
A: Watercheck.com call them if it’s not on the website they can look for almost anything.




Q: Can you repeat the name of the researcher who is doing PFAS and Covid?
A: Phillipe Grandjean PhD




Q: If fish are high in PFAS would fish oil supplement be counterproductive in supporting health?
A: As you know good fish oil undergoes a process of distillation to remove POPs (PCBs, organochlorine pesticides) and can remove PFAS please ask your fish oil manufacturer for a Certificate of Analysis for PFAS, very few will be able to provide it.




Q: What are the most common toxins used on golf courses in the USA? Glyphosate and 2,4-D?
A: Golf courses have 2-4 times the pesticide use of agricultural land, herbicides are commonly glyphosate-containing but yes 2,4-D as well.




Q: Could you comment on the use of apheresis use for chemical and other toxins?
A: Therapeutic apheresis for chemical toxicity is only available in Germany right now and one or two places in U.S. I have never had to use it if able to use sauna, colonics, IV nutrients, chelation.




Q: Does plasma donation help with detoxification of any of these toxins?
A: Yes, it does lower blood levels of PFAS, this has been published by Stephen Genuis MD.




Q: I've heard that using Data on your phone is less EMF exposure than WIFI. Is this true?
A: Yes, cellular data doesn’t have same exposure as phone searching for a Wi-Fi signal.




Q: Does the blood removed from phlebotomy treatment for pfas get donated? Do you have to let know not to use the blood?
A: You are way ahead of the rest of the medical world, but no one can’t donate blood and then tell the blood bank not to use the blood, they won’t listen to you.




Q: Would you please repeat the company name who is using plant based can lining?
A: EDEN foods.




Q: Can you comment on natural cholestyramine alternatives as a binder for PFAs and other toxicants, such as beets and okra?
A: Sorry for any confusion but CSM is only agent that has been shown to reduce PFAS, foods will not do it Genuis also published this data.




Q: Milk cartons - are they a source of BPA type exposures? Is the fact that milk is cold a reliable protector for humans, or are we getting gradually poisoned by such packaging?
A: BPA in food contact materials: cans (beverage and food), hard plastic water bottles, no BPA in tetrapaks (milk, soymilk, almond milk, etc.).




Q: Melamine is frequently used in children's dishes. Is melamine also toxic even if not microwaved?
A: No




Q: As an ND, I love castor oil packs for detox. Is that something you still recommend?
A: Sure, castor oil increases lymphatic flow, but then lymph has to clear blood, kidneys and intestines.




Q: What is your optimum cholestyramine dose and frequency of dosing?
A: Standard dose 4 grams qid, not realistic for patients due to need to dose in between meals. 4 grams bid at bedtime and on waking will do the job.




Q: Where can we find more of your past and future webinars online?
A: Emeiglobal.com or National Association of Environmental Medicine (envmedicine.com) we also have some lectures on YouTube.




Q: What is the lab that measures PFAS for free? What is the lab that measures BPA?
A: PFAS for free will be done by public health depts. If local water levels are high otherwise no free testing. Millionmarker lab does BPA, BPS, BPF.




Q: Did you know Theo Colborn? Please let me know.
A: Yes, Roy I was fortunate to spend time w Theo for a few years before her death, we both live in gas and oil fracking areas in CO, and she was very active in addressing exposures from fracked gas and oil wells. I was very fortunate to know her as a colleague and friend, feel free to email me.




Q: What suggestions would you have for those with histamine intolerance or mast cell activation disorder and want to use a sauna? (Generally, heat can cause issues in those disorders)
A: Bowel tolerance vit. C (L-ascorbate like that made by Perque) or using C Cleanse and luteolin Also keep heat down around 100.




Q: Do you think we should take glutathione every day for the long term? Or should this be in bursts?
A: No idea why “bursts” would be a good idea, please explain that. Oxidative stress is constant so- no glutathione = massive oxidative damage = mitochondrial damage = tissue and immune damage.




Q: What is your opinion regarding the work of the Weston A Price Foundation?
A: Theoretically eating ancestral diets is a great idea. Sadly 80 years of persistent pesticides and organic pollutants like PCBs and PFAS have caused mammal fat to be a depot for toxicants. Butter, farmed fish, and beef have high levels of PCBs: cardiotoxic, immunotoxic, thyroid disruptors, reproductive toxicants.

Identifying and Treating Complex Patients with Mold Toxin | James Neuenschwander, MD

Q: Does freezing foods 24 hours (like grains, nuts, and coffee) kill the mold?
A: The issue is not the mold in the food—it is frequently not there due to processing. The issue is with the mold toxin. Freezing food does not destroy mold toxins. Only cooking to temperatures over 500 degrees will destroy most mold toxins




Q: Have you seen a patient with a VCS that is normal with an OAT or Mycotox that is abnormal?
A: Yes. The presence of a mold toxin does not mean that the person is reacting to it. Most people can have mold toxins in their system and not be sick. The Mycotox would be abnormal with a normal VCS. The OAT is a bit more complicated. Mold markers on the OAT are an indicator of colonization—this is abnormal, and a person is going to have an abnormal VCS—I don’t think I have seen a normal VCS with an abnormal OAT.




Q: Do you have a recommendation for a good vagal nerve stimulator?
A: I have not had great success with these. The one I use is the Alphastim—it clips to the ear lobe. It can also be used peripherally for localized pain.




Q: Are those that are most sick usually have the genetic predisposition? Sometimes when test couples when one has cognitive decline, other spouse feels normal but has exposure on testing.
A: Cognitive decline is almost always linked with ApoE4 variants (along with ApoC1 and TOM40 variants). This has to do with the brain’s ability to detox. Illness is always the intersection of genetic predisposition and the environment. Enough toxicity and everyone gets sick (think Hiroshima). Little enough toxicity and no one gets sick. Everything else is on a bell curve.




Q: Could low serum sodium secondary to mycotoxins be due to suppressed aldosterone?
A: Yes. This would typically be tied to low cortisol and ACTH levels (measure aldosterone in the morning along with cortisol). For most of my mold patients, the issue is not the adrenal cortex (aldosterone) but pituitary signaling (low AVH). Almost always, I will have a high osmolality and low AVH. Low aldosterone would specifically lower sodium but shouldn’t raise osmolality.




Q: Do you have a MARCON test that you recommend?
A: I think the lab we use is MicrobiologyDx—we do the swabs in the office.




Q: What are the best binders for Aspergillus, Penicillium, and Citrinin molds?
A: This table is from a 2014 Townsend Letter on Mold and Mycotoxins. I think Neil Nathan was one of the authors.




Q: Is there less toxin exposure when granular forms of herbicides are used on landscapes rather than sprays?
A: Anything that prevents it from getting airborne would help. You still have the issues of contaminating ground water and absorption through the skin if you work the soil afterward or walk barefoot in the area. Not ideal, but better.




Q: Can you review briefly whether mold toxins need to be commonly considered in treating patients living in all climate types, including semi-arid and arid weather regions?
A: It is less likely, but most arid and semi-arid regions are hot, and people have air conditioning. This offers an avenue for mold to enter the house (there is plenty of mold in Las Vegas, but it is nothing like Michigan).




Q: What may be the biological mechanism of substantial multiple food/chemical/odor sensitivities? When the response does NOT look like IgE mediate, but may be within a few minutes to an hour? Thank you.
A: Cell danger response/immune activation leading to autonomic dysfunction. The cell danger response can be set off chronically by infection, a toxin exposure, or emotional stress. Once that is turned on long enough, you get autonomic dysfunction and become hypersensitive to everything. The key is brain plasticity training—DNRS (www.retrainingthebrain or the Gupta Program (www.guptaprogram.com) are the two that I use. Trying to treat with avoidance is too difficult. This tends to work better than desensitization for those types of sensitivities.




Q: Do you see cardiovascular symptoms with mold and mycotoxins, like poor circulation, cold hand and feet, Raynaud syndrome, etc.?
A: Yes—chronic activation of the cell danger response/immune activation will ultimately cause damage to the endothelium and vascular dysfunction. It will also induce autoimmunity in a susceptible individual.




Q: Assuming they could find such a place, would a 2-week test of living somewhere else and feeling better be a reasonable screen for mycotoxicity in patient with suggestive tests who wants more certainty before spending $tens of thousands on remediation?
A: This is true, if you can find that place. I typically send people to live on a beach for two weeks (preferably in the Caribbean). Even though there may be mold, the air circulation with clean (ocean) air takes care of that.




Q: What is a water fast?
A: ? taking nothing but water (no juices or other nutrients). I typically would do this for 3-5 days and only if I think the individual can handle it.




Q: Would you recommend the Mold IgE test for future antibiotic use for chronic individuals?
A: I have never done that. I have no experience




Q: Can you recommend an ozonator for furniture/etc.?
A: There are many. DMRSUP has one for about $100. You need a generator that has a hose that you can use focally on furniture or feed into a box where you have books and the like to be ozonated.




Q: Can UV light kill mold instead of using ozone?
A: UV light will kill mold, but not mold toxins.




Q: Do you advise Glutathione provocation prior Mycotox testing? DMSA prior heavy metal testing?
A: No on the glutathione. For heavy metals, I do a first mornings urine as the unprovoked sample, give 2000mg of DMSA and collect urine for 6 hours for the provoked sample. I then compare the two.




Q: For your workup list, can you please mention how you test for these things? i.e., what lab you like to use.
A: Sorry, this is too general. I use Great Plains for Mycotoxin and OAT testing. Not sure what other labs they are talking about.




Q: How to measure IP flow and NK cells?
A: Any lab can do this. CD3=T cells, CD4=T-helper, CD8=cytotoxic T cells, CD19=B cells, CD16/56=un-activated NK cells, CD57=activated NK cells. Check your local lab for how to order. Cyrex labs also has an much more in depth panel called a lymphocyte MAP.




Q: Does inactivated MSH, as you mentioned with mycotoxins, have anything to do with melanocytes in the skin (i.e., a patient with small patches of vitiligo on shins.... normal thyroid workup)
A: Vitiligo is an autoimmune disorder. A person can be pale if they have chronically low MSH, but it shouldn’t cause vitiligo.




Q: Do you use the nasal culture to test for intranasal fungus, bacteria, and Marcons and how successful do you find the recommended intranasal antibiotics or antifungals?
A: Yes, I use the nasal culture—not the most sensitive for fungus and mold. I use the intranasal sprays—treats most people.




Q: How do you treat the MMP9, C4a, and TGF𝛽?
A: Eliminate the mold exposure, fix the gut and the diet, use binders. These are makers of immune activation—I don’t treat them directly.

IgG Food Allergy Testing: Scientific Evidence of its Validity in Chronic Illness | William Shaw, PhD


Q: Can you please confirm that the patient MUST be eating all the foods in this IgG xMap test for 6 weeks prior to taking the test?
A: I confirm that.




Q: When doing a retest, do you recommend having the person reintroduce prior reactive foods before testing? I've seen patients test low because they avoided a food for 6 months, but when the reintroduce it after retest and have it several times, they react.
A: If a person has a very high value for IgG antibodies against a particular food, immune memory cells store that information. That person should probably never eat those foods again on a regular basis. Retesting is probably useful only for new allergies, not for previous allergies.




Q: Is sheep or buffalo milk also closely related to cow with respect to IgG?
A: Yes, there is considerable similarity among the milk of all these species and likely cross-reactivity.




Q: How much of gluten sensitivity is related to use of round up or other pesticides causing a toxic exposure rather than a direct reaction to gluten containing foods? Some people report ability to tolerate gluten products when they travel abroad.
A: The food map test will not react to glyphosate so any positive is a reaction to the protein sequences of the foods. The failure to react abroad is likely due to elimination of the food at home and reduced immunity. The occasional exposure when traveling is not enough to trigger a reaction.




Q: Is the IgG testing sensitive to food that the patient has not eaten in months to years? How long does the IgG last in the system?
A: See question 2.




Q: Are molds often present in chocolate, like they are in coffee beans?
A: Virtually any food can develop mold, but coffee is a more common source because it the beans are washed (called fermentation) after harvest, making mold growth more common during this washing and subsequent drying.




Q: Do you recommend any special preparation for the test- eating broader variety of foods - 1-2 days prior the testing?
A: Eating foods a day or two before the test is unlikely to affect the test. Basically, the person should be told to keep the same eating habits before the test.




Q: Can mold mediated Congestive heart failure, with Mito damage be resolved?
A: I suspect that most mold damage can be reversed.




Q: Does the Food Map test meat glue and cooked forms of foods?
A: The allergic reaction is mainly due to the sequence of amino acids in the proteins which does not change with cooking. All food protein, cooked or raw, pass through strong acid in the stomach, and a range of digestive enzymes in the stomach and small intestine. It is likely that these factors are much more important than cooking. Great Plains test checks for meat glue.




Q: Foods are altered by digestion. How do your food antigens you use correspond to what the body is seeing?
A: See question 9.




Q: Will this test help clarify how to address intense sensitivities (that do NOT present clinically as allergies) to multiple foods?
A: IgG food allergies do not (usually) cause histamine reactions like IgE allergies but are associated with a large variety of clinical symptoms such as migraine headaches, irritable bowel, depression, psychosis, seizures, autism, attention deficit, and many others.




Q: How is this compared to a different from Cyrex labs testing?
A: Great Plains test covers milk allergies, is covered by some insurance, and can be done on dry blood spots. Cyrex no.




Q: If IgA deficient individuals have frequent eye infections, is that also the case for patients with frequent upper respiratory and GI infections?
A: IgA deficiency likely increases susceptibility to respiratory and GI infections and greatly increases risk of autoimmune diseases.




Q: What would be the next step or test for someone who clearly has symptoms to a particular food but the IgG Food Map is negative or low?
A: Try an elimination of that food and see if symptoms clear up.




Q: Is this food allergy test effected by cans food it packaged in (BPA can linings ) and / or plastic containers?
A: The test only measures reactions to proteins in the food, not additives.




Q: Do you think that A2 milk would be better tolerated by these patients with Autism?
A: Yes.




Q: Do you find that patient's IgG Food Sensitivity panels show elevations of foods they eat often?
A: For the food test to be positive, the person must eat the food often and have an allergic reaction to it. I eat hamburgers almost every other day but do not have an IgG beef allergy.




Q: Does the food sensitivity testing include any dietary guidelines for patients such as hidden sources of the foods and a rotation plan?
A: Great Plains includes a rotation plan with the test. I am not a big fan of rotation diets. I think you should completely eliminate any food that is strongly positive.




Q: Do you have any data on how sensitivities change with a GAPS diet?
A: The GAPS diet will not change food allergies any differently than any other elimination diet.




Q: How long do you recommend someone avoid gluten in an elimination challenge?
A: I think that gluten is such a common element of most diets that most people are not going to adhere to an elimination diet for at least one month. The food allergy test is much more convenient and gives information on all foods, not just gluten.




Q: How do you decide when to rerun the IgG test? how often is it different?
A: See question 2.




Q: Will IgG show in the blood spot if food has been eliminated for an extended period of time (months or years)?
A: No.




Q: What is the clinical usefulness of the IgG C. albicans result as part of the IgG Food MAP?
A: Candida is a common exposure and carbohydrate control is necessary to control Candida which makes it useful when selecting diets.




Q: Do you recommend three days on and three days off or something like that for moderate reaction to food IgG?
A: Each patient will likely have to determine themselves the degree of improvement in an elimination diet and whether the food restriction merits the restriction.




Q: Do you see a reduction in IgG response on repeat IgG food test after decrease in Toxin load in general (removing mycotoxins, metals, etc.)?
A: I have not evaluated such experiments.


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:

  1. Ability to purchase GPL tests discussed throughout the program at special workshop-only discounted rates.

  2. 60-day access to the full conference recordings.

  3. Permanent PDF access to each speaker’s slides.

  4. The option to purchase continuing education credits (5 credits per day), whether you attend in-person, watch Live Online, or watch the conference recordings at a later date! See detailed information about credits.

  5. An interactive Workshop Hub website where you can live chat and network with attendees and ask questions to the speakers.

  6. And last, but most certainly not least, qualified practitioners will receive a free OAT.

Webinar Q+A: The Toxicity of Trichothecenes - Insights Into This Unique Group of Mycotoxins

On February 16, 2022, The Great Plains Laboratory hosted The Toxicity of Trichothecenes - Insights Into This Unique Group of Mycotoxins webinar with Kurt Woeller, DO. Mycotoxins are toxic compounds produced by many different types of molds. A certain group of mycotoxins called trichothecenes are a large group of chemically related compounds produced by such molds as Fusarium and Stachybotrys. Trichothecenes have some unique toxicity effects, including on cellular production of proteins, DNA synthesis, and more. This lecture explored various mycotoxins within the trichothecene family and some of their related cytotoxicities.

The following Q+A is a grouping of responses from Dr. Woeller’s presentation.


Webinar Attendee Q+A

Q: Is it true that ammonia is an electron donor that degrades the integrity of the epoxide ring?

A: Amines are derived from ammonia and amines can act as nucleophile which attack the epoxide ring - 

 

Q: Dr. Ritchie Shoemaker has deemphasized mycotoxins as a cause of CIRS, saying they are less than 7% of gene activations. He has substituted endotoxins and actinomycetes. Many of his practitioners are saying this doesn't matter, because the structure of these toxins is "all the same.” This has caused them to discount Stachybotrys. Can you address Dr. Shoemakers altered position on toxic mold?

A: I have not dived deeply in Dr. Shoemaker’s claims. From my research, various mycotoxins can be significantly problematic for various reasons through their biological functions. A chemical may have a similar chemical structure on paper, but even subtle differences based on changing functional groups, positions of these groups on the molecule which can alter the chemicals orbital configurations, etc. are sometimes enough to change its cellular reactivity. 

 

Q: Do the same things occur in the body when these are inhaled vs being absorbed in the GI or skin? 

A: Yes, from my research and understanding. Now, there certainly could be some differences in specific cellular responses within the gut versus the skin, but when these toxins find their way into the lymphatic system, and eventually the bloodstream their distribution throughout the body to other organ systems should be the same.

 

Q: Which probiotics are low in histamine? 

A: Here is the link from presentation. This article is a good place to start your research.

 

Q: I am curious of your thoughts on the carnivore diet for patients?

A: I have not looked into this.

 

Q: What does PQQ mean?

A: Pyrroloquinoline Quinone – stimulates mitogenesis


The material contained within this article and webinar 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 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, DO

FOUNDER OF INTEGRATIVE MEDICINE ACADEMY
Kurt N. Woeller, DO, 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.

Is the Honolulu water contamination crisis affecting your health?

Are you or someone you know suffering from petroleum poisoning in Oahu?

In December 2021, the Navy announced that the Red Hill Well on Oahu had been contaminated by a petroleum leak. The contaminated water has made its way into homes and businesses, poisoning some residents. 

One resident described a rash and burning skin that set in after washing her face, while her daughter suffered prolonged uncontrollable muscle spasms.

Petroleum poisoning is often caused by additives to the fuel, specifically methyl tertiary-butyl ether (MTBE) and ethyl tertiary butyl ether (ETBE). These metabolites are volatile and may cause hepatic, kidney, and central nervous system toxicity resulting in uncontrollable muscle spasms, twitches, nausea, vomiting, swelling, rashes, lightheadedness, dizziness, and more. Fortunately, these symptoms are reversible when the underlying cause is properly diagnosed and treated.

The Great Plains Laboratory specifically tests for MTBE and ETBE in our GPL-TOX Profile diagnostic test through a simple urine sample provided by the patient.

If you suspect that you or someone you know may be suffering from MTBE and ETBE poisoning, or if you are a practitioner who wants to learn more about how to diagnose for exposure to these metabolites in your patients, please contact us immediately via email or call toll free at 800-288-0383.

If you are interested in learning more about the GPL-TOX Profile and how to order the test for you and your patients, please contact us at your earliest convenience.

Indicators of Detox: 2-Hydroxybutyric Acid

On the Organic Acids Test, the indicators of detoxification section is a beneficial section to understand. In an earlier blog, the mysteries of pyroglutamic acid were demystified. This post aims to explain the importance of marker 59, 2 hydroxybutyric acid (2HB). This marker is marked with two asterisks to denote its connection to methylation and toxic burden. These two facts make this marker one to keep an eye on. Be sure on every OAT you are checking this marker to be sure it isn't elevated. 

When elevated, 2HB tells us a major fact. We learn that homocysteine, an amino acid used to make other needed compounds in our body, is being broken down at a high level (4). The 2 molecules made from homocysteine are methionine and cysteine (3). Methionine is made via the conversion of homocysteine via methylation dependent reactions.  When methylation is impaired homocysteine is unable to be converted to methionine. This leads to a buildup of homocysteine in the bloodstream. On serum testing, elevations of this amino acid are concerning due to the health implications. High homocysteine is inflammatory and increases the risk of developing cardiovascular disease (3), cognitive decline and dementia (11), high blood pressure, stroke, rectal cancer diagnosis and progression (5), and bone disease (1). 

On the other hand, homocysteine is broken down to create cysteine. This pathway is called the CBS pathway. It gets its name as the enzyme cystathionine beta-synthase is produced. This enzyme joins serine and homocysteine into cystathionine and then it is cleaved to produce alpha ketobutyrate (14). In the production of alpha ketobutyrate, cysteine is formed and 2HB is produced. When up regulated, the CBS pathway causes an increased urinary excretion of 2HB, and it is measured on the OAT (6). This path is upregulated in times of decreased methylation capability, a need for increased glutathione production, and for ATP production. In cases of methylation complications, rising homocysteine causes inflammation which can be detrimental to one's health. The body then upregulates CBS. In times of toxic burden, the need for increased glutathione circulation for detoxification upregulates CBS to increase cysteine production. This is one of the main ingredients for glutathione production and when produced it is then fed into the glutathione production cycle. In times of ATP production, the alpha ketobutyrate produced is shunted to produce an increased amount of propionyl-CoA (6). This is a precursor to succinyl-CoA, which is a major constituent in the TCA or Krebs cycle. Cysteine is also a precursor to taurine (7). This amino acid is needed for bile acid production for fat absorption and cholesterol regulation (7, 8). Homocysteine is a major biological hub used for all of these processes. The 2HB marker on the OAT gives us insight into when it's being utilized at high rates. 

In other cases, 2HB can be elevated for other reasons. This compound has been researched recently as it relates to blood sugar regulation and insulin production. Its elevation has been linked to the impairment of beta cell function along with increased free fatty acids in circulation (12). These two factors are hallmarks of insulin resistance. During insulin resistance, from increased glucose, more glucose flows through glycolysis to make pyruvate and acetyl CoA which causes an increased production of NADH. This increased supply leads to increased pressure on the electron transport chain (ETC) and thus increased oxidative stress since NAD+ is not supplied (12). When an excess of stress in the mitochondria from increased reactive oxygen species (ROS) becomes too much, glutathione (GSH) comes in to mitigate the stress. This constant stress eventually depletes GSH as it cannot regenerate fast enough to meet the demand (12). The body then upregulates the CBS pathway and breaks down homocysteine. 2HB then builds up and spills into the urine. To combat the insulin resistance, lipid oxidation is upregulated which causes and there is an increase of FFAs to be oxidized by the TCA. This heavily increases even more NADH and oxidative stress. This excess leads to a buildup of the amino acids threonine and methionine, which alpha keto butyrate comes from, and it is then metabolized into 2HB (12, 10). Due to these facts, 2HB is being researched as a new biomarker for type 2 diabetes. It is still not widely accepted as a biomarker as it can be elevated in lactic acidosis and diabetic ketoacidosis. Regarding lactic acidosis, there is an upregulation of lactate dehydrogenase activity (LDH) (13). This enzyme breaks down 2 oxobutyrate, a normal intermediate in the metabolism of amino acids where alpha ketobutyrate is also formed and then converted to 2HB (9). LDH is increased in many disease states when cells are damaged or destroyed (15). An increase in the NADH/NAD+ ratio leads to oxidative damage that can increase LDH activity leading to increased lactic acid and 2HB (12). 

When you see this marker elevated, what do you do next? In most cases, the next best step is to check a serum homocysteine level. When elevated disruptions in methylation ability or genetic SNPs in the CBS pathway should be explored (2). Consider DNA Methylation testing with GPL. If the value is lowered, there is a need to explore the possibility of toxic exposure since the CBS pathway is upregulated. In cases of elevated 2HB and increased ketones or lactic acid (markers 43/44 and 22 on the OAT), also consider further testing regarding blood sugar regulation. At the very least, with this marker elevated, we know there is oxidative damage. Antioxidant support can be added to mitigate the stress as we explore all the possibilities of why it is elevated.

This marker is valuable in opening many doors of exploration of underlying disease states. 2HB should not be overlooked when analyzing the OAT. When elevated, be sure to explore the possibilities mentioned above. Hopefully future research will open more doors to the usefulness of this marker in the management and treatment of various disease states. 

 

 

 

References
  1. 1.1.	Behera, J., Bala, J., Nuru, M., Tyagi, S. C., & Tyagi, N. (2017, October). Homocysteine as a pathological biomarker for Bone Disease. Journal of cellular physiology. Retrieved January 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576446/#:~:text=Increased%20homocysteine%20levels%20also%20induces,osteoporosis%20by%20reducing%20bone%20formation.
    
  2. Finkelstein, J. D. (1998). The metabolism of homocysteine: Pathways and regulation. European Journal of Pediatrics, 157(S2). https://doi.org/10.1007/pl00014300
    
  3. High homocysteine. Linus Pauling Institute. (2018, January 17). Retrieved January 21, 2022, from https://lpi.oregonstate.edu/mic/health-disease/high-homocysteine
    
  4. Homocysteine: Levels, tests, high homocysteine levels. Cleveland Clinic. (n.d.). Retrieved January 21, 2022, from https://my.clevelandclinic.org/health/articles/21527-homocysteine
    
  5. Liu, Z., Cui, C., Wang, X., Fernandez-Escobar, A., Wu, Q., Xu, K., Mao, J., Jin, M., & Wang, K. (2018, March 27). Plasma levels of homocysteine and the occurrence and progression of rectal cancer. Medical science monitor : international medical journal of experimental and clinical research. Retrieved January 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883868/
    
  6. Miyazaki, T., Honda, A., Ikegami, T., Iwamoto, J., Monma, T., Hirayama, T., Saito, Y., Yamashita, K., & Matsuzaki, Y. (2015). Simultaneous quantification of salivary 3-hydroxybutyrate, 3-hydroxyisobutyrate, 3-hydroxy-3-methylbutyrate, and 2-hydroxybutyrate as possible markers of amino acid and fatty acid catabolic pathways by LC–ESI–MS/MS. SpringerPlus, 4(1). https://doi.org/10.1186/s40064-015-1304-0
    
  7. Moss, M., & Waring, R. H. (2009, July). The Plasma Cysteine/Sulphate Ratio: A Possible Clinical Biomarker. Research Gate. Retrieved January 24, 2022, from https://www.researchgate.net/publication/232041262_The_Plasma_CysteineSulphate_Ratio_A_Possible_Clinical_Biomarker 
    
  8. Murakami S;Fujita M;Nakamura M;Sakono M;Nishizono S;Sato M;Imaizumi K;Mori M;Fukuda N; (n.d.). Taurine ameliorates cholesterol metabolism by stimulating bile acid production in high-cholesterol-fed rats. Clinical and experimental pharmacology & physiology. Retrieved January 21, 2022, from https://pubmed.ncbi.nlm.nih.gov/26710098/
    
  9. Pettersen, J. E., Landaas, S., & Eldjarn, L. (2003, January 22). The occurrence of 2-hydroxybutyric acid in urine from patients with lactic acidosis. Clinica Chimica Acta. Retrieved January 21, 2022, from https://www.sciencedirect.com/science/article/abs/pii/0009898173903677
    
  10. Showing metabocard for 2-hydroxybutyric acid (HMDB0000008). Human Metabolome Database: Showing metabocard for 2-Hydroxybutyric acid (HMDB0000008). (n.d.). Retrieved January 21, 2022, from https://hmdb.ca/metabolites/HMDB0000008
    
  11. Smith, A. D., Refsum, H., Bottiglieri, T., Fenech, M., Hooshmand, B., McCaddon, A., Miller, J. W., Rosenberg, I. H., & Obeid, R. (2018). Homocysteine and dementia: An international consensus statement. Journal of Alzheimer's disease : JAD. Retrieved January 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836397/
    
  12. Sousa, A. P., Cunha, D. M., Franco, C., Teixeira, C., Gojon, F., Baylina, P., & Fernandes, R. (2021, December 3). Which role plays 2-hydroxybutyric acid on insulin resistance? MDPI. Retrieved January 21, 2022, from https://www.mdpi.com/2218-1989/11/12/835/htm
    
  13. Stojanovic, V., & Ihle, S. (2011, April). Role of beta-hydroxybutyric acid in diabetic ketoacidosis: A Review. The Canadian veterinary journal = La revue veterinaire canadienne. Retrieved January 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058661/
    
  14. U.S. National Library of Medicine. (2020, August 18). CBS gene: Medlineplus Genetics. MedlinePlus. Retrieved January 21, 2022, from https://medlineplus.gov/genetics/gene/cbs/#conditions
    
  15. WebMD. (n.d.). Lactic acid dehydrogenase (LDH) test: Purpose, procedure, risks, results. WebMD. Retrieved January 21, 2022, from https://www.webmd.com/a-to-z-guides/lactic-acid-dehydrogenase-test 


Jasmyne Brown, ND

Jasmyne Brown is a board certified and licensed naturopathic doctor. She earned her Bachelor of Science in chemistry with a minor in biology from Alabama Agricultural and Mechanical University in 2013. Then she earned her Doctor of Naturopathic Medicine and Master of Human Nutrition degrees from the University of Bridgeport College of Naturopathic Medicine in 2017. Her professional training allows her to be able to interpret the GPL lab tests in a clinical manner, plus she enjoys identifying the biochemical pathways within our bodies and how nutrition and lifestyle impact them. Her educational background and her experience as a WIC nutritionist with the Florida Pasco County Department of Health allows her to convey complex concepts in a manner that can be grasped by anyone on multiple levels.

IgG Food Allergy and Mycotoxin Testing with William Shaw, PhD

On November 12-14, 2021, GPL Academy hosted the Environmental Toxin Summit in San Diego, CA as well as streamed online simultaneously. This three-day event focused on the epidemics of toxin exposure, including both toxic chemicals in our environment and mycotoxins from mold. These toxins can cause symptoms of many acute and chronic health disorders. Those who attended the summit learned how to use effective diagnostic and treatment protocols for their patients with toxin exposure and get them on the road to recovery.

The following Q+A is a grouping of responses from Dr. Shaw’s 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.


William Shaw, PhD

LAB DIRECTOR AT THE GREAT PLAINS LABORATORY, LLC
William Shaw, PhD, is board certified in the fields of clinical chemistry and toxicology by the American Board of Clinical Chemistry. Before he founded The Great Plains Laboratory, LLC, Dr. Shaw worked for the Centers for Disease Control and Prevention (CDC), Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, and Smith Kline Laboratories. He is the author of Biological Treatments for Autism and PDD, originally published in 1998 and Autism: Beyond the Basics, published in 2009. He is also a frequent speaker at conferences worldwide.

IgG Food Allergy Testing: Scientific Evidence
of its Validity in Chronic Illness

Q: How do you interpret this test in those with total serum IgG4? No value in running it?

A: The IgG Food MAP evaluates IgG1-4, not just IgG4, and is therefore going to provide more detailed information. Exclusively running IgG4 is not ideal since it has a lower (~6%) representation of the IgGs overall, and it has a reduced ability to induce complement and cell activation.

Q: Do you happen to know if there is a difference in raw milk versus conventional milk in the IgG testing?

A: The IgG test is utilizing the protein from dairy milk, but does not differentiate between raw milk and pasteurized milk.

Q: Regarding food allergies- I have been taught that in patients with leaky gut, then of course their "usual" foods will show as allergens because that's what's in there and are the proteins that leak into the blood the most. So, is it elimination diet that's the most helpful or healing the gut lining? Or a combination of both?

A: Depends on the cause of the leaky gut. In general, reducing the inflammatory foods while the cause is being identified/treated is useful. This can be done by the elimination diet, but the elimination diet can be very restrictive in nature and cumbersome for a lot of patients. The IgG Food Allergy is a short cut to identifying the foods that are causing inflammation without having to remove unnecessary foods, making it easier for the patient.

Q: How does fasting affect IGG?

A: IgG’s are the immunoglobins with the longest half-life (~33 days), and therefore a fasted state should not influence the results.

Q: Cyrex labs say their food allergy testing evaluates cooked and raw food as we don't eat everything raw, and we eat some in cooked form. Does Great Plains also factor this in their tests? Is the difference in type important?

A: GPL evaluates various forms of the proteins in the foods (e.g. Cows’ and goats’ milk, casein, whey, beta-lactoglobulin, sheep’s yogurt, yogurt, mozzarella and cheddar cheese) to account for the changes in epitopes, which can occur during food processing. Remember that any protein, cooked or raw, undergoes exposure to concentrated acid and the enzyme pepsin in the stomach and then extensive exposure to other digestive enzymes in the small intestine. These alterations are much more profound than whether a protein is cooked or raw. Cooking does not change the amino acid sequence of a food while acid and digestive enzymes cause pronounced changes in amino acid sequences of food.

Q: How effective is the IgG Food map on a patient being treated with Humira? And on Xolair?

A: The IgG response of those individuals on the immune modulators may not be favorable for this testing. Humira targets and blocks TNF-alpha, which could potentially reduce the IgG response. Xolair may also because though it inhibits the binding of IgE, it also influences FcεRI receptors on basophils, potentially reducing the IgG’s reactivity.

Register now for our upcoming events and workshops.


Organic Acids and Mycotoxins: Correlations
With Mold in Various Chronic Illnesses

Q: What would you do with pregnant women with mycotoxins? Would you detox them or wait until pregnancy is over?

A: I would advise the woman to move out of the contaminated space immediately. I wouldn’t advise active detox while pregnant as you may increase transference to the fetus.

Q: If glutathione is the issue with provocation, are there other products that may increase the probability of an accurate test? Heat, NAC, use of binders etc. These are so tissue bound I have seen negative tests become extremely positive 3 months later with the use of recommended detox.

A: The test was developed without use of any provocation methods. If you choose to do anything a warm bath/shower or sauna the night before may encourage more toxin into the urine.

Q: For a patient with chronic and relapsing cocci infection for years, would you have a high suspicion of mycotoxicity? Would daily use of itraconazole for over a year affect urine MycoTOX test?

A: It may be in the differential for things to consider. Itraconazole can reduce toxins on the MycoTOX Profile if the mold exposure is eliminated. I would suspect that most mycotoxins would be negative or low after a year of itraconazole if the source of mold in the house has been eliminated.

Q: Do you have a mold treatment protocol vs Shoemaker protocol?

A: Check out New Beginnings Nutritionals’ mold protocol.

Q: I've seen patients with histamine intolerance and mold colonization have reactions when taking binders, particularly GI Detox or another combination binder. Is this something you've experienced? What would be a good binder or something else to consider first for these sensitive individuals?

A: This is common. Slower administration of binders or use of single agents before a combo product is a strategy to consider. For very sensitive patients allow for reduction in aggravation before addition of next dose, even if that means waiting a few days for the client to feel able to handle another dose.

Q: What testing can be done to determine Mycotoxins in the sinuses? What is the best way to remove Mycotoxins from the sinuses? Is there going to be information about treating sinuses directly in conjunction with the other treatments? Do you have any pearls? What is an example of a nasal anti-fungal inhaler- product and dosage and duration?

A: Urine mycotoxin testing looks at mycotoxins that circulate in the blood stream (all over the body, including the sinus). If you want to know about mold growth in the sinus look at nasal symptoms or consider a nasal swab and culture. For removing mycotoxins you use detox factors like binders and glutathione. For mold removal direct nasal sprays are recommended. Prescription and natural options are available. Consider nasal GSE

Q: Does nano zeolite clinoptilote just bind metals or can it be used with mycotoxins?

A: It can bind to mycotoxins

Q: Can you please give us doses of Binder for infants and children?

A: Dose depends on the binder. Low and slow is always a good strategy. It should not be given more than once a day.

Q: Does a mold colonization on the OAT test need to be treated if the MycoTOX Profile is within reference range?

A: Yes. A colonization can still produce mycotoxins at a low, consistent level. Mold itself has harmful effects, like those of yeast.

Q: Do mold infestations in GI tract produce biofilm? If so, are antifungals always successful in breaking down the biofilm barrier?

A: Biofilms can be produced. Herbal antifungals usually have biofilm disruption properties. Prescriptions may not have this capability. Antifungal with biofilm disruption properties can be successful. Always, is a loaded word and I cannot guarantee it will always be effective.

Q: What is the best anti-fungal treatment regimen for candida?

A: Common antimicrobial herbs can be used to treat candida like garlic, ginger, berberine, etc. there is no one size fits all. Nystatin or Diflucan are also options.

Q: I have a patient with high fungal markers on OAT, but his mycotoxins had only a slight elevation in ochratoxin. Please advise.

A: A colonization can still produce mycotoxins at a low, consistent level. Mold itself has harmful effects, like those of yeast. The person is most likely not currently exposed to water damage.

Q: How many days prior to taking the OAT test should we be fasting from medications or supplements that could mask correct OAT results?

A: You only need to fast from the listed foods/supplements. Others can be discontinued if you would like for your own interpretation purposes. A good time frame is 1 week if this is possible for the patient.

Q: Please comment on treatment for Chaetoglobosin A, particularly when both the house and the office where the patient lives were found negative?

A: Treatment for this toxin is like others. You would need to remove the source and detox the toxins. Binders like charcoal bind all mycotoxins at some level and can be effective for this toxin too. Consider a combo binder product. I suspect that the house and office mold testing are likely giving false negative results.

Q: What botanicals do you use to treat SIBo?

A: Common antimicrobial herbs can be used to treat SIBO like garlic, ginger, berberine, etc.

Q: The notes indicate that oxalates are produced by molds like aspergillus and penicillium. Does Chaetoglobosin A also produce oxalates?

A: Chaetoglobosin A is a toxin therefore doesn’t produce anything. Chaetomium mold, which produces chaetoglobosin a, hasn’t yet been shown to produce oxalates.

Register now for our upcoming events and workshops.


Non-Metal Toxic Chemicals and Their Effects
on Health: Glyphosate and Beyond

Q: Do any of the GPL-Tox values extrapolate polyethylene glycol or polysorbate? Will it be added?

A: Both Polyethylene glycol (PEG) and polysorbate utilize ethylene oxide in the manufacturing process, which is measured on the GPL-Tox Profile; marker number 9.

Q: It was mentioned pine wood is not ideal for a sauna <link sauna to https://www.greatplainslaboratory.com/gpl-blog-source/2016/12/12/how-to-maximize-the-benefits-of-sauna-for-detoxification?rq=sauna>, but a lot of saunas are made with pine wood. Does pine wood inhibit the effects of detoxification? Can you explain further?

A: The resin that pine contains has certain alkaloids, and other nitrogen containing organic compounds, that can be toxic when released with excessive heat.

Q: Can lower toxin levels be significant in those with neurologic compromise? Immune suppression? mycotoxin load etc.?

A: Statistically speaking, above the 95th percentile is the most significant. There are always the outliers who are extremely chemically sensitive, or have multiple comorbidities to which they have overfilled their bucket so to speak, who will react to lower values.

Q: Have you seen any increase in toxins with kids using slime, which uses glue as a base?

A: Not directly.

Q: Can you comment on brevatoxins and red tide? Testing treatment binder types?

A: We are not currently measuring these toxins, but plan to add them in the future. However, the general detoxification method utilized for the other environmental toxins would likely help with the elimination of these toxins, theoretically.

Q: What is your recommendation to detox from glyphosate in addition to removing the source? There are multiple protocols out there. Do you have a favorite?

A: The most important detox method is to switch to organic foods. This step is 10 times more important than other detox methods although Chlorella, sauna, and humic and fulvic acids, have also been recommended.

Q: Does Sauna and liposomal glutathione eliminate glyphosate?"

A: Sauna may help but I know of no evidence that glutathione is effective. Switching to an organic diet is the single most important therapy.

Q: What's best type of sauna (Infrared, near-infrared or far-infrared)? Would you suggest a particular brand for in-home use?

A: IR is the preferred due to its ability to increase the internal temperature without excessive heat. It is generally a good option for patients who are heat sensitive.

Sunlighten has a very good reputation.

Q: Are hyperbaric chambers any help in removing molds and toxic chemicals?

A: Hyperbaric chambers can be helpful in the elimination of the mycotoxins and toxic chemicals by increasing oxidative detox reactions.

Q: Can you explain the difference between NAC and Cysteine and whether Cysteine may be a good substitute if NAC not available?

A: N-Acetylcysteine as compared to L-cysteine (the supplemental form of cysteine derived mainly from swine hair or poultry feathers) has the acetyl group attached to the nitrogen, making it more water soluble, increases the absorption and distribution, as well as reduces the thiol reactivity making it less susceptible to oxidation.

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Functional Medicine Answers with Kurt Woeller, DO

On November 12-14, 2021, GPL Academy hosted the Environmental Toxin Summit in San Diego, CA as well as streamed online simultaneously. This three-day event focused on the epidemics of toxin exposure, including both toxic chemicals in our environment and mycotoxins from mold. These toxins can cause symptoms of many acute and chronic health disorders. Those who attended the summit learned how to use effective diagnostic and treatment protocols for their patients with toxin exposure and get them on the road to recovery.

The following Q+A is a grouping of responses from Dr. Woeller’s 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, DO

FOUNDER OF INTEGRATIVE MEDICINE ACADEMY
Kurt N. Woeller, DO 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, LLC. He is co-founder of Integrative Medicine Academy, which is an online training academy for health practitioners learning integrative medicine.

Q: If you have been supplementing with Lithium orotate 10mg and the hair test comes back HIGH do you back down, stop, or just continue at the same dose? The child has high Glutamate marker on Neurotransmitter test.

A: I would personally back down to the 4.8 mg dose and retest again in 90 days, particularly if there have been some positive changes. If there is no significant change, then I would likely just discontinue the supplement.

Q: Based on various research studies, it has been shown Biocidin can treat primary hyperhidrosis. Would you recommend long-term daily Biocidin dosing or implementation of a cyclic protocol over a shortened period?

A: For this, I would recommend a long-term daily dosing versus cyclical dosing.

Q: Why did you choose Biocidin capsules vs drops?

A: I do not remember the specifics for that particular case. Usually, it comes down to taste sensitivity of a child versus their ability to swallow capsules.

Q: Did you increase the dose slowly?

A: No.

Q: Was there a die-off at full dose?

A: It did not happen in that case, but that is a possibility. Therefore, starting at a lower dose is okay to do if you get the sense die-off could happen.

Q: How did you choose Flagyl dose of 250 mg tid for the 2-year-old?

A: The medications were being handled by another physician since the child lived in another state. It was a higher dose for sure with the child having already been through multiple other treatments up to that point that were unsuccessful.

Q: I am a bit unclear but is it ok to continue Vit C with high oxalates?

A: This is a controversial situation, and it is not clear cut in every situation. There are quite a few studies and reference websites for kidney stone sufferers that describe up to 2000mg daily oral of Vitamin C to be okay. Therefore, in my experience modest dosing of ascorbic acid, e.g., 250mg to 500mg daily has been fine. I have even gone to 2000mg daily and not seen any problems. However, in most situations, I keep the dosing to less than 500mg daily but do not stop it entirely.

Q: What cholesterol triggers your concern as I find iCNS issues with 120 -135? Is it a variable number depending on the severity of the CNS presentation?

A: Yes. I have seen people who have a total cholesterol of 120 (or lower) and seem fine. In others that value is problematic for them.

Q: Can you augment a 165?

A: At this level I would not be supplementing with Sonic Cholesterol.

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Considerations And Protocols For The Complex Patient With James Neuenschwander, MD & Elena Villanueva, DC (Copy)

The Great Plains Laboratory has been educating practitioners for over 15 years on how to help patients heal through cutting-edge testing, research and protocols. In our recent 2-Day OAT+TOX Workshop, speakers focused on the epidemic of environmental toxin exposure, from the many chemicals we encounter every day to mycotoxins released from mold. Attendees learned about many common environmental pollutants from the 173 chemicals tested by the GPL-TOX Profile.

The following Q+A is a grouping of responses from a distinguished pool of speakers who participated in the OAT+TOX Workshop with his own unique topics and lectures as labeled.

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.


James Neuenschwander, MD

A graduate of the University of Michigan with both a Bachelor of Science degree in Molecular and Cellular Biology as well as a MD degree. Dr. Neu (as he is also known) is dually board certified in both Emergency and Integrative Medicine and has been the owner of the Bio Energy Medical Center since its opening in 1988.

Q: What cutoff is ‘Lots” on an ERMI? 

A: I typically start paying attention if the number is over 2; but in my state (Michigan), many houses are over 2. The ERMI score also does not take into account how moldy the house is in general, only the difference between toxin producing mold and non-toxin producing mold. I will use the mold numbers to calculate a HERSMI Score.  If it is over 16, the house is a problem. 12-16 might be a problem if the person is sensitive.

Q: Can mycotoxins cause a progressive pulmonary fibrosis?

A: I think that anything that causes consistent immune activation (like mold toxins) can cause pulmonary fibrosis.

Q: How about triphala? Ayurvedic herb that helps with constipation and detoxifier, antioxidant and more.. 

A: I frequently use Triphala to help with constipation. I don’t use is it as a detoxifier/antioxidant/etc—I think there are better options for that.

Q: Are you familiar with phenomenal AIRE? It produces ions? Is this ozone?

A: It is not ozone, but it incidentally generates ozone from room air. The idea behind an ionizer is to charge particles so they stick to each other and surfaces. The energy needed to create the ions can also create ozone from the oxygen in the air. I am not a fan.

It is said to join particles to bond together known as agglomeration.

Q: What are your thoughts regarding treating mold with thermal fogging with a solution like BioBalance vs. treating with ozone generator? 

A: I think ozonation is probably the most effective way of treating mold after you have removed the obvious contamination (this won’t get mold off of wood joists or rafters because it won’t penetrate the wood deeply enough) with other techniques. This requires that people are out of the building and requires an industrial strength, whole house ozonator.

Q: In a patient with Gilbert’s, what precautions are needed?

A: The issue with Gilbert’s is that they will be more susceptible to certain environmental toxins. Supporting glutathione (NAC, ALA, liposomal glutathione supplements, Setria) can help with glucuronidation (the problem with Gilbert’s).

Q: I also live in Michigan. What water filter do you find works well with our water?

A: Every water system will have different issues. I am on a well. I have completely different issues than someone that is on Detroit City water. I use the Zero Water filter—this is a pour through, multi-stage system that removes almost everything. My biggest problem is iron and bacteria—not any issues with other water supplies. This system will also remove chlorine and fluoride and heavy metals. Most of the time, a combination charcoal/reverse osmosis water filtration system works for most things, but does not remove all the thyroid.

Q: Can you just take ox bile with binders so patients have more time flexibility?  Some must take meds before eating.

A: Yes. You can take them together.

Q: Patients with severe MCS that have such a hard time taking ANY med/supplement...where do you start with mold or mycotoxin treatment? Slow small amounts of binder until tolerating?

A: First, I will start with supportive supplements (like vitamin C) before I start with detox supplements. Then, I will start with a single binder (not a combination) at low dose and work my way up. Many of the symptoms MCS patients have are related to histamine, so I also tend to start with things like luteolin (and quercetin if they are not sensitive to salicylate).

Q: Is Cholestyramine constipating?

A: It is almost always constipating. I always start something (like magnesium citrate or sodium ascorbate) to help with the constipation.

Q: Do you have any protocols for people to detox from the CV injections and their injuries?

A: I assume you are referring to the COVID vaccines—check out the FLCCC.org website. They have a protocol for long-haul COVID. It works for most vaccine injuries. Above and beyond that, it requires someone familiar with detox from vaccine injuries—that is an entire workshop, not a simple answer.

Q: It’s been shown that DMSA, etc. provoking sends toxins all of the body, into joints, etc. Do you see this?

A: Not really. DMSA will bind metals in tissues. Because it is a sulfur bond, it is not easily reversible. The metal can be displaced by another metal with a higher affinity, so you can have some distribution. I also give DMSA according to the Cutler protocol—every three hours for three days every two weeks. I also make sure that patients have adequate glutathione and that they don’t have intestinal yeast. There is no way to remove metals without some distribution, but that is better (when managed properly) than leaving the metals in the body.

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Elena Villanueva, DC

Elena Villanueva is an internationally recognized health coach and crusader for ending the global mental health crisis and educating the public and other health professionals that mental health conditions are actually ‘brain health’ issues and when the underlying causes are found, the brain health conditions can be reversed.

Q: Do you have a toxic exposure history form that you like?

A: The questions we ask in this area of our intake include the following. We also ask if they have any history of these exposures from their past.

Q: Would you be willing to share your symptom sheet and what you are utilizing for these patients to track symptoms?

A: Thank you for asking! Great question! We offer this and much more for our practitioners who go through our MHH certification program.

Q: What home mold testing do you recommend?

A: Home testing kits are not effective. We recommend our clients find a local mold testing company in their area to come out and test the house for mold. The price, depending on the state can range between $600-$800 for the testing and report.

Q: What do you use to break up the biofilm?

A: There are many different substances that can break up biofilm. The humic/fulvic compounds (like the ones found in the Cellcore product lines are effective at breaking up biofilm.  

Biofilm X and Interphase are also great biofilm busters, as are coffee enemas, and Biocidin also breaks up biofilm. Keep in mind that biofilm, depending on how dense and how much build-up there is, can take as little as 8 weeks to as long as 8 months to fully break up and come out. I am basing this comment on our experience with our clients.

Q: Are you giving biofilm disrupters alongside the binders in your patients that had new molds show up in later tests, or do you think just using binders alone was lowering the load enough to allow the body to break up the biofilm on its own?

A: The protocols we put them on do break up biofilm, so it’s not common that we need to add something extra like Interphase or some added additional biofilm buster.

Q: Is the “chemical toxin” test the GPL-TOX?

A: Yes.

Q: I do see a lot of sick patients that have high B12 lab readings.  What are your thoughts on that?

A: Such a great question! They could be showing high levels of blood serum B12 or urinary metabolite patterns of high B12 for the following reasons:

  1. They are taking B12 currently.

  2. They have specific genetic methylation SNPS (MTRR A66G) that may be ‘mal expressing’ where they are not able to uptake the B12 into the cell … so they may show ‘high’ levels in blood serum or in urine, but are actually cellularly ‘deficient’ - in these cases either a sublingual or transdermal delivery method for methylated B12 is going to be the ideal delivery method for cellular uptake.

Q: Can you comment on when you choose Liposomal Glutathione vs N acetylcysteine for detox?

A: There are definitely varying opinions on this one. We actually use BOTH, glutathione, and NAC. Previously, a few years ago, we were using glutathione and saw marked improvements in homocysteine, CRP, and MCV numbers, which can indicate methylation issues, which can cause inefficiency of phase 1 AND 2  detox pathways, leading to excessive inflammation (of course we also had clients on methyl folate/methyl B12 as well, per their genetics -- to make sure phase 1 and 2 Detox pathways were optimized). In the last year or so we have added NAC as well.

Q: I am interested in what exactly she is using for kidney/liver detox

A: We vary what we use from LVGB by DFH, to SP products, to Cellcore liver gallbladder support. There are many different brands that all work well.

Q: do you add in digestives like bile or HCL etc for support?

A: When we see it’s needed, yes we do.  We definitely do when we are doing specific gut repair (after removing the toxins and confirming with labs) It’s a fine line when we are not wanting to overload the client with supplements. We want them to be able to take the least amount of supplements with the greatest effect. Too many supplements make the clients/patients feel overwhelmed and often they lose compliance.

Q: Please expand on biofilm treatment protocol… list options and when to use in the overall treatment protocol.

A: Discussed biofilm in the above questions.

Q: What is TUDCA and what is inside Para 1;2;3

A: Tudca provides liver/gallbladder support. You can go to HERE to see the labels on the Para’s.

Q: Do you see 3-4 week cough as a herx symptom?

A: I would ask more questions and get a deeper history on this. The client/patient may be having an IgG type of inflammatory reaction to an ingredient in one of the supplements that is causing the cough. Or it could be a recent food they recently started eating. More times than not, a herx is more ‘severe’ symptom wise, than a cough. So definitely ask more questions. You could also do an ‘elimination’ test by having them stop all supplements to see if the cough goes away, and then one at a time every 5 days or so, start adding in one more of the supplements on their list…. and record if sx comes back with one of the supplements.

Q: …But you are putting them on new supplements.  So how do you tell the difference between a reaction and a herx?

A: It’s not as common to have a true ‘reaction’ to food/herb/nutraceutical based protocols. More than likely the sx are because the client is detoxing which can lead to mild sx or more severe ones (herx). If you are suspecting a true reaction, talk to the patient/client to get a history … they usually are already aware of their allergies to certain things. Use your discernment and if needed, take them off all supplements and slowly have them add one in at a time, sometimes micro dosing them with each supplement even. You’ll learn with experience!

Organic Acids, Invasive Candida, Clostridia & More With Kurt Woeller, DO

The Great Plains Laboratory has been educating practitioners for over 15 years on how to help patients heal through cutting-edge testing, research and protocols. In our recent 2-Day OAT+TOX Workshop, speakers focused on the epidemic of environmental toxin exposure, from the many chemicals we encounter every day to mycotoxins released from mold. Attendees learned about many common environmental pollutants from the 173 chemicals tested by the GPL-TOX Profile.

The following Q+A is a grouping of responses from Kurt Woeller, DO, who participated in the OAT+TOX Workshop with his own unique topics and lectures as labeled.

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, DO

Kurt N. Woeller, D.O. has been an integrative and functional medicine physician and a biomedical autism specialist for over two decades. He is an author, lecturer and clinical practitioner offering specialized diagnostic testing and health interventions for individuals with complex medical conditions such as autism, autoimmune conditions, gastrointestinal and neurological disorders.

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Q: Can you see parasite infection on here and can that impact dopamine? Dopamine markers are elevated / too low but no clostridia in ASD child.

A: There is no specific marker absolutely diagnostic for parasites on the OAT. You would need to do stool testing.

Q: Hippuric acid - is this indicative of bacterial infection i.e. parasites?

A: It is indicative of increased normal digestive bacterial activity in the presence of chlorogenic acid found in many foods, e.g. fruits, potatoes, and other vegetables. There is a full list of foods in the interpretation section of the OAT.

Q: If 61 is high but no sweeteners in diet what could be the cause?

A: Often seen with bacterial markers found on page 1 of the OAT. Could also be phenols found naturally in foods.

Q: Is there an issue if ALL amino acid metabolites are low?

A: No. This section of the test is only significant when the values are elevated. This section of the OAT is to evaluate for certain metabolic diseases. Therefore, when the values are low it indicates that there is no evidence of a genetic disease linked to the specific marker.

Q: Ascorbic acid is extremely low in a child on a very high veg whole food diet - what would be the reason?

A: Ascorbic acid is commonly low on the OAT because it is an unstable acid in urine. The main reason the marker is on the OAT is to pick up on high values that might be associated with high oxalic acid.

Q: Do you recommend treating candida, when values are high, even if patient is asymptomatic?

A: Yes. I feel it is still worthwhile to treat.

Q: Does the high vitamin C ascorbic increase oxalate?

A: In some circumstances it might.

Q: Will uracil be elevated in those recently vaccinated?

A: I do not know. This would be a good thing for you to watch for in your practice.

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Q: If a person had pseudomonas aeriginosa and never took antibiotics for it, curing it naturally is there still the possibility of having a biofilm present?

A: Yes. It appears many of these bacteria produce biofilm as a natural part of their existence.

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Q: What is your opinion on the effectiveness of Botanical treatment versus Abx/Antifungal prescription medication?

A: It depends on what you are treating and how severe the condition is. I mostly try and use botanicals and reserve antibiotics for more severe conditions.

Q: I have a patient with 3 oxoglutaric acid which is listed in the intestinal overgrowth panel. He has elevated HPHPA and arabinose also. Is the 3 oxoglutaric different?

A: It gets produced from different types of intestinal yeast. Remember, candida is a type of yeast too, but there are different yeast species.

Q: What is the significance of 3-Oxoglutaric acid?

A: It gets produced from different types of intestinal yeast. Remember, candida is a type of yeast too, but there are different yeast species.

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Q: For fungal markers, do you do a course of binders and if no response prescribe?  What would make you add itraconazole/other antifungal?

A: I will typically add binders for any infections, e.g., candida, mold, bacteria. The use of Itraconazole would be based on the severity of the condition and known exposure to environmental mold. It is not a medication I will typically start with. I have seen good success with digestive mold, e.g., aspergillus, with oral Amphotericin B (from a compounding pharmacy).

Q: Has Dr. Woeller ever worked with people (children especially) with Bardot Biedl Syndrome (BBD)?  Parts of the Schizophrenia case seem similar to traits of this especially with inability to absorb or break down fats and low cholesterol.

A: I have not. In fact, I have never heard of this syndrome before. I will look into it.

Q: The question is about what trips the trigger to make him add the antifungals.

A: I am always going to treat yeast regardless of how high the OAT markers are. As a basic level this would be a botanical like Biocidin and probiotic. However, if I feel the severity of the condition warrants medications, I will use these too such as Nystatin. If I have a autistic child that is extremely yeast reactive such as inappropriate laughter, high self-stimulatory behavior, bloating, excessive flatulence than Nystatin may be needed. However, I have seen botanicals work too. As a general rule, I attempt botanicals first, then go with meds if these do not work.

Q: How do you treat a 2.5 year old with high arabinose, oxalic acid and quinolinic acid, mold exposure (+ penicillium)?

A: First, you need to find out if the mold exposure is causing high mycotoxins. The high oxalic should be addressed with a low oxalate diet and calcium/magnesium with meals, minimally. But, oxalic can often occur from mold exposure, so this needs to be addressed too. High arabinose is linked to invasive candida. Both the mold and candida might be able to be addressed with botanicals and probiotics. Medications are not my first option in most cases. The quinolinic acid can often be helped with niacinamide. This type of scenario is really based on the severity of the condition and what type of child we are supporting. Are they autistic? Do they have self-injurious behavior? How well do they take supplements? All of these questions and more need to be asked and determined before proceeding with any type of treatment program.

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Mycotoxins, Glyphosate, IgG Food Allergy Testing & More With William Shaw, PhD

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The Great Plains Laboratory has been educating practitioners for over 15 years on how to help patients heal through cutting-edge testing, research and protocols. In our recent 2-Day OAT+TOX Workshop, speakers focused on the epidemic of environmental toxin exposure, from the many chemicals we encounter every day to mycotoxins released from mold. Attendees learned about many common environmental pollutants from the 173 chemicals tested by the GPL-TOX Profile.

The following Q+A is a grouping of responses from William Shaw, PhD, who participated in the OAT+TOX Workshop with his own unique topics and lectures as labeled.

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.


William Shaw, PhD

William Shaw, PhD, is board certified in the fields of clinical chemistry and toxicology by the American Board of Clinical Chemistry. Before he founded The Great Plains Laboratory, Inc., Dr. Shaw worked for the Centers for Disease Control and Prevention (CDC), Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, and Smith Kline Laboratories.

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Q: How long should someone be on a binder?

A: Binders should be utilized for the duration of the mold exposure and treatment.

Q: Only antifungal treatments for removing mold from lungs and nasal passages?  I have heard/seen that nebulized GSH and nasal irrigation with specific sprays gets rid of it. Evan Brand discusses alternatives to antifungals as he got rid of his severe mold infection without using them.

A: These can be utilized. It is not guaranteed that these therapies alone will be enough in each case. Antifungals should be considered in each case where needed.

Q: Can you speak to products like XClear vs nasal Glutathione for sinus colonization? Also, oral Amphotericin, …is it more/less/equal in efficacy to oral nystatin for GI mold/yeast? (I know IV it can be really harsh).

A: Both Xlear and nasal Glutathione can work to clear nasal colonization. They also can work well together. Amphotericin can work well for GI mold. It is more beneficial than Nystatin when nasal/respiratory colonization is involved as Nystatin doesn’t get absorbed by the GI tract.

Q: Why would a patient have a Mycophenolic Acid in the high abnormal range (302.17) if he is not taking an immunosuppressant drug and does not have an autoimmune disease? He does think he has a penicillin allergy and hasn’t had penicillin since childhood. How is the high Mycophenolic Acid treated in such a case?

A: Mycophenolic acid will be in the high range if there is a current exposure to penicillium mold in foods and/or a water damage building. Also if there is a high colonization and that mold is producing large amounts of the toxin you can see elevated levels. Typically, if someone is on the immunosuppressant prescription you would see this value closer to the >10,000 range.

Q: What has been used in place of Cholestyramine if the patients are unable to tolerate it?

A: You can try Welchol or charcoal. These have similar binding affinities.

Q: What is the dosage of Cholestyramine for children?

A: The research dose is 240mg/kg/day in 2-3 divided doses. It usually evens out to 8g total per day. LINK

In most cases this is a lot for a child to handle. You can always divide this dose in half to 2g one to two time a day.

Q: Can you discuss how you dose binders like charcoal & clay?

A: These binders should be dosed according to the client’s bowel movements. Most products recommend 2 caps for about 500mg give or take. If someone has normal bowel movements this should be a suitable dose for them. If constipation is an issue, then only use 1 capsule a day and be sure that they are having a regular movement every day they take the binder. If diarrhea is an issue, consider using 2 capsules 2 times a day to slow gastric movement and allow for nutrients to have increased time in the GI tract for enhanced absorption. Be sure they are giving away meals/meds/supplementation. 2 hours on each end is usually suitable. 4-6 hours is ideal to ensure no interaction. Some find it best to give before bed 2 hours after dinner or first thing in the morning and waiting a couple hours to eat breakfast.

Q: So to clarify, you don't recommend any type of provocation before a urine mycotoxin test?  I understood that a completely negative test just meant that there was no provocation.

A: Correct there is no need to provoke our MycoTOX profile. A completely negative test usually means the mycotoxins the person was exposed to were not tested by our assay.

Q: Would a person who has a penicillin allergy by infected be penicillium?

A: A penicillin allergy differs from an overgrowth of Penicillium mold. There is a specific protein from the mold organism that penicillin is made from. This is specific to a penicillin allergy. This differs from a mold exposure. An exposure won’t necessarily make you allergic to penicillin.

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Q: Do you know if general anesthetic gases show up in any of the compounds measured on the GPL-TOX?  Wondering if anesthesia providers measure higher in any of these?

A: If it is administered intravenously, phthalates may be present (Marker number 3.). This chemical is also present in some pharmaceuticals, depending on the compound used.

Q: At what temperature should the sauna be for best treatment? What if patient is unable to tolerate high temps but can tolerate 130 degrees?

A: The main function of utilizing sauna in detoxification is to increase internal body temperature to help liberate toxins from adipose tissue and increase perspiration for a route of elimination. Whatever temperature that happens for the patient should be utilized. It may need to be started slow and progress as tolerated.

Q: Do you include in the testing kits urine bags for infants? Can infants be tested with the EnviroTOX Complete Panel with one sample too?

A: Infants can be tested, and to ensure you receive the urine bags, request them at the time you order the test kit.

Q: Do you recommend traditional or infrared sauna?

A: When the original research was being conducted on this method as a part of detoxification, the original saunas were utilized. Infrared is now the preferred, but traditional will still work.

Q: Sauna at what temp for one hour?

A: What ever the patient can handle that will induce perspiration.

Q: Is an infrared suana effective in detoxing bromopropane?

A: Yes, along with Glutathione or NAC. 

Q: How long should a patient stay in sauna a day?

A: That is dependent on the patient, and what they can tolerate.

Q: Can you repeat the recommendation for IR sauna?  How many times per week?  For how long?

A: 1 hour, daily, for 6 weeks

Q: Where do you find glyphosate on the GPL-TOX report?

A: It is not on the GPL-TOX, it is a separate test

Q: The 40 Year old male with high glyphosate and HVA/VMA ratio was also on a dopamine/norepinephrine reuptake inhibitor. How do you interpret the OAT given this circumstance?

A: Pharmaceuticals acting in the synaptic cleft are not likely to influence urinary metabolites more than daily variability.

Q: Are there significant amount of glyphosate in marijuana? I have several patients using cannabis who presented with dysbiosis.

A: Depending on the source there could be trace levels of it, but not likely sprayed on the plant or flower itself, as it would kill the plant (or a weed in some agricultural communities).

Q: what do you think of Ion Cleanse foot bath detox?

A: Clinicians and patients have reported some benefits from it, but beyond anecdotal evidence, the very limited research does not favor it.

LINK

Q: I have an infrared sauna in my home office and have my cancer patients use it. What is the fear of cross contamination from chemo drugs being excreted in sweat passing to others? We use towels and burn off with 10 minutes of 150degree heat  in between people. hoping that is

A: That will vary greatly depending on the chemo agent used. In general, chemotherapy drugs take 48-72 hours to leave the system, and some can be excreted through sweat. Caution is advised for using sauna treatments with patients actively on chemo agents.

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Q: I've tested a patient wth know history of food allergies. Nothing showed so we did IgE since she has high eosinophil/histamine response. Again, nothing showed. All patients -4 -people I’ve tested showed zero allergens. This has not given me confidence in the testing. Thoughts?

A: There are a multitude of variables that could explain this, so I would recommend taking one or two of these tests, and discussing it with one of our consultants.

Q: How long do should gluten be reintroduced prior to doing the Food IgG test?

A: This depends on the individual’s response, but generally around a week prior to testing should suffice. 

A: Do you have a recommendation to detox from gluten after exposure?

Q: You can add enzymes to help break it down quicker, or a binder to help adsorb it in the gut if an accidental exposure occurred.

Q: IgG4 is used to detect autoimmune pancreatitis. Why do you say it’s not involved in inflammation?

A: IgG1-3 do not exchange heavy and light chains with other antibodies to form specific antibodies, allowing them to create inflammation. Once these immunoglobin antibodies bind to food antigens, they form larger immune complexes, and increase the inflammation. IgG4 antibodies to food antigens show  the presence of antibodies to food, and therefore an immune response, but they will not usually cause inflammation.

Q: Is there a difference between testing dried blood vs whole blood?

A: Mainly in the ease of obtainment of sample. Comparisons of both have been found to be equally valid. LINK

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Genetics & Mycotoxins: Learn From the Experts

The Great Plains Laboratory has been educating practitioners for over 15 years on how to help patients heal through cutting-edge testing, research and protocols. In our recent 3-Day Environmental Toxin Summit, speakers focused on the epidemics of environmental toxins and pathogen exposure after a foundation of the OAT is presented. Speakers reviewed patient cases and present testing and treatment protocols for toxin and mold-induced illnesses.

The following Q+A is a grouping of responses from a distinguished pool of speakers who participated in the Environmental Toxin Summit with their own unique topics

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.


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MARK FILIDEI, DO

The Hidden Threat of Mycotoxins

Dr. Mark Filidei is an Internal Medicine physician who completed training in General Internal Medicine at Brown University. He is the Director of Integrative Medicine for the Amen Clinics. Dr. Filidei is an officially trained member of ILADS and treats Lyme disease and mold illness with both natural and conventional treatments. He specializes in Hormone Replacement Therapy and the treatment of Mental Health disorders.

Q: Do you see these mycotoxins eliminated with binders on follow up? What do you suggest for patients with constipation?

A: Yes. Plenty of fluids, and magnesium powder if needed.

Q: Has the level and/or distribution of mold and mycotoxins in food changed with climate changes and soil depletion?

A: I do not know, but it would not surprise me at all if that was the case.

Q: What is an example of nasal anti-fungals?

A: Nystatin, itraconazole (compounding pharmacy)

Q: Have you seen any good data with foot detox?

A: No. None. I keep asking them to provide some.

Q: Antifungal nasal spray, more info?

A: Comounding pharmacies like hopkinton do this.

Q: What is your rx for high Citrin levels? What are your main concerns about this?

A: Nothing special for that mycotoxin. Same treatment protocols.

Q: Are you treating with antifungals orally?

A: Yes, when indicated.

Q: After you have remediated and taken binders when do you treat with anti fungal?

A: When there is evidence/concern for systemic mold/yeast.

Q: After you remediate and take binders when you treat with antifungals. what is the rtinale for the various medications?

A: Fluconazole has a lot of resistance so not used often, voriconazole has cns penetration if indicated.

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Ben Lynch, ND

Genetics and the Impact of Environmental Exposures

Dr. Ben Lynch is the best-selling author of Dirty Genes and President of Seeking Health, a company that helps educate both the public and health professionals on how to overcome genetic dysfunction. He received his doctorate in naturopathic medicine from Bastyr University. He lives in Seattle, WA with his wife and three sons.

Q: Will StrateGene be available in Canada?

A: StrateGene is available internationally and NY via 23andme and Ancestry raw data. Rules and regulations prevent us from offering the StrateGene DNA Kit internationally and in NY. There are many rules surrounding the export of DNA material.

Q: When it says increased copper, are we talking about the relative levels or absolute?  Zn and Moly possibly generating a relatively different level vs an absolute level of copper that may be higher.

A: I do not remember the specifics. We do have a bibliography which will help identify the specifics.

Q: Do you have a pharmacogenetic list in StrateGene?

A: We do not. Pharmacogenetics requires FDA approval. If any genetic reports offer pharmacogenetics without FDA approval, I would steer clear of it due to potential serious misinformation and bad clinical information.

Q: Which air filter do you recommend?

A: I like Alen Air. And here are other products I use and recommend as well:

Q: How do we get this information/reports?

A: There is a lot of education available on strategene.me which requires a login. Access is provided once a test kit is purchased. You may purchase the genetic test HERE.

Q: Cost-effective genetic testing options?

A: Cost-effective or effective? StrateGene is both if you look at the quality of research behind it, the haplotypes offered, detail of epigenetic information on each gene, and the mapping of how genes work together giving you a more comprehensive approach to treatment – and more accurate.

Q: How do we even get started with researching genes for the most conditions that we see?

A: Rephrasing the question is important.

How do we begin understanding the genetic and epigenetic mechanisms of actions behind various conditions so we can better make strategic treatment plans for our patients? StrateGene will help you do it. We have lots of training available in our Education center. The training is included with your purchase of StrateGene.

Q: Can you give some recommendations to dealing with COMT and MAO along with MTHFR genetic deficiencies?

A: In the book, Dirty Genes, I have entire chapters dedicated to each of these genes. I highly recommend picking up that book to give you lots of recommendations, lab testing direction, patient history intake questions, examples and lifestyle, diet, environment and supplement recommendations.

StrateGene also provides this information along with your patient’s specific genetic findings for these genes – including the COMT haplotype which is more clinically relevant than just looking at COMT SNPs alone.

Q: Disulfiram is working against borrelia very well but blocks many Cyp40-enzymes. Any recommendations?

A: Depends on the specific CYP450 enzyme. Anytime supporting Phase 1 detox like CYP450’s, one must be sure to also support Phase 2 and 3 otherwise significant side effects will be created. Sauna is also highly recommended here as that’s fantastic Phase 3 basically.

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Bob Miller, CTN

IL-6, The Good, the Bad and the Ugly

Bob Miller is a Traditional Naturopath specializing in the field of genetic-specific nutrition. He earned his traditional naturopathic degree from Trinity School of Natural Health and is board certified through the ANMA. In 1993, he opened the Tree of Life practice and he has served as a traditional naturopath for 27 years. For the past several years, he has been engaged exclusively with functional nutritional genetic variants and related research, specializing in nutritional support for those with chronic Lyme disease.

Q: How many different protein-coding genes and how many SNP's are tested in the YGR saliva test?

A: 220,000 SNPS.

Q: Can you talk about how Estriol increases IL-6 production?

A: I don’t know the exact mechanism, but if you search for IL-6 and Estriol, the literature will be there.

Q: I am looking into Hyperoxaluria Type 1,2,3. My sons OAT revealed all three markers Oxalic, Glyceric, Glucolic are high. Looks like this test will help clarify the genetic variations, correct?

A: Yes, it looks at several enzymes related to the inability to degrade oxalates.

Q: Is there a particular Gene that causes increased seizures or inability to take or utilize N-Aceytl-Carnitine?

A: Seizure are very complex, and likely not one mutation, but I have observed higher seizure activity when there are NQO1 mutations.

SLC22A5 is the carnitine transporter. Mutations here may make carnitine transportation more difficult.

Q: So for MCAS patients, anxiety and COMT variants, quercetin can worsen anxiety?

A: Yes, as Quercetin may inhibit comment.

I have seen poor response to quercetin.  Interesting - I just looked this patient up and there are many COMT mutations.  Thanks.

Glad that was helpful.

Q: Can you please go over oxidized glutathione inhibiting sulfation. When you take liposomal GSH, what form are you getting?

A: Liposomal to the best of my knowledge, is reduced. I am not aware of the mechanism, but oxidized glutathione inhibits the SULT enzyme, which is responsible for sulfation.

Q: Do the ATG13 mutations up or downregulate?

A: We have not seen any literature on this yet.

Q: This patient's family ages very slowly and has multiple homogenous mutations ATG13 - so would that indicate upregulation?

A: It’s really hard to know, as there are so many variables that could impact aging.

Q: Diamine Oxidase /DAO is another alias for ABP1 gene. Its approved name is AOC1: Amine Oxidase Copper Containing 1.

A: Unfortunately DAO is also an alias for D-Amino Acid Oxidase…which indeed does not break down histamine. It is a perfect storm of bad naming convention.

Yes, it is and confused often.

Q: Sometimes I see that giving Magnolia actually aggravates a person's sleep or doesn't help at all or stops working after a while.  Is there a pathway that would explain this?

A: I’ve seen this on rare occasions and don’t know why it happens.

Q: Given how many variants people have, I am concerned they will be needing to take too many supplements and that has its own issues. How can we decrease how many multi-ingredient supplements in our chronically ill patients with lots of pertinent genetic variances?

A: That’s a common problem with no easy answer. A good rule of thumb is to start with decreasing inflammation first.

Q: For mitigation of EMF effects do you need to take a combination of the Magnesium, K2, Resveratrol etc or take one of item listed individually?

A: A combination is best, check out the product EMF Support at www.functionalgenomicnutirtion.com.

Q: Any thoughts on elevated LDL particle number in patients with mold, Lyme, and MCAS? Could elevated IL-6 be an issue mediating elevated Lipids?

A: It’s quite possible, but really can’t say for sure.

Q: Can you say something about IL-18?

A: We have not researched this yet.

Q: Recommended testing for Hyperoxularia 1,2,3?

A: GPL Organic Acids Test.

Q: Can you do blood or urine tests for Il 6 or Il 8?

A: Blood tests, but it is cyclical during the day, and may be high in the tissue and not the blood.

Q: What was the product you referred to regarding GABA?

A: Excito Blox Clarity.

Contact Yvonne at director@tolhealth.com for information on how to order.

Q: Does your software support 23andme?

A: Yes, but the newer V5 has very limited data.


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Elena Villanueva, DC

Mycotoxins: Considerations, Case Studies and Protocols

Elena Villanueva is an internationally recognized health coach and crusader for ending the global mental health crisis and educating the public and other health professionals that mental health conditions are actually ‘brain health’ issues and when the underlying causes are found, the brain health conditions can be reversed.

Q: My problem is what to do with these test results?

A: Yes, this can be confusing if you don’t understand what to do with the results. 

The reason for ordering the mycotoxin and chemical toxins testing is to see if an individual has any of these toxins. These toxins in general all cause central nervous system dysfunction, GI dysfunction, immune system imbalances, inflammation, oxidative stress, kidney, and liver stress. As you research and learn more about the issues these various toxins because you will get a better understanding of why you want to test for these toxins in the first place. 

I would recommend you sign up for the GPL clinician courses and really dig into those to learn and get confident in how to use protocols, what to expect, etc. when working with these clients. 

We also offer a program that teaches our protocols and our approaches like how to identify ALL the underlying causes of disease and health conditions, realistic timeline expectations, frequency of re ordering labs and what to look for on the lab re orders, what protocols we use, how to trouble shoot, etc.

Q: Why do some patients get really constipated with addition of vitamin k?

A: If the patient is having issues with increased constipation with Vit K being added to their supplement regimen, it is most likely they already have dysbiosis to start with and most likely they already had or were borderline constipated before they started. A healthy gut microbiome will have bacteria that will naturally produce vitamin k. 

 It will be a good idea to find out what was going on with their gut, as a baseline, before you started adding the vitamin K…the constipation issues should be transient and supporting the gut motility while you are working with the patient may be necessary  for a short period of time.

Q: What coffee are you using for your coffee enemas? Wilson's is supposed to be mold free, but I question this based on MycoTOX testing.

A: We use Aussie Co which comes not only with a great quality coffee for the enema but also the entire coffee enema kit. Here is the link if you want to check them out.

Q: I notice you continue to say “client” how are you able to order tests across state line? Do you have a license in more than one state?

A: Good question. We have moved from a doctor-patient relationship with our patients over to a coaching relationship with them. We did this about 3 years ago. We now teach and coach our clients to understand and interpret their own labs and to learn how to use protocols to address their own issues. We can order labs because we are licensed practitioners.

We have chosen to educate our clients rather than ‘treat’ patients because we feel the ‘treatment’ approach is outdated and not sustainable. Yes, some of my coaches including myself are licensed in more than one state. Depending on the lab company you use, they have work - arounds for being able to order labs for client’s or patients that are in another state from where you practice… it just depends on your state rules too, and what license you have, and how you are approaching your work… i.e. are you a doctor or a coach? You will want to check with your state and scope of practice to be sure.

Q: The 65-year-old with heavy long periods - did she have endometrial biopsies?

A: I do not recall that client having heavy long periods at 65. I would have to go back and look at that again, but I am pretty sure that was not one of her issues.

Q: Is the tinnitus referred to in patients the ringing or the pulsatile kind? Provided there is no vascular abnormality could mycotoxins cause or contribute to pulsatile tinnitus?

A: This is usually caused by an infection or inflammation of the middle ear or the accumulation of fluid there. Because infection /inflammation could be an underlying cause I would say that yes, mycotoxins or even heavy metals or chemical toxins could be an underlying cause -- because they DO cause inflammation in the body and can allow for co infections to occur as well.

Q: What was the kidney liver support you used?

A: The KL support from Cellcore. There are also others that work quite well like brands from Designs for Health to Standard Process, to Apex…so the exact one I use doesn’t have to be used. Because we see large volume of clients, we streamline our processes and use the Cellcore brand the most for the detox part of our protocols.

Q: What is your favorite biofilm buster - is it Interfase or Interfase plus or the CellCore products?

A: The Interfase and I. Plus are great, and we use those as well, in addition to the cellcore products, especially if we see in their history clues that lead us to believe they may have a lot of biofilm build up. Coffee enemas are also great at busting up biofilm.

Q: Explain Para 1, Para 2, para 3

A: Para 1 is mimosa pudica, which is a gelatenous, sticky type of plant that ‘grabs’ onto biofilm and parasites in the intestines. It is kind of like a ‘sticky tape’ that grabs on to the biofilm and carries out in the stool. 

Para 2 has ingredients in it that are anti-microbial

Para 3 also has ingredients in it that are antimicrobial and it is much stronger than the Para 2. 

You can go onto the Cellcore biosciences website to check out their products. 

I’m also happy to do an intro email to them if you’d like. My email is drv@modernholistichealth.com. If you want to email me I can do an intro email to any of you who are interested. Please do not put me on any email list!

Q: What do you suggest as the most effective way to address patients emotional issues?

A: The most effective way to address their emotional issues is to start with a good history and some baseline labs like the mycotoxin, heavy metals, chemical toxins, and OAT test, as well as an IgG food sensitivity test. These initial tests can reveal if any of these could be triggers affecting one’s mood, emotions, and brain chemistry. If any of these are found to be underlying causes, then these issues need to be addressed - to remove the barriers to healing. 

You will also want to find out if there are any other triggers like trauma, PTSD, or other heightened emotional experiences that have happened in their lifetime, in utero, or even in previous generations as traumas can be passed down in their genes. These can also be barriers to healing. You will also want to find out what their current situation is… i.e., are they in a stressful environment with their job, relationship, etc. These are all underlying causes that cannot be tested for like toxins but are a huge underlying factor in emotional disturbances and mental health issues and these need to be addressed. And they can be addressed very effectively. We teach trauma work in our certification courses if you are interested.

Q: Would a liver cleanse be helpful during the protocol? If so, when?

A: Yes, it would be. Between the dietary changes we make with our clients and the first month of detox we do with them, they get a good liver cleanse in the beginning of their program. The Standard Process 21 Day cleanse or 28 day are both great to detox the liver and reduce inflammation. I have seen huge decreased in liver enzymes with their detoxes in just a month (using before and after blood labs to see the changes). Also, even if you do not do that, the cellcore protocols will also detox the liver as well.

Q: Can you elaborate on Coffee enemas? Why and how?

A: Coffee enemas are great for stimulating the liver to dump glutathione and produce more of it. It gets absorbed through the hepatic portal vein and goes into the liver. It works great for detoxing, breaking up biofilm, and inflammation reduction.

Q: What brand nebulizer do you recommend?

A: There are many brands that work well. So, I don’t stick to a particular one. I will say that I prefer that one use the face mask attachment rather than just the mouthpiece because we want the C. Silver to also get up into the sinuses… btw, this also works great for sinus infections.

Q: Colloidal silver burns in the nose- how do you buffer since it can't be in saline.

A: Which colloidal silver are you using? The Argentyn shouldn’t burn the nose. I have never had anyone say that when they are using the Argentyn. Also, you can add distilled water to the C Silver to dilute it. 

Q: Would nebulized propolis be helpful in the protocol? If so, when?

A: I am not familiar with nebulized propolis.


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Phases of Detox: An Overview

 

By JASMYNE BROWN, ND, MS

In today’s world various exposures to harmful substances, or toxins, is inevitable. With the invention of various chemicals used for processes like agriculture, construction, and other industrial processes, toxic exposures are a part of the average human's daily life. These toxins that are released into the atmosphere are collectively known as the chemosphere. It's an odorless, tasteless, invisible collection that has entangled itself into each breath we take. The comforting news is that the human body was designed with its own systems for detoxification. Our liver, kidneys, urinary and gastrointestinal system work together to expel  unwanted harmful toxicants the body encounters. At the Great Plains Laboratory we offer a wide variety of testing that will identify toxic exposure. We also assess detoxification capability and the metabolic effects of chronic insult to the body. To assess detoxification ability evaluate the OAT. This profile may also give you direct insight into mold overgrowth and indirect insight into further testing of other toxicants such as heavy metals and toxic chemicals. 

 During a toxic exposure and post exposure sequelae, individuals may experience a wide variety of symptoms. Depending on the toxic substance or substances, length of exposure, and level of exposure will determine the type and extremity of symptoms experienced. Common symptoms are fatigue, anxiety, brain fog, depression, chronic pain, skin rash, allergies/sensitivities, immune suppression and dysregulation, among others. When we are exposed to toxins our designed detox systems turn up the volume and work to make them less toxic and able to be cleared. In times of over exposure, like in a source of water contamination or close proximity to a large exposure source, our detox capabilities are outweighed by the toxic load. Understanding this dose dependent design of toxin exposure is key to understanding why we experience sequelae of increased toxic load. Another consequence of this increased load is increased Phase 1 activity. This can overwhelm Phase 2 leading to increased toxic metabolites that haven’t been conjugated. These unconjugated compounds, in some cases, are more toxic than the toxin itself. An overload of these overtime can lead to increased damage. This cellular damage is known as the cell danger response (CDR). Below is a description of the phases of detox that can be supported to relieve symptoms of toxic exposure.

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When it comes to detoxification, we typically start analyzing the process at Phase 1 liver detox. For overall full detoxification, Phase 0 is the true first step. Phase 0 is really your investigation stage. After reviewing the results of an Organic Acids Test, MycoTOX Profile (Mold Exposure), GPL-TOX Profile (Toxic Non-Metal Chemicals), Glyphosate, and Heavy Metals Test, the next step is finding the source or sources of exposure. This step is crucial to full resolution of symptoms. Oftentimes, I find clients and practitioners alike who want to detox without removing the source. This is a wonderful thought and would be amazing if we could do this. Unfortunately, it's almost impossible to out detoxify a current exposure. Most often we do not know the extent of an exposure source and how that is going to affect the client or how quickly the severity will increase. Once you know the toxin or toxins, finding and eliminating the sources of exposure is top priority. Without completion of Phase 0, added detox support will be just that, support. The great thing about finding out someone is toxic is that the severity of symptoms can help dictate how quickly one needs to find and eliminate the sources of exposure. The more severe the symptoms, the higher the priority.

Common sources of exposure are usually found in the home, workplace, or school environment. I often find that individuals are getting mold and mycotoxin exposure from water damaged buildings and cars, with food as a lesser exposure source. With chemicals, pesticides, and heavy metals I find water contamination to be a common exposure source. Testing home, school, and occupational water supplies can pinpoint one or potentially dual exposure. Also, where you live may influence your exposure source. Some individuals live near golf courses, parks, airports, factories, farms, etc that are using chemicals that you then breathe. New construction buildings like homes, workplaces, and even your favorite grocery store’s new renovation project could be off gassing toxic chemicals that affect you. Unfortunately, we cannot dictate what is in our every breath.  The chemosphere is so vast and varied that it’s nearly impossible to know everything you're inhaling. In some cases, moving is the best option. In other cases, waiting until the off-gassing stops is enough to reduce exposure and detoxing and employing the use of air purifiers can reduce toxic load. In any case, eradicating the offending exposure is always necessary for full resolution and detoxification.

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Once toxins have been encountered by the body, Phase 1 is the first physiologic phase of the detoxification process. This phase occurs in the liver as the toxins reach hepatic circulation for detox. The goal of this phase is biotransformation. Biotransformation is the chemical alteration of compounds, including toxins, for enhanced excretion. During Phase 1, there are certain reactions that are utilized. The transformation of the toxins prepares them for Phase 2. There are three main classes of reactions that happen in this phase: oxidation, reduction, and hydroxylation.

Oxidation reactions occur by a loss of electrons through oxygenation, dehydrogenation, and electron transfer. The following are examples of oxidation enzymes used:

  • Alcohol dehydrogenation: aldehyde dehydrogenation

  • Alkyl/acyclic hydroxylation

  • Aromatic hydroxylation

  • Deamination

  • Desulfuration

  • N-dealkylation

  • N-hydroxylation

  • N-oxidation

  • O-dealkylation

  • Sulfoxidation

The reduction enzymes work to add electrons to the compound. In some cases, reduction can actually activate the toxin making it more detrimental to the host. These reactions are:

  • Azo reduction

  • Dehalogenation

  • Disulfide reduction

  • Nitro reduction

  • N-oxide reduction

  • Sulfoxide reduction

The hydrolysis reactions work by cleaving the compound with the addition of water. This process splits the compound and adds an OH group to one part and the other is bound to hydrogen.

Phase 1 enzymes are collectively known as Cytochrome P450 (CYP450) enzymes and encoded by various genes. They are located in the mitochondria and endoplasmic reticulum of the hepatocytes. A common enzyme is the CYP1A family, which is involved in metabolizing procarcinogens, hormones, and pharmaceuticals. Various natural agents can be added to induce or attenuate the activity of these enzymes. Cruciferous vegetables, berries, resveratrol, and quercetin can upregulate this family of enzymes to support Phase 1 detox. Chrysoeriol is a compound in rooibos tea and celery that can be helpful in those with genetic upregulation. This is helpful as these individuals will have more toxic byproducts due to upregulated phase 1 detox even at an expected exposure rate. The CYP2 family metabolizes drugs, xenobiotics, hormones, ketones, and fatty acids. Polymorphisms in these enzymes can lead to poor metabolism of warfarin, metoprolol, phenytoin, or omeprazole for example. Polymorphism in the CYP2D may be associated with Parkinson’s and lung cancer. Inducers of this family are broccoli, quercetin, chicory root, rosemary, and garlic. Significantly high doses of resveratrol green and black tea, and cruciferous vegetables can inhibit these enzymes in those who have upregulation. The CYP3A4 family regulates the metabolism of caffeine, testosterone, progesterone, PAHs and aflatoxin B. This is the enzyme family that's commonly inhibited by grapefruit and also goldenseal. Supplements that induce this enzyme are St. John’s wort, valerian, and ginkgo biloba. The CYP4 enzymes have extrahepatic activity and metabolize MCTs (medium chain triglycerides), as well as the bioactivation of pneumo toxic and carcinogenic compounds. Polymorphism here is associated with bladder cancer and colitis. Not much research has been done on this class of enzymes. CYP4A1 is induced by green tea and CYP4B1 is induced by caffeic acid.

After Phase 1 biotransformation, some toxins have now been biotransformed to a hydrophilic state and can be excreted. Other toxins are then acted upon in Phase 2 for excretion. Due to the dose dependent and time dependent nature of toxin exposure, if exposure rates outweigh the body’s detox capability, some of these Phase 1 biotransformed compounds can build up if not conjugated in Phase 2 in a timely manner. Since Phase 1 can sometimes make toxic more toxic this can be detrimental to human health. This is often when individuals suffer from symptoms prior to Phase 2 supportive therapies. The support of the enzyme function will speed the conversion and eventual clearance of the toxins. 

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After toxins are biotransformed in Phase 1, Phase 2 is the conjugation of the biotransformed substances. These reactions create hydrophilic compounds. This causes the fat-soluble toxins to become water soluble for urinary excretion. Some of the primary reactions used by the liver to conjugate are the following:

  • Glucuronide conjugation

  • Sulfate conjugation

  • Acetylation

  • Amino acid conjugation

  • Methylation

Glucuronidation is the process of adding glucuronic acid to a toxic byproduct to make it water soluble. This is one of the most prevalent in drug metabolism and detox. Saccharomyces boulardii, a probiotic yeast, can reduce bacterial species that produce beta glucuronidase. This enzyme functions to break down the glucuronidation in the gut. This will release the toxic compound and allow for resorption. Utilizing S. boulardii in detox is a great addition. Another supplement choice is calcium D-glucarate. This compound works to enhance glucuronidation by supplying glucarate. Studies have shown that this compound increases blood levels of D-glucaro-1,4-lactone, which suppresses blood and tissue beta-glucuronidase activity. It works to inhibit beta glucuronidase activity in liver, kidney, and intestinal microbiome tissue. In sulfate conjugation, sulfur is used to make the toxins water soluble. Sulfur donors like n-acetyl cysteine (NAC) and sulforaphane from cruciferous sulfur-rich foods will support this process. Acetylation conjugation involves the transfer of an acetyl group from acetyl coenzyme A via N- acetyltransferases. This family of enzymes is supported with choline, vitamin D, vitamin B12, and quercetin.

The next conjugation reaction is amino acid conjugation. This reaction involves the binding of toxic carboxylic acids, bile acids, and xenobiotics to the amino group of amino acids. The most common amino acids used are aspartate and glutamate. Other amino acids used are taurine, glycine, lysine, serine, proline, ornithine, glutamine and valine. A protein rich diet will supply these amino acids. In particular, the pesticide, 2,4-Dichlorophenoxyacetic Acid (2-,4-D) that is measured on the GPL-TOX, is conjugated to aspartate for detoxification. The addition of this amino acid can be helpful in detoxing this pesticide.

Exposure of this pesticide in rats showed a significant increase in aspartate aminotransferase activity. The last two common conjugation reactions are glutathione conjugation and methylation. Glutathione is use by the body to conjugate acetaminophen toxicity and alcohol toxicity most commonly. It is used to metabolize some medications and many toxins. Glutathione production activity can be assessed on the OAT in marker 58, Pyroglutamic Acid. By adding in NAC, the precursor, or glutathione supplementation, this common Phase 2 enzymatic reaction can be readily supported to support detoxification.

Other foods and nutrients will also support the glutathione S-transferase enzymes like garlic, fish oil, black soybean, purple sweet potato, curcumin, green tea, rooibos tea, Honeybush tea, ellagic acid, rosemary, ghee, and genistein. Methylation is a common topic in the recycling of homocysteine. It is also a key in Phase 2 detox. Measuring homocysteine can be used to support dosing of methylation factors to support detoxification. A methyl group is added to toxins to make them water soluble.  The methyltransferases used a methionine group from S-adenosyl-L-methionine (SAMe). The most common methyltransferase enzyme is COMT. This enzyme is highly studied due to its effect on neurotransmitters and estrogen detoxification. Methylation is supported by cofactors and methyl donors like methionine, vitamin B12, vitamin B6, betaine, folate, and magnesium. Food high in protein will provide methionine and legumes, seeds, liver, leaf greens, avocado, asparagus, and certain grains can provide food sources of the other vitamins and nutrients.  Sucrose can inhibit methylation and slow this process. These are processed high sugar foods. The OAT can give insight to how well someone is methylating or not. By supporting all these enzymatic reactions Phase 2 detox will be able to function adequately to fully detox and make toxic compounds hydrophilic for urinary excretion. 

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Once the source of exposure has been identified and detoxification has begun to be supported, supporting the last phase of detoxification is crucial. In my opinion, it is more important to speed up this phase of detox prior to upregulating Phase 1 and 2. Once toxic substances are sent through the liver to be biotransformed and conjugated they must be eliminated. Phase 3 is the elimination stage of detox. Without proper support of elimination, toxins and potentially more toxic biotransformed products will stay in the body longer. The body has two main ways of excretion. The kidneys and urinary tract and through bowel movements are how we eliminate most toxins. By priming these routes of excretion, we can round out treatment. In times of urinary retention or constipation, upregulating the body’s detox capacity would lead to the retention of toxins and potential reabsorption. In times of dehydration or kidney damage the kidneys are unable to adequately filter and release toxins.

In the body, bile is used to help us absorb fat- and fat-soluble substances. Many toxins are fat soluble and get packed in bile and travel to the GI tract. Here 95% bile is normally reabsorbed in the ileum to be recycled and used again in the liver via enterohepatic recirculation. In time of detoxification this recirculation can impede healing as the toxin can be recirculated repeatedly before it's a part of the 5% of bile that gets excreted.  To combat this recirculation phenomenon, binding agents called binders are used. They act like static cling and attract compounds to them. The adsorbent nature of these compounds attracts bile and bind them tightly. This binding ability is great, but it is reversible. Bile can be released from the binding agent if left too long in the GI tract without excretion. In the intestines, there are also intestinal flora enzymes that can hydrolyze some glucuronide and sulfide bonds and cause resorption of toxic compounds.  Due to the binding nature of binding, they can increase the risk of constipation. In previously constipated clients, ensuring adequate bowel movements prior to adding detox factors and binders is an important top priority. By priming Phase 3 detox all the wonderful work done to support Phase 1 and 2 will be easily eliminated.


Overall priming Phases 0-3 of detox are all necessary in any state of healing. These phases work together and were designed to protect and heal our bodies. By supporting each phase individually, their synergistic activity is enhanced. Through testing with GPL you can identify offending toxic load and begin the investigation stage, or Phase 0. Then, look to New Beginnings Nutritionals for support in choosing the best quality supplements for detoxification.


References

1. Crichton, R. (2018, May 25). Zinc – Lewis Acid and Gene Regulator. Biological Inorganic Chemistry (Third Edition). SOURCE
2. Doull, J., & Rozman, K. K. (2000, April 3). Dose and time as variables of toxicity. Toxicology. SOURCE
3. Dwivedi C;Heck WJ;Downie AA;Larroya S;Webb TE; (n.d.). Effect of calcium glucarate on beta-glucuronidase activity and glucarate content of certain vegetables and fruits. Biochemical medicine and metabolic biology. SOURCE
4. Gupta, P. K. (2016, September 2). Biotransformation. Fundamentals of Toxicology. SOURCE
5. Hodges, R. E., & Minich, D. M. (2015). Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. Journal of Nutrition and Metabolism. SOURCE
6. Hundt, M. (2020, October 3). Physiology, Bile Secretion. StatPearls [Internet]. SOURCE
7. Knights, K. M., Sykes, M. J., & Miners, J. O. (2007). Amino acid conjugation: contribution to the metabolism and toxicity of xenobiotic carboxylic acids. Expert Opinion on Drug Metabolism & Toxicology, 3(2), 159–168. SOURCE
8. Macherey, A.-C., & Dansette, P. M. (2003). CHEMICAL MECHANISMS OF TOXICITY: BASIC KNOWLEDGE FOR DESIGNING SAFER DRUGS. The Practice of Medicinal Chemistry, 545–560. SOURCE
9. Mohamed, M.-E., & Frye, R. (2010). Effects of Herbal Supplements on Drug Glucuronidation. Review of Clinical, Animal, andIn VitroStudies. Planta Medica, 77(04), 311–321. SOURCE
10. National Institutes of Health. (n.d.). ToxTutor - Chemical Reactions. U.S. National Library of Medicine. SOURCE
11. Naviaux, R. K. (2019, December 23). Perspective: Cell danger response Biology-The new science that connects environmental health with mitochondria and the rising tide of chronic illness. Mitochondrion. SOURCE
12. Nilsen, O. G., Hellum , B. H., & Hu, Z. (2007, January). The induction of CYP1A2, CYP2D6 and CYP3A4 by six trade herbal products in cultured primary human hepatocytes. Basic & clinical pharmacology & toxicology. SOURCE
13. S;, S. J. L. V. N. K. L. C. C. (n.d.). 1,25-Dihydroxyvitamin D3 treatment results in increased choline acetyltransferase activity in specific brain nuclei. Endocrinology. SOURCE
14. Secretion of Bile and the Role of Bile Acids In Digestion. (n.d.). SOURCE

Indicators of Detoxification: The Assessment of Pyroglutamic Acid

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By JASMYNE BROWN, ND, MS

In assessment of the Organic Acid Test (OAT), a beneficial section is the “Indicators of Detoxification,” The first marker found in this section, marker 58, gives insight into detoxification and glutathione synthesis. As this marker increases, it can guide practitioners to the possibility of toxic exposure being a piece to the client’s clinical picture. In understanding the biochemistry of this marker, further dysfunction may potentially be prevented.

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Marker 58 In this section is a urinary metabolite known as pyroglutamic acid. This is a functional marker of glutathione status.  Though it does not directly look at glutathione status, it measures the activity of the rate limiting enzymatic process in the production of glutathione. Thus, it is assessing the process of antioxidant production, and when upregulated informs us of increased stress on the system. Glutathione, itself, is the major antioxidant produced in abundance in the liver. It is composed of three amino acids: cysteine, glycine, and glutamate. In periods of nutritional deficiency, stress, increased reactive oxygen species (ROS), toxicity, mitochondrial dysfunction, cellular proliferation, Phase 2 detoxification, etc. glutathione stores are depleted, and the production status is upregulated. Prolonged glutathione depletion leads to mitochondrial dysfunction, that can be assessed on the OAT, and is directly supported with glutathione administration.

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In general, the production of glutathione involves a series of enzymatic reactions that combine the three necessary amino acids for its production. On a regular basis the following process is completed to produce daily needed amounts of glutathione:

The process of glutathione production is known as the gamma-glutamyl cycle. In this cycle pyroglutamate, also known as 5-oxoproline, is degraded by the ATP dependent enzyme 5-oxoprolinase into glutamate. Glutamate is then combined with cysteine via the enzyme gamma-glutamyl cysteine synthetase. The next step is the incorporation of glycine via GSH synthetase to make glutathione itself. Glutathione is then transported out of the cytosol for use throughout the body. For the cycle to continue, reduced glutathione is transported back into the cytosol. In order to be transported back into the cell, it must be enzymatically cleaved by gamma glutamyl transpeptidase (GGT- another significant blood biomarker for glutathione status) to break it down into a cysteine-glycine complex and free glutamate. The cysteine-glycine complex is then cleaved further into the respective amino acids then transported into the cell. The glutamate is then transported into the cell as gamma-glu-aa and is transformed into 5-oxoproline via gamma glutamyl cyclotransferase. From here it can then be cleaved into glutamate via 5-oxoprolinase, continuing the cycle. This process is always happening at some extent regularly in the human body.

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During this process, as glutathione is produced, there is a negative feedback loop. When in abundant supply, glutathione inhibits the gamma-glutamyl cysteine synthetase enzyme. This blocks the combining of cysteine and glutamate before being joined with glycine to form more glutathione. This is the body's way of regulating the amount of glutathione in the system. In times of oxidative stress, toxic exposure, inflammation, etc the glutathione production cycle is upregulated due to an increased need for glutathione to protect the body. When glutathione is deficient, the negative feedback loop is dysregulated allowing for more cysteine to be joined in the production of more glutathione. Since the regulation is no longer happening the entire cycle of production is upregulated. Thus, there is also an upregulation of 5-oxoproline being converted into glutamate. Because the enzyme, 5-oxoprolinase, is ATP dependent and the rate limiting enzyme of the whole cycle there becomes a buildup in pyroglutamic acid. This is because the need for glutathione production, in times of stress and toxicity, outweighs the rate in which 5-oxoprolinase can transform 5-oxoproline into glutamate. So, 5-oxoproline builds up leading to elevated urinary values of pyroglutamic acid.  Also, due to the ATP dependent nature of the enzyme, energy depletion is seen and stimulates the expression of energy depletion symptoms.


When evaluating marker 58 on the OAT, elevations give insight to how upregulated the glutathione cycle is at the moment of testing. In instances of true elevations, out of the reference range, there is clear glutathione deficiency. It can be said that the person’s body is struggling to make adequate glutathione. In situations like this all aspects of the client’s health presentation and medications/supplements should be evaluated. Certain pharmaceuticals, like large amounts or regular small doses of acetaminophen, which is known for its hepatotoxicity, stimulate the need for more glutathione. This is especially significant when people are taking multiple pharmaceuticals that may be liver toxic and have a cumulative effect. Other things that deplete glutathione include alcohol, recreational drug use, a fructose rich diet, the natural aging process, prolonged fasting (24 hours or longer), and anything that causes increases in oxidative stress. If this has been ruled out as the cause of elevations in pyroglutamic acid, then toxic exposures can be assessed. As stated, glutathione production is upregulated during a toxic exposure. Since the body upregulates glutathione for various reasons, it's hard to pinpoint which toxin test to perform. It could be heavy metals, non-metal toxins, mold toxins, or a combination. Consider running GPL offered profiles: MycoTOX, GPL-TOX, Heavy Metal Testing.

Assessing for depleting causes is helpful in the healing process as it can open up people to environmental testing and detoxification. Pyroglutamic acid is a useful marker and upregulation can give insight to glutathione needs. 


References
1.    CG. Alfafara, A., CG. Alfafara, K., Anderson, M., A. Anschau, L., M. Ask, V., A. Ayer, C., . . . X. Zhang, H. (1992, January 01). Microbial production of glutathione. Retrieved December 11, 2020, from HERE
2.    Francini F;Castro MC;Schinella G;García ME;Maiztegui B;Raschia MA;Gagliardino JJ;Massa ML;. (n.d.). Changes induced by a fructose-rich diet on hepatic metabolism and the antioxidant system. Retrieved December 11, 2020, from HERE
3.    M;, E. (n.d.). Acetaminophen toxicity and 5-oxoproline (pyroglutamic acid): A tale of two cycles, one an ATP-depleting futile cycle and the other a useful cycle. Retrieved December 11, 2020, from HERE
4.    M;, E. (n.d.). Acetaminophen toxicity and 5-oxoproline (pyroglutamic acid): A tale of two cycles, one an ATP-depleting futile cycle and the other a useful cycle. Retrieved December 11, 2020, from HERE
5.    Martensson, J., & Meister, A. (1989). Mitochondrial damage in muscle occurs after marked depletion of glutathione and is prevented by giving glutathione monoester. Proceedings of the National Academy of Sciences, 86(2), 471-475. doi:10.1073/pnas.86.2.471
6.    Pizzorno, J. (2014, February). Glutathione! Retrieved December 11, 2020, from HERE
7.    Richman, P., & Meister, A. (1975, February 25). Regulation of gamma-glutamyl-cysteine synthetase by nonallosteric feedback inhibition by glutathione. Retrieved December 11, 2020, from HERE
8.    An Under Recognised Cause of Metabolic Acidosis. (2018, September 13). Retrieved December 11, 2020, from HERE
Vogt, B., & Richie, J. (2002, November 05). Fasting-induced depletion of glutathione in the aging mouse. Retrieved December 11, 2020, from HERE

Mold Testing for Your Body and Your Home

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By Jasmyne Brown, ND, MS

Do you ever walk into a room in your home or office building and notice a faint odor?  Or have you or someone you love had the unfortunate experience of a chronic condition that isn’t easily explained after consulting with various doctors?  Well, mold toxicity could be a major factor in your clinical picture.  So how do you know if you have mold toxicity?  Testing with GPL’s MycoTOX Profile along with the Organic Acids Test, via a urine sample, will help you understand your body’s mycotoxin load.  The MycoTOX Profile looks at 11 mycotoxins from 40 different mold species.  These toxins have been shown to be immune dysregulating, neurotoxic, reproductive toxic, amongst other effects.  The OAT can help you understand if there is intestinal overgrowth (colonization) of Aspergillus mold that requires antifungal treatment.  The highly qualified consultants at GPL can help you and your clients understand the values reported and the extent of their toxic load.  But after testing your body for mold and mycotoxins, there still lies the question of whereIt came from.  Mold inspection of your home or office may seems like an insurmountable feat since most of us don’t even know where to start.  Since there is currently no gold standard for mold testing, the following is information outlining the basics of some common mold testing companies:

Home Mold Testing – Do-It-Yourself Kits

The Environmental Relative Moldiness Index (ERMI) is a common choice for mold testing.  This method of testing was developed by the US EPA Office of Research and Development but is currently not endorsed by the EPA for mold testing.  It is available from many mold testing companies – just do a web search for “ERMI test.  The ERMI was developed during a 2006 HUD American Healthy Home Survey based off 1,096 homes to research the moldiness of American homes.  The ERMI uses a mold specific quantitative PCR to test a single sample of dust.  From there, the sample’s potential mold is analyzed and the results are compared to water-damaged related molds (group 1) and other common indoor molds (group 2).  Using an algorithm, the ERMI score is then calculated.  The range for the score is -10 to 20, -10 being the lowest moldiness level and 20 being the highest.  Your home’s score is measured comparatively to the water damaged homes studied and a score is populated to rate the moldiness of your environment, compared to the reference or non-moldy homes tested from the research data.  The score identifies your home’s relative moldiness.  Only one sample is needed and can be completed by the average person.  Carpet dust is used and is seen as beneficial to use, as it seems to hold on to mold spores and it may give a better representation of long-term mold exposure as opposed to air testing.  The ERMI is a good test for understanding how moldy your environment is compared to other homes in the U.S.  Sampling for the ERMI is outlined on the Eurofins EMLab P&K Laboratories’ web site.  To conduct the test, you purchase a filter for your vacuum cleaner.  This allows for the dust with the mold spores to be collected during the timed vacuum cleaning session.  After collection, labeling the sample and overnight shipping are required for analysis. Once analyzed, you receive a detection and quantitation of mold from group 1, water damage associated molds from water-damaged homes used in development of the ERMI, and group 2, molds from reference homes or homes without water damage, from your sample.  With this you get a relative score that is the difference of group 2 from group 1, which is your ERMI score.  Price wise, this testing can cost around $300 plus the cost of the sample filter needed for collection which is about $7.  This is a viable option for anyone looking to understand where their environment lies in comparison to other moldy homes.

ERMI Photographic representation

ERMI Photographic representation

Another company that has been used for mold testing is ImmunoLytics.  Their testing method involves the use of plates with a specialized agar utilized to allow the mold spores to grow.  Their analyst will look at your test plates under the microscope to identify the types of molds growing.  The analysis reports on the quantity and type of mold found and assigns a health index score in accordance to what was found.  ImmunoLytics also allows you to collect several types of samples.  You can test the air in a room, the air in your car, your pets, and visible mold you will swab directly.   Their website outlines the different collection techniques in a stepwise manner for ease of sample collection.  In general, you will need to keep all windows closed in the room you are testing, have the test plat agar side up, and open two feet away from the walls, and leave it there to collect for approximately 30 minutes.  This can be done simultaneously in various rooms with different plates and you and your family can go about your lives while testing.  This allows for more rooms to be tested at the same time to ensure no part of the home is missed when investigating for mold.  Testing the car involves running the A/C for 30 minutes, then placing the plate in the car with the A/C running for 30 minutes for collection.  There is also the direct swab option. I f there is a vent, windowsill, etc. with visible mold, this is a direct way to collect said sample.  The cost of Immunolytics’ testing is dependent upon how many plates and/or swabs are requested.  Each plate or swab is about $33 each.  This includes the testing materials with labels required for testing.  With this you can then self-analyze your plates and determine your homes mold yourself.  For an additional fee, you can send in your samples and have an ImmunoLytics analyst analyze them for you and provide a consultation to review your results and help you understand next steps.  This company allows for tailor-made testing materials to be ordered for by the client to fit their needs.

EnviroHealth Consulting, Inc,  is a company dedicated to helping people limit their environmental exposure.  This company gives information regarding electromagnetic fields and how to reduce your exposure, clean air and how to make you indoor air cleaner, and mold exposure.  This company has a Certified Microbial Consultant certified through the American Indoor Air Quality Council with over 3,000 home inspections worth of experience.  As the client, you can collect your own samples at home or in your office and have them analyzed.  The website outlines how to collect the samples.  Their testing is different in that it doesn’t require a plate with agar or a dust filter.  They require a tape method for collection.  You can purchase clear tape and collect dust from multiple areas, as outlined in their collection instructions, and apply them to a plastic bag.  From here, you send in your samples and they are analyzed for a fee.  The fee ranges from approximately $25-$100.  This an affordable option for clients.  The turn-around time for results is said to be about a week with results e-mailed directly to the client.

Professional Home Inspections

For those looking for someone to come out to your home for an inspection, there is a company called Environmental Analytics (EA).  They will do an indoor environmental inspection of your home or office looking for potential off-gassing of chemicals, microbial overgrowth, and how your environment is potentially encouraging or minimizing your toxic exposure.  It is an overall assessment of your potential environmental toxic exposure.  Based off your results, a customized plan is developed to help you combat the results and follow ups are given as needed, according to the company’s website.  Not much information is given regarding what type of testing equipment is used, as it is based off their assessment of your home for what type of testing is needed.  It appears they follow Indoor Air Quality Association (IAQA), Surviving Mold, and International Society of Environmental Acquired Illness (ISEAI) guidance on best practices for their testing.  The benefit is that there is someone that will come to your space and do a visual inspection.  Even though this service isn’t offered everywhere there is the option for virtual consultations.  They will help you determine, over the phone, where you should go or look next in your environmental investigation.  Second opinions on other lab testing for environmental inspections and sample gathering assistance are also offered to those out of state and out of the country.  This may be a good follow up for those out of their service area to better understand results from another company or to get a second opinion.

Another resource for seeking out mold inspectors in your area is the National Association of Mold Remediators and Inspectors (NAMRI).  NAMRI is dedicated to ensuring professionalism in the mold inspection and remediation profession.  It is for mold professionals to have an ethical code and standard of practice befitting the mold industry to protect all.  Inspectors associated with this group are held to a minimum requirement for describing and reporting microbial overgrowth and contributing factors.  Members also must have a minimum of 90 hours of accredited mold education training.  If they do not have this training, at least 25 mold inspection or remediation jobs need to be successfully completed to apply for membership.  Their list of accredited mold educators includes Professional Mold Inspection Institute and Professional Home Inspection Institute.  There is also an exam all applicants must take and pass before membership is granted.  This organization also serves as a directory for clients looking for professional mold inspectors in their area.  For those looking for an actual person with credentials in mold inspection, this may be a good resource to explore when searching for a mold inspector.

In the journey of mold-related illness, finding the source of exposure is a crucial part of the puzzle.  When it comes to finding the right test or inspector, it can be overwhelming.  I hope this guide has outlined a few options to make it simpler to navigate the choices that are out there.  Currently there is no gold standard for how many mold spores in the air or environment are an acceptable amount.  There is also no gold standard in the testing of mold.  Continue to do your own research when looking for a mold inspector or mold testing company.  When looking for an inspector in your service area, ensure the inspector is qualified with a degree in microbiology and/or has experience in looking for mold in the home or other building environments.  Utilize resources that you trust, that are credentialed, and that provide clear and detailed information about how they sample and test for mold, their price point, and quality communication for any questions or concerns that may arise.  Before going with any home mold test or inspector, be sure you know what questions you want answered.  Are you more interested in how your home’s moldiness compares to other homes or are you curious about what is growing in your environment?  Who you decide to go with on this journey to understanding your exposures is ultimately up to you.  This will hopefully serve as a guide to help your decision-making process.

References

  1. Consumer Information: National Association of Mold Remediators and Inspectors (NAMRI). (n.d.). Retrieved April 8, 2020, from https://www.namri.org/consumer.php

  2. ERMI Sampling for PCR Testing. (n.d.). Retrieved April 7, 2020, from https://www.emlab.com/resources/sampling-guides/pcr-ermi-sampling/

  3. ERMI Testing Lab Services. (n.d.). Retrieved April 7, 2020, from https://www.emlab.com/services/ermi-testing/

  4. How to Test for Mold (n.d.). Retrieved April 8, 2020, from http://createyourhealthyhome.com/checking-for-mold/how-to-test-for-mold/

  5. Services. (n.d.). Retrieved April 8, 2020, from https://environmentalanalytics.net/services/

  6. Testing & Treatment - The ImmunoLytics Mold Testing Kit. (n.d.). Retrieved April 8, 2020, from https://immunolytics.com/testing-treatment/

Detoxifying Your Body - Water Filtration 101

Jessica Bonovich, RN, BSN

Hello, and welcome back to the GPL Blog.  Today we are talking about water filtration, which is a subject a lot of clients have asked about since we introduced our GPL-TOX test.  What we have seen through our studies, and those of other labs is that many of the toxins assessed by GPL-TOX have been found in many water supplies.  Any treatment plan needs to encompass a plan to prevent re-exposure. 

I recently reached out to over 12 water filter distributors and manufacturers to learn about the best filtration system for removing volatile organic compounds (VOC’s) from water and why. I was very transparent about the needs of our patients and the company I work for. I also reviewed information provided by The Environmental Working Group, who offers this Water Filter Buying Guide.  In addition, I contacted the Industrial Wastewater Management Center, the Department of Natural Resources, NSF Public Health and Safety Organization, and the Environmental Protection Agency.  Here is what I learned:

Carbon Block Filters

Carbon block is the commercially available standard for removing VOC’s. These very small compounds adhere to a surface of carbon (a process called adsorption) but will not be removed through reverse osmosis, ceramic, deionization, ozone, or ultraviolet light filtration. Factors that affect adsorption include the concentration of the compound, surface area, and the contact time between the water and the carbon. Of these factors, filters control the latter two.

The surface area of the carbon refers to the size of the pores in the carbon filter. This is where the “block” comes in. The filtration companies pack the carbons in very tightly which creates a very small pore size. The smaller the pore size the greater the chance of catching very small molecules like the VOC’s. The pore size of carbon block filters is generally measured in microns and ranges from 0.5 up to 1 micron.  This is sometimes also called submicron filtration. These tiny pores also remove lots of other small molecules like bacteria and particulate matter. Our main concern here is the removal of VOC’s because the carbon is the only filtration that will eliminate these compounds. Many other kinds of filters are available to remove the other materials. It’s a bonus but not a big selling point.

The contact time equates to how much water can contact the filter over a given period and directly affects the gallons per minute (gpm) of filtration. Companies intentionally build in methods to restrict the water flow to increase the amount of contact time the water has with the filter. The water restriction lowers the gpm which can slow the water flow. Consumers tend to want higher gpm for greater water pressure but this can affect the removal of contaminants.  The size of the filter also influences the removal. So, if you want high water flow (gpm) you need a larger filter that will handle the larger volume. This will cost you a bit more. If budget is your main concern, low gpm is the priority. Whole house filtration systems are not as effective at removing VOC’s because they are geared toward optimizing the water flow, in other words, fast filtration. The size of the filter needed to overcome the pressure drop on whole house filters is cost prohibitive for most people. Several companies do make carbon block filters for your shower head which is a nice option for reducing the VOC contaminants in your shower water. The under-the-sink and counter top units are often called point of use (POU) filters. The industry standard for good carbon block filters is between 0.5 and 1 gpm. The filter size that is needed to accommodate the larger gpm and still remove VOC’s can be deduced by looking at the performance data sheets that companies provide. This is what people should focus on to determine how robust the filter really is.

Filter Specifications

Understanding filter specifications can be a learning curve in itself. Companies will have third parties test the amount of contaminant coming in (called influent) and the amount going out (called effluent) through a company called NSF. The data sheets do not report the actual effluent, but instead report the “maximum permissible product water concentration” established by the EPA. This number will be the same on all data sheets. This testing is an important factor because we know that the concentration of the compound influences the ability of the filter to adsorb. NSF spikes water samples with a known amount of a compound and then measures the amount that is still in the specimen after filtration. These reports vary considerably and range from very well-organized to quite confusing. Some performance data sheets list these figures as a chart, while others use graphs. The only real difference is the percent reduction. This is the amount that was eliminated during the testing. I have asked multiple companies why they do not provide the actual effluent data and even contacted NSF about this. No one has been able to tell me why they don’t provide the raw data.

Filter Housing Options

Choosing the housing for your filter is the final step. Most of the companies use stainless steel, aluminum, or polypropylene plastic housing. Polypropylene is considered nontoxic by the Environmental Working Group. However, it can be oxidized when exposed to stress like heat and UV.  On top of this, many of our patients have developed severe chemical sensitivity. Once this acute phase has established itself, it can be difficult to predict what the patient will react to. I recommend the stainless steel option to remove any concern about plastic toxicity. Once your water has been filtered, do not store water in a container for more than 24 hours. Without chlorine, the water becomes a target for microbes to take up residency. 

Testing Your Water

Most filtration companies recommend that you have your water tested prior to getting a filtration system so you know exactly what you need. I have focused on single stage filtration designed to remove VOC contaminants. If you have heavy metals or bacterial contamination, you will need a multistage filter that will remove all the other contaminants. To find a laboratory in your area that can test your water, the EPA suggests that you start with your local municipality. I contacted the local water department here in Johnson County, KS to test this theory and they provided me the names of three local laboratories that can test water for contaminants.  Only one of these companies responded to my request and they offered to test for 29 VOC’s for $140.

An acceptable level of contamination has not been established for every chemical compound. The VOC’s that do have a limit are listed on pages 257-533 of this document.  According to the most current information available on the EPA website, municipal water suppliers must test the water for these VOC’s four times per year. If there are no contaminants reported for three years, the municipality can test just once per year. Municipalities can go a step further and apply for a waiver that exempts them from testing any VOC’s for up to six years. If a contamination is found, quarterly monitoring is required. If the municipality does not comply with this, there are no stated penalties or further requirements, which is a bit disconcerting. If you find that your water exceeds any of these standards, you should report this contamination to your state EPA office.  

Final Thoughts

The company (and person) that was the most helpful to me by far on this journey was Ron at Water2drink.com. All of their filter performance sheets are disclosed here. Individual requirements will vary based on price and available space. If you want my personal opinion for a good filter to remove VOC contaminants, this is a great place to start.