GPL-TOX: Common Markers And Environmental Testing

Jasmyne Brown, ND

This webinar discusses some common toxins assessed on the GPL-TOX Profile. We discuss the effects of exposure and where to find these common toxins. Briefly, we will take a look into options for testing the environment to identify potential exposure in your everyday life. Below are answers to questions from the webinar.

GPL-TOX: Common Markers And Environmental Testing from The Great Plains Laboratory on Vimeo.

Q: What if the person is not able to excrete in the urine and stores in the fat tissue?  How would you determine those toxins?

A: These are stored in the fat tissue when there is long term or a high level of exposure. In that case, whatever could not be excreted at that time would then be stored, but you would still see elevations on the test from the toxin that had been excreted at that time. If you are still concerned, you would need to find a company that does a fat biopsy and would test for the toxins that are in question. I’m not aware of labs that do that.

Q: Would you refrain from using this test in individuals with compromised kidney function?

A: If there is an issue with concentrating the urine, you may consider not doing the test, but since a variety of these can cause kidney disease, I would at least rule them in or out. If the creatinine is too low, the sample will be rejected. This is the worst that would happen in someone with compromised kidney function.

Q: Are you seeing low RBC counts and low minerals in general?

A: In some clients, I see low minerals, but this isn’t a consistent, across the board finding

Q: What do you see mostly, or all the time?

A: Acrylamide and 1-bromopropane are the most prevalent that I see.

Q: Are there common exposures you are seeing with excess marijuana use?

A: I haven’t seen many reports from those that admit to using marijuana so I couldn’t really say. The few cases I have had acrylamide higher and some pesticide. The practitioner and I were concerned it was marijuana grown with pesticides.

Q: What do you think about well water?  What are the risks if they don’t have a water filter?

A: I think well water is a good option but depending on what is near the well can open a door for any of these contaminants and heavy metals. High level exposure and subsequent symptoms are the risks if there is no water filter. If you are concerned, check out the EWG Tap Score and see what could be in the water.

Q: So if you work in IT, around electronics, how do you protect yourself?

A: If you are working in IT, meaning not manufacturing the electronic, your risk of exposure has greatly decreased. Take breaks from your computer and if you have a new system, consider wearing a mask for the first few weeks to reduce your exposure as it is still off gassing.

Q: Please talk about marker 17.

A: This toxin is a common herbicide and used in chemical industries. Cigarette, gasoline, and oil burning also produce acrolein. It can contaminate water supplies and it is produced by clostridium bacteria.

Q: My husband tested very high on propylene oxide. Level is 2,603. We are gluten free and eat a lot of nut-based products and almond milk. Could this create this high level or is it his work environment? He works at an auto sales lot around a lot of car chemicals, etc. (for 30 years). Have you seen a level this high for this marker?

A: Your diet may be a contributing factor, but due to his occupational exposure that would be a larger source of exposure. You can reduce his exposure by switching to organic nut products. I have seen this marker this high before, it was due to contaminated water supply.

Q: What about testing for glyphosate?

A: Water testing and testing glyphosate exposure can both be done with GPL.

Q: RE your MTBE statements. "Does not test for past exposure." Does the test measure for fat storage or not?

A: Fat storage can only be directly measured by a fat biopsy and then testing of the chemicals. I am not aware of a lab that does this. The urinary metabolite does not directly tell us if the toxin was only from what was stored in fat tissue. But if it is stored, that means there is a large source of exposure or prolonged consistent source the body cannot process fully and is storing for later detox.

Q: Do you know of something like the EWG Tap score for Canada?

A: I’m not sure honestly. I tried a Canadian zip code and it seemed to work. Give yours a try: HERE

Q: What is contact info for my tap score?

A: HERE

Q: Which whole house water purification unit do you recommend?

A: I don’t recommend whole home systems. I have heard many horror stories of mold being found in them.

Q: Which air filter do you recommend?

A: Any product that uses a HEPA filter would be good to consider.

Q: Glyphosate 2.15 how bad is this?

A: This is in the expected range but higher than those that typically eat 100% organic. You may try eating more organic. If you already do there may be a hidden air borne or water exposure.

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Ten Reasons to do an Organic Acids Test from Great Plains Laboratory

By Kurt N. Woeller, DO

Organic acids (OAs) are compounds that have acidic properties, and many are normal byproducts of biochemical, a.k.a. metabolites. However, there are certain compounds that provide clues regarding metabolic disorders, including mitochondrial dysfunction, and potential toxin exposures which can negatively impact health. Certain elevated amino acid metabolites can even be linked to rare genetic diseases called inborn errors of metabolism. These markers found on page five of the Organic Acids Test (OAT) are fortunately rare.

Other organic acid compounds are seen elevated with overgrowth of opportunistic and pathogenic digestive bacteria, as well as yeast and other fungi. Certain microorganism-produced compounds, e.g., HPHPA, can alter neurochemical activity, affecting the brain and nervous system, which leads to behavioral, cognitive and various physical health problems.

The OAT from Great Plains Laboratory evaluates over 70 urinary metabolites that can be useful for discovering underlying causes of chronic illness. Treatment(s) based on OAT assessments can often lead to improved energy, sleep, and mental health conditions, as well as reduced attention and concentration problems, chronic pain, and digestive issues. The OAT is more than just a single test. Instead, it should be viewed as a comprehensive profile that combines different categories that when organized together and understood from a fundamental standpoint is a game changer in practice or for any individual seeking deeper answers to often overlooked health problems.

The following is a list of ten descriptions for why the Organic Acids Test from Great Plains Laboratory is worth doing and learning more about:

The OAT evaluates for various fungal toxins, including specific markers for candida, as well as other fungus such as mold and yeast. Many individuals rely on stool testing for candidiasis diagnosis. However, a stool test is often negative for candida overgrowth detection, while the OAT often detects the presence of candida and yeast toxins (authors experience). The OAT is overall more sensitive for candida analysis because it is detecting chemical production within the digestive system that is reflective of these organism’s metabolic activity, and tissue invasion along the mucosal lining of the gut. The organic acid arabinose, often elevated on the OAT, is linked to this process of mucosal invasion. Some of candida toxins can create problems with brain function including memory, attention, and focus. 

The OAT evaluates for specific toxins related to various clostridia bacteria. Clostridia bacteria such as Clostridia difficile (C. diff.) can lead to digestive problems and poor health (1). For example, certain strains of C. diff. produce virulence factors which cause inflammation, bleeding, and diarrhea within the digestive system. However, there are other clostridia toxins that work outside the digestive system. The main toxins evaluated on the OAT linked to different strains of clostridia are HPHPA and 4-cresol (2). Both HPHPA and 4-cresol can inhibit a dopamine converting enzyme leading to excess dopamine in the brain and nervous system (3).

High dopamine can form toxic compounds that adversely affect brain cells. Long-standing elevation of these dopamine related compounds such as DOPAC (and dopamine-o-quinone, a compound not measured on the OAT) are known to trigger free radical damage within the brain. The elevation of the neurotransmitter dopamine can also cause mood instability, and other cognitive problems. In severe cases, the presence of these clostridia toxins can trigger aggressive and self-injury behavior from high amounts of dopamine. This is a common scenario in special needs individuals such as those with autism. Evaluating for clostridia organic acid toxins is essential for anyone struggling with a developmental disorder, mental health problems, and neurological diseases.

The information from the OAT helps to prioritize treatment intervention decisions, along with symptoms and clinical history, between candida (fungus) and clostridia (bacteria). Treating for candida alone when clostridia bacteria toxins of HPHPA and 4-cresol are present may lead to significant problems aggravating the digestive system, but also leading to adverse changes in neurochemicals affecting behaviors, cognitive abilities, mood, and mental stability.

The OAT evaluates for high oxalate (a.k.a. oxalic acid). Oxalate is a compound found in many foods such as nuts (e.g., almonds), fruit (e.g., berries) and certain vegetables (e.g., spinach). Oxalate can also be produced by candida overgrowth, aspergillus mold, as well as certain metabolic imbalances linked to deficiency in oxalate metabolizing enzymes. High oxalate is often associated with joint and muscle pain but can lead to bladder and bowel discomfort as well. Severe cases of oxalate accumulation can cause kidney stones. Oxalate can trap heavy metals such as mercury, lead, and arsenic in the body and lead to mineral imbalances.

The OAT evaluates for mitochondrial imbalances. The mitochondria are the energy factories of our cells producing large amounts of adenosine triphosphate (ATP). ATP acts as energy currency for our body. Mitochondria are often stressed because of toxins from candida, bacteria, oxalate, heavy metals, and environmental chemicals. Mitochondrial dysfunction is common in many chronic health disorders.

The OAT evaluates for imbalances in dopamine and norepinephrine (4). The relationship between these two important brain chemicals is critical for attention, focusing, mood, calmness, and other functions of the nervous system.

The OAT evaluates for deficiency of excess of serotonin, an important brain chemical for mood, fine and gross motor skills, calmness, and sleep. There are other markers evaluated on the OAT that can indicate toxic stress in the brain and nervous system. One of these potentially toxic compounds is called quinolinic acid (QA). Elevated QA can be toxic in the brain triggering increase receptor activity that allows for increase influx of calcium into a brain cell. This mechanism can lead to a host of cell problems causing or contributing to brain cell death and destruction. For these reasons, it is beneficial to perform an OAT before implementing high dose amino acid L-tryptophan supplementation which is often used to assist with sleep or some mental health disorders.

The OAT evaluates for two specific chemicals related to folate metabolism. Folate is linked to the methylation cycle that supports the inner workings of the cells related to DNA function and metabolism. Poor folate metabolism can lead to cognitive problems.

The OAT evaluates for various nutritional markers such as vitamin B6, vitamin B5, vitamin C, CoQ10, as well as N-Acetylcysteine (NAC). NAC is necessary as a precursor for the antioxidant glutathione.

The OAT evaluates for glutathione deficiency. Glutathione is a powerful antioxidant in our cells and protects against toxicity. The lack of glutathione leads to oxidative stress within the brain and nervous system which causes poor attention, focusing, and overall cognitive challenges. Glutathione deficiency can also compromise immune system health. Glutathione is a necessary compound involved liver detoxification of chemicals.

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In summary, the Organic Acids Test is an essential profile for anyone seeking additional information related to underlying gut derived bacterial and fungal toxins, as well as evaluating for less known metabolic imbalances such as mitochondrial function. It is not a test limited to just a few conditions, but instead can be done on anyone dealing with a complicated and chronic health problem.

As mentioned previously, it is game changer in clinical practice, and I encourage every health professional learn to become proficient in its use.

For the general public, know that the OAT is an important tool to assess deeper layers of human biochemistry and digestive system imbalances from opportunistic organisms that conventional medicine often overlooks.

Through our online training website called Integrative Medicine Academy, we offer various courses related to the use and interpretation of the organic acids test in practice, specifically the Essential OAT Mastery and Advanced OAT Mastery courses. More information about these courses and others can be accessed from our academy’s website at https://integrativemedicineacademy.com.

For access to the Organic Acids Test, health professionals can set-up an account directly with Great Plains Laboratory. For others, the OAT can be ordered through a website called Lab Tests Plus. All lab testing ordered through this website comes with a written interpretation of findings and action step suggestions based on the lab tests relevant information.

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References

1. Leesa FC, Mu Y, Bamberg WM, et al. “Burden of Clostridium difficile infection in the United States.” N Engl J Med. 2015;372: 825-834.
2. Shaw, W. “Increased urinary excretion of a 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA), an abnormal phenylalanine metabolite of Clostridia spp. in the gastrointestinal tract, in urine samples from patients with autism and schizophrenia.” Nutr Neurosci. 2010. 13(3):135-43.
3. Goodhart, PJ, et. al. “Mechanism-based inactivation of dopamine beta-hydroxylase by p-cresol and related alkylphenols.” Biochemistry. 1983 Jun 21; 22(13):3091-6
4. John D. Hunt. Associate Clinical Professor of Psychiatry, Vanderbilt University Medical School, Nashville, Tennessee; CEO & Medical Director, Center for Attention and Brain Function, Nashville, Tennessee “Functional Roles of Norepinephrine and Dopamine in ADHD: Dopamine in ADHD” Associate Clinical Professor of Psychiatry, Vanderbilt University Medical School, Nashville, Tennessee; CEO & Medical Director, Center for Attention and Brain Function, Nashville, Tennessee.

8 Binders for Mycotoxins

BY JASMYNE BROWN, ND, MS

After a positive Organic Acids Test and MycoTOX Profile, the presence of mold and mycotoxins are usually significant answers for many symptomatic clients. When working with mycotoxicosis, choosing the correct binder can present a challenge.  Oftentimes I get the question: which binder is correct for which toxin? Since the research for the binding capacity of each binder isn't as heavily researched as other agents, it can be daunting to sift through the information. Below is a collection of research connecting mycotoxins to a good binder choice.

In our bodies, toxins are detoxed and excreted through a few pathways. Routes of elimination include urine, stool, bile and through our skin. Other routes include tears and saliva but are negligible in the realm of detoxification. Another route is breast milk. Since breast milk is a route of excretion this means toxins can be transferred to another life this way. This fact makes binders even that much more crucial in childbearing age women.

When it comes to binders, bile and stool are the target routes of elimination. Fat soluble substances such as dietary lipids, certain vitamins and fat-soluble toxins like mycotoxins get packaged into bile for absorption and detoxification. During bile’s life cycle it gets excreted into the GI tract and is what gives stool its brown color. In the colon most of the bile is reabsorbed so the liver and gallbladder do not have to work as hard to make more bile. It is recycled and reused. Dysfunction of this phenomenon, bile acid malabsorption, chronic diarrhea is the main symptom.  Since bile is reabsorbed, in the ileum and jejunum, if toxins are packaged in the bile then the toxins can be reabsorbed as well. They would then re-enter circulation via the hepatic portal system. This is where binders come in handy. Binders will adhere to the bile that packages the toxins and then it cannot be reabsorbed. Due to the nature of this adherence, it cannot be trusted that the bond is irreversible. This bond is more like static cling, as described by Dr. Neil Nathan. The lack of a tight bond allows for the bile to be released if not excreted regularly. Meaning, irregular bowel movements from constipation, lack of fiber, or motility issues could cause resorption of toxins even with binder usage. Binders by nature are constipating and this should be mitigated and assessed regularly during binder usage. Properly moving bowels through diet and supplements should be achieved prior to adding in any binding agent. View products for gut motility on the New Beginnings Nutritionals Website. 

In the world of prescriptions, cholestyramine and colesevelam hydrochloride, more commonly known as Welchol, are often binders of choice. They are known for their intended use and design, which is their lipid lower activity and use in glycemic control in patients with type 2 diabetes mellitus. They work by directly binding bile in the GI tract. This causes a reduced bile resorption and an increased conversion of cholesterol to bile, via 7a-hydroxylation, thus lowering cholesterol levels. In this process toxin laden bile is bound and thus excreted via stool.

These two binders are often used in mycotoxin detoxification protocols. As seen above, this is for good reason. The mycotoxin that responds best to these prescriptions is ochratoxin a (OTA), according to the research. This is a notorious mycotoxin. OTA is produced by many species of Apergillus and Penicillium molds. These are two of the most ubiquitous molds in the environment. This fact makes OTA the most common mycotoxin. It is so common that even regular ingestion of commonly moldy foods will most likely expose you to small, negligible amounts of OTA - We outline this in our article: Mycotoxins in Food. In cases of water damage building exposure these drugs are valuable assets to binding this mycotoxin. 

A few years ago, activated charcoal was the new buzz trend. It was popping up in drinks, snacks, even ice cream. Due to this most people are familiar with this binder. It is commonly used for firming loose stools, binding toxin from food poisoning, and now for mycotoxin binding. According to the research most binders will bind to just about anything, including nutrients necessary for life. They are non-discriminating. This fact made the charcoal trend rather troubling for those engaging in high intake of this substance with no regard to its potential danger if not taken responsibly. But, due to this, activated charcoal is an effective toxin binder to just about any toxin that is excreted in the gut. It works similarly to cholestyramine by adsorbing to toxins packaged in bile.

Research shows that in food stuff and in the body activated charcoal is beneficial in mycotoxin binding. OTA is bound effectively by charcoal products. This a good alternative for non-prescribing practitioners. Charcoal has also shown efficacy in adsorbing to macrocyclic trichothecenes. Two of the most common are verrucarin a and roridin e, and these are assessed on the MycoTOX Profile. Other subvarieties of verrucarin, including ‘J’ have shown binding efficacy with charcoal administration. Also T-2 toxins from fusarium are bound by charcoal.

Another common binding agent is bentonite clay and zeolite clay. These two clays have been touted as working wonders in the cosmetic arena by pulling toxins from the skin. These clays have been shown to bind greatly to toxins in animal feed, reducing the toxic load before consumption. Another clay is montmorillonite clay, also known as Novasil. This clay has ample research as a mycotoxin adsorbent in animal feed, a highly mycotoxin contaminated source. Great news, these clays do the same adsorbing action in the GI tract. Both agents show great affinity for binding aflatoxins best. These clays do not have much other research connecting them as strong adsorbents to other toxins as they do with aflatoxins. Although they can be useful in clients with these toxins and zearalenone, OTA, and gliotoxin as there is some adsorbing activity with these toxins.

This water-soluble polysaccharide is a well touted weight loss solution. It comes from the elephant yam, konjac. It is a hemicellulose fiber with beta-D-glucose and beta-D-mannose with acetyl groups with beta 1–4 linkages. Due to the lack of enzymes in human saliva to break these linkages, glucomannan goes through the GI tract unchanged. This allows for it to bind without absorption. Due to its content, this fiber can adsorb up to 50 times its weight. Glucomannan has shown efficacy in binding various mycotoxins.  Aflatoxin and OTA are major toxins affected by this binder. Others include zearalenone and Toxin T-2. not much efficacy was seen in binding DON-1 (Deoxynivalenol). Since glucomannan is a fiber this may be an option to consider in more constipated clients with ample water intake.

Speaking of fiber, in general fibrous supplements and foods can act as simple overall binders. Fiber from oats, wheat bran, alfalfa, lignans in flax and chia, guar gum, etc have been used as early interventions in lowering cholesterol. It has the same effect that cholestyramine has on cholesterol. It is due to the bile sequestering activity of these fibers that work to lower cholesterol. In turn this will also lower toxic load. Even though fiber doesn't have much direct research in the binding of specific mycotoxins, it is always a good dietary change to implement. Barley and oats showed highest absorptive capacity amongst other fibers when tested. Another great fiber binder to consider is modified citrus pectin (MCP). This binder has shown great efficacy in binding heavy metals such as lead. Though this isn't a mycotoxin, this shows us that MCP has a great potential utility in any detox protocol.

This next binding agent is a common plant-based agent. Chlorella is a type of freshwater algae that is packaged into a tablet, liquid extracts, and powders. It is often touted as a superfood due to its highly nutritious profile. It is high in protein, vitamins A, C, and E and is a great source of fiber. Because of its nutrition, chlorella is known for its wound healing, anti-cancer, anti-aging, and immune boosting potential. In breastfeeding mother’s chlorella intake increased circulating immunoglobulins in breast milk. This plant is great as a heavy metal binder and as a binder of aflatoxins. It has even been shown to inhibit aflatoxin B1 induced liver cancer.

Due to the safety profile of chlorella, it is a great binder for all populations. It is difficult to detox a constipated child or a woman expecting a child and is planning to breastfeed. Since so many other binders bind not only toxins, but also nutrients it can be difficult to support detox. Adding in small doses of chlorella is a safe and effective way to add in supportive detox without stimulating too much toxin release to the unborn fetus or breastfeeding child. 

Humic acid and its related counterpart, fulvic acid, are the final products of decomposition of organic matter. They are formed through humification of plant and animal matter via biologic processes of microorganisms. This byproduct acts as an adsorbent in soil to bind to toxic substances. Agriculturalists use these substances as soil additives to boost the growth and health of their crop due to its concentrated amount of nutrients. Due to its rapid lifecycle humic acid doesn't compete for nutrients with the plant or any other organism that uses it. This makes this biotoxin binder simpler to utilize when taking a variety of nutritional supplements.

Not only is humic acid a great biotoxin binder, but it also has shown efficacy as an anti-inflammatory. It also has shown promise in stimulating apoptosis in promyelocytic leukemia cells. This substance, along with fulvic acid, is a wonderful well-rounded addition to any detoxification protocol. 

This section of biotoxin binders may come as a surprise. Probiotics are best known for their activity in repopulating the GI microbiome after antibiotic use, killing of pathogenic organisms like C. difficile, and as a support in a whole host of chronic diseases. What many do not realize is that these organisms can also directly bind to mycotoxins. Strain of lactobacillus work to directly bind aflatoxins especially the B1 variety. The specific strains are L. pentosus and L. beveris. Another promising strain is L. plantarum C88. This strain works not only to bind to aflatoxins, but it also works by upregulating the antioxidant activity of glutathione s- transferase. It also shows great binding capacity to the common mycotoxin, sterigmatocystin.

Strains of saccharomyces also work well to bind mycotoxins. S. cerevisiae has been shown to bind tightly to aflatoxins. It has also shown great efficacy to bind to OTA and zearalenone. Saccharomyces boulardii, clinically, has shown great efficacy against gliotoxin. It has also shown efficacy in reducing Aspergillus and Fusarium molds in the GI tract. This will indirectly reduce mycotoxins, as it is reducing the producers of mycotoxins including zearalenone, enniatin b, OTA, gliotoxin, and aflatoxins. Mannan oligosaccharides (MOS) are prebiotics derived from the outer cell wall of S. cerevisiae. This prebiotic has been shown to bind to citrinin, which a wide variety of molds produce.  Using a variety of these strains will round out not only your gut treatment but also the detoxification process.

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All in all, binding agents are an integral part of mycotoxin illness detoxification. Whether someone has 1 or 10 mycotoxins populate on the MycoTOX Profile, having the correct binders can be a challenge. Hopefully, this can be used as a resource to guide you in planning toxin binder regimens to best help your clients. Using a combination of binding agents will allow for well-rounded binding capacity in any mycotoxin toxicity case. View a wide variety of binding agents at New Beginnings Nutritionals to support you in choosing the best biotoxin binders.

This is a table matching mycotoxin with binders that have research to their binding affinity

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References

1. Agawane, S. B., and P. Lonkar. “Effect of Probiotic Containing Saccharomyces Boulardii on Agawane, S. B., and P. Lonkar. “Effect of Probiotic Containing Saccharomyces Boulardii on Experimental Ochratoxicosis in Broilers: Hematobiochemical Studies.: Semantic Scholar.” Undefined, 1 Jan. 1970, SOURCE. 
2. Ardeshir Mohaghegh,Mohammad Chamani,Mahmoud Shivazad,Ali Asghar Sadeghi &Nazar Afzali. “Effect of Esterified Glucomannan on Broilers Exposed to Natural Mycotoxin-Contaminated Diets.” Taylor & Francis, SOURCE. 
3. Armando, M.R., et al. “Adsorption of Ochratoxin A and Zearalenone by Potential Probiotic Saccharomyces Cerevisiae Strains and Its Relation with Cell Wall Thickness.” Journal of Applied Microbiology, vol. 113, no. 2, 2012, pp. 256–264., doi:10.1111/j.1365-2672.2012.05331.x. 
4. “Chlorophyll and Chlorophyllin.” Linus Pauling Institute, 1 Jan. 2021, SOURCE. 
5. D. Lloyd-Jones, R. Adams, et al. “Impact of Daily Chlorella Consumption on Serum Lipid and Carotenoid Profiles in Mildly Hypercholesterolemic Adults: a Double-Blinded, Randomized, Placebo-Controlled Study.” Nutrition Journal, BioMed Central, 1 Jan. 1970, SOURCE. 
6. De Mil, Thomas, et al. “Characterization of 27 Mycotoxin Binders and the Relation with in Vitro Zearalenone Adsorption at a Single Concentration.” Toxins, MDPI, 5 Jan. 2015, SOURCE. 
7. Devreese M;Girgis GN;Tran ST;De Baere S;De Backer P;Croubels S;Smith TK; “The Effects of Feed-Borne Fusarium Mycotoxins and Glucomannan in Turkey Poults Based on Specific and Non-Specific Parameters.” Food and Chemical Toxicology : an International Journal Published for the British Industrial Biological Research Association, U.S. National Library of Medicine, SOURCE. 
8. El Khoury, Rhoda, et al. “OTA Prevention and Detoxification by Actinobacterial Strains and Activated Carbon Fibers: Preliminary Results.” MDPI, Multidisciplinary Digital Publishing Institute, 24 Mar. 2018, SOURCE. 
9. Garcia Diaz, Tatiana, et al. “Use of Live Yeast and Mannan-Oligosaccharides in Grain-Based Diets for Cattle: Ruminal Parameters, Nutrient Digestibility, and Inflammatory Response.” PloS One, Public Library of Science, 14 Nov. 2018, SOURCE. 
10. Guo M;Hou Q;Waterhouse GIN;Hou J;Ai S;Li X; “A Simple Aptamer-Based Fluorescent Aflatoxin B1 Sensor Using Humic Acid as Quencher.” Talanta, U.S. National Library of Medicine, SOURCE. 
11. Hamidi, Adel, et al. “The Aflatoxin B1 Isolating Potential of Two Lactic Acid Bacteria.” Asian Pacific Journal of Tropical Biomedicine, vol. 3, no. 9, 2013, pp. 732–736., doi:10.1016/s2221-1691(13)60147-1. 
12. Hope, Janette. “A Review of the Mechanism of Injury and Treatment Approaches for Illness Resulting from Exposure to Water-Damaged Buildings, Mold, and Mycotoxins.” The Scientific World Journal, Hindawi, 18 Apr. 2013, SOURCE. 
13. J;, Santos RR;Vermeulen S;Haritova A;Fink-Gremmels. “Isotherm Modeling of Organic Activated Bentonite and Humic Acid Polymer Used as Mycotoxin Adsorbents.” Food Additives & Contaminants. Part A, Chemistry, Analysis, Control, Exposure & Risk Assessment, U.S. National Library of Medicine, SOURCE. 
14. Jay Y. Jacela, DVM; Joel M. DeRouchey, PhD; Mike D. Tokach, PhD; Robert D. Goodband, PhD; Jim L. Nelssen, PhD; David G. Renter, DVM, PhD; Steve S. Dritz, DVM, PhD. Fact Sheet: Mold Inhibitors, Mycotoxin Binders, and Antioxidants, SOURCE. 
15. Jubert, Carole, et al. “Effects of Chlorophyll and Chlorophyllin on Low-Dose Aflatoxin B(1) Pharmacokinetics in Human Volunteers.” Cancer Prevention Research (Philadelphia, Pa.), U.S. National Library of Medicine, Dec. 2009, SOURCE. 
16. Kerkadi A;Barriault C;Tuchweber B;Frohlich AA;Marquardt RR;Bouchard G;Yousef IM; “Dietary Cholestyramine Reduces Ochratoxin A-Induced Nephrotoxicity in the Rat by Decreasing Plasma Levels and Enhancing Fecal Excretion of the Toxin.” Journal of Toxicology and Environmental Health. Part A, U.S. National Library of Medicine, SOURCE. 
17. Kraljević Pavelić, Sandra, et al. “Critical Review on Zeolite Clinoptilolite Safety and Medical Applications in Vivo.” Frontiers in Pharmacology, Frontiers Media S.A., 27 Nov. 2018, SOURCE. 
18. Kumar, C. B. ; Reddy, B. S. V. ; Gloridoss, R. G. ; Prabhu, T. M. ; Suresh, B. N. “ Effect of MOS Based Toxin Binder on Low Level Citrinin Toxicity in Commercial Broilers.” Mysore Journal of Agricultural Sciences, vol. 48, no. 1, 2014, pp. 75–82. 
19. L,Haus M;Žatko D;Vašková J;Vaško. “The Effect of Humic Acid in Chronic Deoxynivalenol Intoxication.” Environmental Science and Pollution Research International, U.S. National Library of Medicine, SOURCE. 
20. Lauterburg BH, Dickson ER, Pineda AA, Carlson GL, Taswell HF. “Removal of Bile Acids and Bilirubin by Plasmaperfusion of U.S.P. Charcoal-Coated Glass Beads.” Europe PMC, 30 Sept. 1979, SOURCE. 
21. Li, Yan, et al. “Research Progress on the Raw and Modified Montmorillonites as Adsorbents for Mycotoxins: A Review.” Applied Clay Science, Elsevier, 30 July 2018, SOURCE. 
22. Naumann, Susanne, et al. “In Vitro Interactions of Dietary Fibre Enriched Food Ingredients with Primary and Secondary Bile Acids.” Nutrients, vol. 11, no. 6, 2019, p. 1424., doi:10.3390/nu11061424. 
23. Riaz, Sana. “Cholestyramine Resin.” StatPearls [Internet]., U.S. National Library of Medicine, 25 May 2020, SOURCE. 
24. Rotter, R G, et al. “Influence of Dietary Charcoal on Ochratoxin A Toxicity in Leghorn Chicks.” Canadian Journal of Veterinary Research = Revue Canadienne De Recherche Veterinaire, U.S. National Library of Medicine, Oct. 1989, SOURCE. 
25. Vahouny, George V., et al. “Dietary Fibers: V. Binding of Bile Salts, Phospholipids and Cholesterol from Mixed Micelles by Bile Acid Sequestrants and Dietary Fibers.” Lipids, vol. 15, no. 12, 1980, pp. 1012–1018., doi:10.1007/bf02534316. 
26. “Verrucarin A (T3D3720).” T3DB, SOURCE. 
27. S,Baker; W,Shaw. “Case Study: Rapid Complete Recovery From An Autism Spectrum Disorder After Treatment of Aspergillus With The Antifungal Drugs Itraconazole And Sporanox.” Integrative Medicine (Encinitas, Calif.), U.S. National Library of Medicine, SOURCE. 
28. Wang JS;Luo H;Billam M;Wang Z;Guan H;Tang L;Goldston T;Afriyie-Gyawu E;Lovett C;Griswold J;Brattin B;Taylor RJ;Huebner HJ;Phillips TD; “Short-Term Safety Evaluation of Processed Calcium Montmorillonite Clay (NovaSil) in Humans.” Food Additives and Contaminants, U.S. National Library of Medicine, SOURCE. 
29. Yang, Hsin-Ling, et al. “Humic Acid Induces Apoptosis in Human Premyelocytic Leukemia HL-60 Cells.” Life Sciences, Pergamon, 25 June 2004, SOURCE. 
30. Zhao ZY;Liang L;Fan X;Yu Z;Hotchkiss AT;Wilk BJ;Eliaz I; “The Role of Modified Citrus Pectin as an Effective Chelator of Lead in Children Hospitalized with Toxic Lead Levels.” Alternative Therapies in Health and Medicine, U.S. National Library of Medicine, SOURCE.

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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Organic Acids and Mycotoxins with William Shaw, PhD

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 response to remaining questions Dr. Shaw was unable to answer during his 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.

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William Shaw, PhD

Organic Acids and Mycotoxins

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.

Q: What if the client presents with muscle wasting, severe weight loss and high CRP marker?  Can food sensitivities be a cause?

A: Yes. Food sensitivities can be the cause.

Q: Were the IgG antibodies to Casein A or Casein B or both?

A: They are to both. A and B are not distinguished.

Q: When you have multiple IgG food reactions, I would think leaky gut first and it’s not the “foods fault.” If you remove all the elevated IgG food reactions most patients might develop problems with eliminating too many nutrients from their diet. Can you discuss how you approach this?

A: Initially remove the offending foods that the immune system is overreacting to while treating the cause. If the cause is leaky gut, candida, mold, or other toxicities removal/treatment should reduce the sensitivity. At this point you can retest or challenging the offending foods beginning with the lows, moderates, then highs.

Q: Would IgG or OAT be useful in managing G6PD deficiency?

A: Both profiles would be useful. The IgG Food Map would identify immune stimulating foods that would increase inflammation and oxidative stress in an already compromised client. The Organic Acids Test can show you what gut organisms are impacting their function, mitochondrial distress and nutrient needs that can be met. By addressing the concerns on these profile, you can take the stress off of the genetic code and help the client to reduce symptoms.

Q: If someone has intestinal permeability is it more likely that he/she will show multiple sensitivities on testing?

A: Yes

Q: If a patient tests positive for Brewers Yeast and Bakers Yeast, do they have to stop eating bread?

A: If the bread they eat has yeast in it, they should abstain.

Q: How does mold increase oxalate urinary excretion?

A: Mold and yeast create the precursor to oxalates, glyoxylate. Our body then takes this in the liver and creates the oxalic metabolites and then we excrete them in the urine. This happens in normal, non-moldy, conditions due to the normal levels of yeast residing in the body. The over exposure to mold/yeast growth increases their production/excretion.

Q: When are systemic drugs indicated and is mitochondrial toxicity a significant concern?

A: Symptom severity and extent mold colonization and exposure level are wonderful guides for judgement on need for drugs. Mitochondrial toxicity from mold is a concern and can be a concern when using drugs. Also be sure to assess liver function tests depending on which drug you use.

Q: After mold remediation how long should you wait before your test again to se if antifungal medication is required?

A: Retest the OAT and MycoTOX three months after remediation and antifungal therapy. If you want to wait for testing to see if you need antifungals until after remediation, test immediately after remediation is complete.

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Q: Can mold be seen coming out of the skin from detoxing? My son does have one marker indicating possible mold. He details car, wears latex gloves, his hands sweat inside and has black color all over his fingers and hands is coming out. Could that be mold?

A: I’ve not heard of mold coming out of the skin in this way. But since he is a car detailer you may look into the GPLTOX/heavy metal testing to see if he’s detoxing anything other chemicals that he could be exposed to at work.

Q: It the ochratoxin is extremely high but on oat test no aspergillus, it is because of food and not colonized? How can you tell if it is colonized or just need detox? Does the mold recirculate or the mycotoxin?

A: Ochratoxin A also comes from Penicillium mold and the OAT doesn’t directly test for Penicillium. This is more than likely the cause of the Ochratoxin A elevation on the MycoTOX. Foo exposure can cause colonization in the same way water damage building exposure can. The only way to know if it is food exposure is to test and rule out environmental exposures. In most cases mold has colonized. At this time the OAT can only give you specific colonization info regarding Fusarium and Aspergillus. Other molds will need to be clinically assessed to determine if colonization has occurred. Mold organism is not recirculated just mycotoxins.

Q: Is there a way to know how long the mold has been in our bodies?

A: That would be awesome but unfortunately no.

Q: Did he just say the sig for cholestyramine was 4 gr bid WITH food?  But just before that...was saying not to take any of the binders with food as these will bind vitamins and minerals?

A: Cholestyramine can be harsh on the stomach and may cause it to be upset. It can also have an unfavorable taste and is recommended with food. It shouldn’t however be taken with a large meal for interference with nutrient absorption. Consider adding to applesauce or crushed pineapples. See more info HERE.

Q: Would cutting mold off soft fruit or other food, but perhaps consuming the hyphae confer infection or mycotoxin exposure?

A: Cutting away the moldy portion of food would be helpful. There is just no way of knowing for sure you have removed all hyphae/spores. Also eating commonly contaminated foods in moderation you should be able to clear this exposure. This practice would be best for someone dealing with an over exposure of mold toxicity.

Q: Is there a preferred anti-fungal drug or regime for Penicillium mold?  I have a patient with very high values of Mycophenolic acid.

A: Itraconazole is the drug of choice.

Q: Do herbal antifungals work as well as pharmaceutical antifungals?

A: The short answer is no. This is because herbal agents are non-specific, unlike there man made and design antifungal counter part pharmaceuticals. Herbal agents can be utilized and do work, but you should not expect the same timeframe of completion of treatment in relation to that of pharmaceuticals.

Q: Do You recommend OAT urine-test in 24-h urine with HCl?

A: The HCl shouldn’t affect the OAT. It’s not necessarily recommended but it doesn’t have to be discontinued.

Q: How can you tell if the mold is somewhere else than intestinal tract- sinus? How would you treat the sinus, or should you automatically treat sinus as well? Do you need to use biofilm support with mold? Do you always use the binder and how high do you go with binder?

A: Sputum and nasal culture will tell you if there is respiratory/sinus colonization, but clinical symptoms can allude to that as well. Treatment is with oral and intranasal antifungals. If symptoms or culture alludes to mold you should treat. Biofilm disruptors can be helpful and should be considered. Binders are necessary for proper clearance of mycotoxins. They can be given 1-2x a day depending on client bowel movements.

Q: If patient has + organic acids for aspergillus and high levels of mycophenolic acid and citrin do you have to rx with antifungals or can you use herbals and remediation? or does it depend on symptoms?

A: You don’t have to treat with pharmaceuticals, but you should base that decision on clinical presentation.

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Q: Have several patients with torticollis (neck dystonia), any relationship comments?

A: Since this is due to contraction of the neck muscles there could be a neurologic issue causing this. That may be due to mold illness and is an option to consider.

Q: No connection to schizophrenia?

A: There is a potential connection to any neurologic condition. Ruling mold out should be considered.

Q: Is there any association of mold or mycotoxin with PTSD?

A: There is a potential connection to any neurologic condition. Ruling mold out should be considered.

Q: What do you think of anti-fungal herbs?

A: I think they are great. They can be used for antifungal therapy. Check these blog post for more info:

·         https://www.greatplainslaboratory.com/gpl-blog-source/2021/12/essentialoils

·         https://www.greatplainslaboratory.com/gpl-blog-source/2021/01/5herbal

Q: Does hydrogen peroxide kill mold? The companies that fumigate with it state it will penetrate and kill everything, so you don’t have to move. Is this accurate?

A: It has the potential to kill mold. I’m not sure if it penetrates porous materials. You may ask a company that doesn’t use this product for another point of view.

Q: Does the generation of Glutamate in the mercapturic acid formation pathway act as a neurostimulator? can it cross the BBB?

A: Glutamate can cross the BBB, and excess levels can cause increased excitation of the nerve cells, however it is not clear that the glutamate production via the mercapturic pathway is going to the brain directly.

Q: Is bromopropane affecting pituitary hormones such as prolactin similarly to bromocriptine and thus causing HPA disruption?

A: The current studies available on pituitary influences from 1 bromopropane’s  are not strong enough to make that association.

Q: With the increase of the use of e cigarettes with teenagers, are their markers within this test measuring the chemicals found within these products?

A: E cigarettes have been found to have acrolein and benzenes, both measured on the GPL tox. They have also been found to have cadmium, nickel, tin, and lead, so a heavy metal test might also be warranted.

Q: Almost all our homes have some PVC piping. What do you recommend handling this common toxic exposure?

A: Utilizing a water filtration system that includes Reverse Osmosis and Activated carbon.

Q: Does phthalate contamination hold true for all enteric coated medications and supplements?

A: It would depend on the actual medication or supplement.

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Q: Please speak to toxin metabolites not readily released in urine but stored in body.

A: Based on the current research that is available on these toxins, it appears we remove a significant amount of the exposure. However, there may be some residuals left over in the body that are not being excreted, but this is incredibly difficult to account for unless various other tissue samples could be obtained.

Q: How can we detoxify from each of these major chemical groups?

A: Most of the toxins measured can be eliminated by removing the exposure, and utilizing sauna, and glutathione and/or NAC.

Q: Does the type of sauna used i.e. Infrared or moist heat, make a difference in clearance of toxins?

A: The premise of using a heat source is to get the body temperature elevated and create a perspiring effect. When the initial research on this was first conducted, a regular sauna was utilized, and it worked. With the evolution of different heat sources, it certainly has become more sophisticated, but the basics are the same, so the answer is technically, no.

Q: If mitochondria are damaged, can they be repaired?

A: Depends on the extent of damage, but in general, yes.

Q: When you see these compounds elevated in your urine, do you know when thes exposures have occurred? Is this only a test for recent exposure?

A: They are likely recent/current exposure.

Q: Why kind of insect repellants have xylene?

A: You can find out which ones you have questions about using the app “Think Dirty” or EWG’s “Healthy Living.”

Q: Are pyrethrin’s the same as pymethrine for tick prevention?

A: Both compounds have the same mechanism of action (disrupting sodium channel currents, causing loss of motor coordination, paralysis, and death of the insect), and they are very similar in chemical structure. Exposure to either would likely show up on the GPL Tox.  The only real difference is Permethrins are synthetically derived, while pyrethrin is derived from Chrysanthemums. Although pyrethrin is allowed in organic farming when it is not combined with other synthetic ingredients, it is still extremely harmful to the environment, especially to the bees.

Q: Do you see diphenyl phosphate as a listed ingredient on nail polish?

A: It is usually listed as Triphenyl Phosphate (TPHP)

Q: If we can only do so much to avoid phthalates, how do we handle keeping our toxicity as low as possible?

A: Avoiding the most likely sources as much as possible and supporting the body’s natural elimination of them.

Q: Are the phthalates in the medication itself or could it be coming from the plastic bottle the medication comes in?

A: The medications themselves.

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Q: Do you have any data on leaching from implanted devices such as ports?

A: Not that I am aware of.

Q: Can you speak to low long you can show elevated phlalate levels in the urine after exposure?

A: The data is limited on time frames regarding excretion, but the half-life can be somewhere between hours and days within the human body. Excretion is also going to be somewhat individualized based on the patient’s overall clinical picture, and highly dependent on the length of time and amount of exposure.

Q: Is there a risk of Bromopropane absorption in foam mattresses? I have a few patients that felt flu like after getting new foam mattresses.

A: It is very possible.

Q: When our children are jumping on the foam cushion furniture are they out gassing these VLCs.

A: This would be highly dependent on what type of furniture it is, where it is from, and the age of the furniture piece.

Q: Have several patients presenting with torticollis, (neck dystonia) and links that you have seen.

A: Not specifically, but it might be worth testing for toxins, especially if they are within the same geographical region.

Q: How does the amount of glutathione in the body affect the results of the tests?

A: There is no definitive data to support that high levels of glutathione would increase certain levels on the test, but in theory, it is possible. However, it is not advised to take glutathione prior to testing, since the values that are being compared are based on individuals who were not utilizing glutathione, and it would make it difficult to evaluate the levels if it did increase them.

Q: Maybe his grain alcohol consumption is causing an elevate glyphosate level?

A: It is a possibility.

Q: Glyphosate and Chewing tobacco - also in regular tobacco or marijuana (edible or smoking).

A: Smoking tobacco and Marijuana, likely, but would be dependent on the farm that is cultivating it, and what chemicals are being utilized.

Q: if glyphosate can disturb aromatic amino acids, can lower values for HVA and 5-HIAA be related to glyphosate presence (75th %)

A: It is one possibility.

Q: How do I find out the glyphosate in water in specific places where I lived? How much is absorbed through the skin (a bath for example )?

A: Great Plains can test water for glyphosate.

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Q: Recent study reported high unconjugated 4-cresol correlated with kidney disease. this might connect glyphosate with CKD.

A: This is a very interesting connection.

Q: I am hearing that glyphosate is now found in rain. Can you speak to this?

A: Glyphosate is very water soluble and has been found in water and air samples.

Q: Does Glyphosate persist in conventionally fed chickens and their eggs?

A: Previous evidence suggested this was not an issue. LINK. However, a more recent study was able to detect glyphosate in the eggs of Quails that were exposed at high levels, so it seems it may be a potential issue. LINK

Q: With testing well water, with well within 8 feet of corn and soy farm; will testing the nitrates/nitrates within water be enough to glean whether glyphosate is a problem in the well water?

A: No, because there are a lot of factors that contribute to nitrogen sources and levels.

Q: I’m assuming that pesticide spraying over a period of years and in home raise Glyphosate levels..  The patient eats organic non-GMO foods, no Clostridium markers but has Aspergillus/Penicillium markers on OAT.  What type of rx can help besides detox of mold? Thanks

A: Glyphosate levels are measured based on recent exposure.  If they are currently spraying Glyphosate or there is left over amounts in the surrounding soil (usual half-life in the soil is somewhere between 2 and 197 days), there could still be exposure. Glyphosate is not related to mold directly. Sweating, and removal exposure is the best way to eliminate glyphosate. Additional Binders and Glutathione or NAC for mycotoxins.

Q: Do you recommend sauna for children? infrared?

A: If the child can tolerate it, and hydration is monitored, then it can be a therapy utilized in the pediatric population.

Q: Should NAC be taken on empty stomach?

A: It is preferred.

Q: What type of Sauna is effective?

A: The premise of using a heat source is to get the body temperature elevated and create a perspiring effect. When the initial research on this was first conducted, a regular sauna was utilized, and it worked. With the evolution of different heat sources, it certainly has become more sophisticated, but the basics are the same.

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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.

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.

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. 

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. 

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.

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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.

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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

Common Questions on the Organic Acids Test 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 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 response to remaining questions Dr. Woeller was unable to answer during his 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.

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Kurt Woeller, DO

Functional Medicine
and the Organic Acids Test

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.

Q: Can there be significant reason for Low Vitamin C? When Arabinose is high?

A: There can be many reasons for low Vitamin C. However, the OAT value is typically low because it is unstable in urine. Therefore, you cannot use a low value to absolutely diagnose someone as deficient.

Q: Can you see elevations in the amino acid metabolite markers in patients who are carriers for the autosomal recessive inborn errors of metabolism diseases?

A: These elevations would only occur in someone affected by the genetics. They could be a carrier and not affected and their individual metabolites would be normal.

Q: For OAT ranges, sex is relevant. What do we report for sex when patient is trans on HRT? Biological sex or identity due to HRT use?

A: I do not know. You would have to ask the laboratory technicians about that.

Q: Should a patient stop mitochondrial support supplementation before OAT testing?

A: They can, but typically not necessary. It is not known exactly how long someone would have to be off supplements in all cases. A general rule if this is going to be done is about 72 hours prior to testing, but only if tolerated.

Q: Can you review mood disorders and markers on OAT?

A: This would fall under the influence of the neurotransmitters.

Q: Do antidepressants affect those OAT markers and how?

A: They could. You need to look at the mechanism of action of the drug. For example, an SSRI could influence the 5-HIAA.

Q: In the order of treatment where do you place mycotoxin treatment with clostridia and yeast?

A: It is a priority and could be taken on simultaneously with other treatments.

Q: Do you use bouvardia when treating candida?

A: I personally do not use it that often. I have seen too many adverse reactions from it in my patient base.

Q: What is the recommended anti parasitic agents for use with invasive candida?

A: It depends on the parasite and how invasive it is.

Q: Do pharma anti-fungals like Diflucan also break down biofilms?

A: I have heard some might, but do not have any firsthand knowledge of this.

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Q: What factors cause dietary oxalate to become an issue for some people but not others (e.g. leaky gut, vitamin A deficiency, B6 deficiency?)

A: Vitamin B6, Vitamin B1 status, leaky gut, sulfate status, microbiome diversity.

Q: My teenage son has all three high Glyeric (7.5), Glycolic (232) and Oxalic Acid (125) on OAT. He has a clean diet, no to low dairy or gluten, does have high Arabinose (92). Red skinned arms turn white when touched. No other symptoms other than cold/clammy hands. Shall I get him tested for Hyperoxaluria?

A: It sounds like implementing a low oxalate program could be worthwhile. If things are not resolving taking a deeper look at genetics might be beneficial.

Q: Would you recommend Mag Citrate to absorb oxalates versus Ca Citrate given concern about providing too much Ca?

A: The calcium binds to the oxalate and the complex gets excreted in the stool. Mag citrate is fine too, just most the protocols are using calcium citrate, but a combination is certainly okay in my experience.

Q: I am a bit confused by the statement that K2 will keep Ca in bones and not make it available for oxalates. It seems contradictory to taking calcium citrate. What am I missing?

A: Calcium citrate in the gut dissociates and it oxalates are present they form a complex in the gut. This complex is they released out of the body in the stool. Likely little of that complex gets absorbed. Vitamin K in circulation helps calcium that has been absorbed linked to bone metabolism and other physiological needs. Therefore, there is less free calcium available to bind to circulating oxalate

Q: In your experience, have you noticed that there is a connection with high oxalates with parasites or other pathogens die off?

A: I have seen some literature on this, but have not been able to make a connection in practice. It might be happening, but I am not sure.

Q: Do you recommend hair analysis for heavy metal when quinolinic acid is elevated?

A: Yes. But I use hair analysis testing in most patients whether their quinolinic is high or not.

Q: Can you speak some more about using niacin if also doing infrared sauna?

A: It helps induce lipolysis and flushing. It is helpful to take about 20 minutes or so before sauna in those that can tolerate it.

Q: Both lower levels of dopamine & serotonin, would you consider glyphosate toxicity impacting aromatic aminos?

A: I think there is a stronger connection to mycotoxins and/or organophosphates. Glyphosate could be a possibility.

Q: Can you take too much elemental lithium?

A: Yes

Q: Are you using regular or liposomal biocidin?

A: Both. I also use the capsules. I would suggest making an appointment with a representative at BioBotanical Research to discuss the various options.

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Q: What test would you recommend in a young man with low testosterone and altered hormonal status?

A: Salivary adrenal profile with cortisol and DHEA. Also, look at thyroid, liver enzymes, lipid panel for low cholesterol and OAT and mycotoxins.

Q: In individuals who have mold toxicity and severe fatigue what do you recommend for them to do for exercise?

A: Minimally walking, but they need to be careful about doing too much. Their exercise is based on individual tolerance.

Q: How do you work with patients who live in other foreign countries? - lab testing? supplements?

A: Most of these are done through Zoom. People outside the United States can order their own labs and then I help interpret the information, along with suggestions.

Q: Have you seen mold play a role in prostate cancer becoming more aggressive?

A: I am very sorry to hear this. Personally, I have not worked with a lot of individuals with cancer. Based on what Dr. Shaw is discussing with regards to mycotoxin toxicity I am sure this can happen. I wish for you recovery in this process.

Q: I just returned overseas, have lived in Yangon, Myanmar, yeah our water heater was on the roof in our house too...

A: I have now seen this with people in Pakistan, India, and some Middle Eastern counties like Qatar.

Q: What about cholestyramine for mold?

A: This will bind certain mycotoxins of mold, but will not treat the mold organism itself.

Q: Can psilocybin use contribute to fungal growth?

A: These are not something I believe shows up on the MycoTOX profile, but I would not be surprised if someone were fungal toxic that they could become extremely sensitive to these psychedelics.

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Oxalates, Mold & Bacteria - Q&A with Andrew Rostenberg, DC, James Neuenschwander, MD & Emily Givler, DSC

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 Master Practitioner Workshop, speakers shared detailed information on how the MycoTOX Profile, IgG Food MAP and Glyphosate Test can work for you. As well as gave additional information about markers in the OAT and GPL-TOX.

The following Q+A is a response to remaining questions speakers were unable to answer during their 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.

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Andrew Rostenberg,
DC, DIBAK

Bacterial Phenol Overload - A Hidden Cause of Gut-Brain Dysfunction

Andrew Rostenberg, D.C., DIBAK, is a chiropractor, kinesiologist, functional medicine expert, methylation researcher, author, and director of Red Mountain Natural Medicine in Boise, ID.

Q: So if patient with likely phenol overload from SIBO, but also has mycotoxin and oxalic acid issue, what to treat first - the gut?

A: The gut is Phase 0 detoxification – literally detoxification starts in the gut before it even begins in the body. If we are trying to cleanse the metabolic tissues of a toxic patient, but the gut is completely out of order and dysfunctional, then we will not see the best results. Always treat SIBO and other chronic, hidden gut infections first as that opens up the pathways for improved detoxification as the treatment process goes on. You might treat SIBO for 3- or 4-months max, then shift to helping with mycotoxins, mold, heavy metals, xenoestrogens, etc…just depends on what your patient needs.

Q: What if a patient with this high dopamine presentation does WORSE on taurine and TUDCA bile salts?

A: Some people just do not tolerate taurine well. It is a very small minority of people, but they do exist. Studies have shown a relationship to people with psoriasis and an intolerance to taurine. So even though certain supplements are very neutral and well tolerated, you will always find one or two people who are just sensitive in ways that are different from everyone else.

Q: What if someone is missing their Ileocecal valve, (cancer cut out), PLUS no gall bladder? Plus, daily PCN due to no spleen and immune deficiency? What is this person at risk for and how do they fix SIBO?

A: In our experience herbs and natural anti-microbials are well tolerated even by complex patients such as this. Someone without their ICV could perform bowel massages to help regulate peristalsis in the correct direction. They will likely need long-term herbal support to kill excess bacteria and yeast that inevitably get into the small intestine. They will need support for their upper GI tract like betaine HCl, pancreatic enzymes, and bile support (choline, methionine, taurine, ox bile, etc.). They can only fix SIBO by helping to correct the environment in the small intestine, and that will require consistent attention.

Q: So then what can that patient do? Also they have PPI due to GESR and ever increasing brain fog (used to think just due to chemo but suddenly has worsened significantly in the last year, since the pandemic).

A: PPI therapy is a guarantee of nutritional deficiency. That is what we see in practice as the number one problem in our patients – poor nutrient status be it Vit. C, or Vit. D, or any other of the 50 nutrients we need. The goal is to get patients off these PPI medications using any and all available natural medicine tools. Anything that improves the stomach function of our patients will improve their health, and any drug that interferes with normal stomach physiology is a big problem for the long-term health of our patients.

Q: Is this why certain service dogs can smell BS, blood sugar drops? Cancer etc.? phenols vocs, mind blowing…

A: Most likely yes.

Q: What causes flushing when taking high quality B complexes-- SIBO?

A: Any strange or paradoxical reaction to supplements should be investigated as a hidden gut problem until proven otherwise.

Q: So mycotoxins increase aldehydes and also clog up pathway towards COMT and glyphosate can inhibit aromatic aminos, so could things "balance" out, but still be toxic?

A: It’s possible that there are many mechanisms at play and that people can be “balanced out” but still heavily toxic. Best idea is to test and treat these hidden problems and get the balanced without the toxic side effects.

Q: How does mold affect dopamine?

A: Mold inhibits the ability of the body to breakdown catecholamines, so the higher the mold the more slowly dopamine and other catecholamines will be processed which can lead to dangerously high levels of half-way-broken-down dopamine. Mold produces toxic VOC chemicals (essentially indoor pollution) that must be metabolized through Phase 2 pathways in the liver and kidney. If mold levels are high, there is less bandwidth available for dopamine to get processed correctly. We tend to see people with mold exposure as individuals who cannot adequately metabolize their catecholamines due to the interference from the mold poisons the liver is trying to break down.

Q: Could you provide references for the nutrients to decrease/increase Dopamine?

A: References can be found by searching the PubMed library…sorry nothing convenient to share or hand out on this one.

Q: Patient with intermittent PVCs for several years after mold exposure intermittent anxiety completely resolved with B6 50mg daily. What’s the mechanism?

A: Could be multiple things, but B6 with lower SIBO and it is a cofactor for ALT enzyme in the Liver so it will upregulate detox reliably as well.

Q: Same protocols for SIFO as SIBO…. ? What do you think SIFO is?

A: SIBO protocol is more strict than a protocol required to treat SIFO, so if you treat SIBO you will also help reduce the fungal burden in parallel with the bacterial overgrowth.

Register now for our upcoming events and workshops.

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James Neuenschwander, MD

Identifying and Treating Complex Patients with Mold Toxin Induced Illness

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. He 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: Prefer IV Voriconazole or oral, and what doses?

A: Oral: 200mg twice daily.

Q: Are there special considerations for treating a patient with diverticulitis (on a third round of antibiotics) with Hx of chronic fatigue, ebv, and mold. I’m not her physician, she’s my sister.

A: I can’t give treatment recommendations for someone that is not my patient.

Q: What do you think about testing as a preventative - even if you don’t have symptoms - it may be brewing and present as a problem later on?

A: Testing for mold toxins is not that helpful if you are not symptomatic—most people don’t have problems.

Q: Have you found any treatment particularly useful to eradicate MARCONS, possible explanations for non-resolution of MARCONS and how do you treat low MSH?

A: Usually from persistent exposure. Need to regular Neti pot or saline rinses in addition to the antiseptic nasal sprays. Can use PT141 to try to increase MSH, but MARCONS will continue to break it down.

Q: On one panel, all mycotoxins were 0 except for OCHRATOXIN, which was high. Could this be from her excess coffee drinking alone?

A: It depends on the degree of elevation. Food sources will typically elevate levels slightly.

Q: I've heard other practitioners say that S.boulardi produces oxalates, so not good for those who already have mold/fungal issues and too much oxalates. Do you have any thoughts on this?

A: Not in my experience. The balance of the microbiome by S. boulardii usually reduces oxalates. There are some people that don’t tolerate any yeast.

Q: Do you check for adrenal fatigue and how do you treat it if present?

A: That is a two hour lecture.

Q: Do you consider EMFs in your patients?

A: Yes, but extremely difficult to treat.

Q: How do you give Itraconazole dose and interval ? With binders?

A: I use voriconazole.

Q: How do you fix VAGAL dysfunction in your practice? fix underlying mold, but how do you stimulate MMC after the eradication of toxicity?

A: I typically use DNRS. LINK

Q: What is the electron transport chain test called?

A: MitoSwab

Q: Any specific lab for AVH alpha MSH?

A: Not really—you need to know your ranges.

Q: Any recs for alternative to tenting for termites?

A: Not an exterminator.

Q: Vocabulary check POP (persistent organic pollutants)?

A: Yes.

Q: Can you say more about the origins and mechanisms involved in generating high osmolality / low sodium?

A: Don’t know the specific mechanism, but has to do with both renal and brain signaling dysfunction.

Q: What is the conference you were referring to in August in Arizona and are you presenting?

A: August 2021 is Integrative Medicine for Mental Health in Atlanta - use promo code: 50MPW21 for $50 off! The Arizona Conference is MAPS and will be 9/30-10/2 in Scottsdale.

Q: High ANA but no other elevated typical Autoimmune panel-would mycotoxins and/or environmental toxins be a potential cause?

A: Yes.

Q: Since binders are absorbing toxins why would too much of a binder cause a Herxheimer Reaction

A: Too quick of a detox will create symptoms.

Q: Can mycotoxins be responsible for persistent fever?

A: Any immune activation can cause a persistent fever.

Q: In the chronically ill patient with known history of Lyme, co-infections, mold toxicity, long term antibiotics, does the OAT help you differentiate what issues are still active and priorities? Any pearls?

A: It won’t differentiate between Lyme and co-infections, but will tell you about mold and toxicity.

Register now for our upcoming events and workshops.

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Emily Givler, DSC

Oxalates & Mold: A Hidden Source of Inflammation

Emily Givler, DSC is a Functional/Genetic Nutrition Consultant and Dietary Supplements Counselor with the NutriGenetic Research Institute and Tree of Life. She specializes in food sensitivities, utilizing genetically influenced dietary protocols designed to maximize health outcomes while maintaining a healthy relationship with food.

Q: Anything to consider during treatment for clients with NO gallbladder?

A: These individuals are vulnerable to hyperoxaluria without adequate digestion support with something like TUDCA or ox bile. They may benefit from including calcium alongside higher oxalate foods to aid in the excretion of oxalic acid in stool.

Q: Could you recommend a lab for urine sulfate testing?

A: I use over the counter Quantofix sulfite and sulfate test strips. These are a urine dipstick and are good for home testing.

Q: I've heard Dr. Grace Liu say that O.forminges gets too much attention and that other bifido bacteria and lacto bacteria are actually powerful oxalate degraders.  What are you thoughts on this?

A: There are other organisms that can degrade oxalate under various conditions, but the research currently shows that O formigenes plays a primary role in degrading oxalic acid under any physiological conditions. Ideally, we should have a robust microbiome that has a large diversity of symbiotic organisms. I agree that we should not overstate the importance of any one organism. I do find the association between disruption of O formigenes by certain classes of antibiotics helpful to know when taking a history.

Q: How can you increase O. formigenes if not in a probiotic?

A: I try spore-based probiotics like MegaSpore. The goal would be to create diversity even if we cannot target that specific species.

Q: Please be specific with the prebiotics that you use that help the body regrow O.Formigenes

A: I have had good success with MegaSporebiotic, but there aren’t any studies that I can point to on it, only anecdotal evidence.

Q: Lichen Sclerosis not on list, do you suspect any link here?

A: I see associations in my own clients, but it isn’t there in the literature yet. LINK

Q: Where do you get the sulfate test strips?

A: Amazon.

Q: So, what comes first treating the mold or the oxalates? Or do you treat both at same time?

A: This must be an individual decision, but you can start reducing oxalate at any point (as long as a slow reduction approach is taken). You may not see full resolution of the oxalate issue until the mold is addressed if that is the primary driver, but it does not need to be gone before you start the oxalate reduction process.

Q: Do you ever use a Ca Mg citrate combo or the like?

A: Yes, that can be a great choice with meals.

Q: Which product or manufacturer for urinary sulfate testing and what was the range?

A: Quantofix Sulfite optimal 0-10; Sulfate range 400 - 800 optimal; <200 is insufficient, >1200 consider sulfate dumping.

Q: If you see high glycolic or glyceric but oxalic in normal range.  We think Genetic, but how do you get them to start excreting the oxalate?  Sulfate supplementation?

A: Yes, sulfate is likely going to be effective to start mobilizing trapped oxalate, but I would always start slowly in these cases. Epsom salts are generally my starting point. If sulfite is elevated, molybdenum can increase sulfate. Adding B6 can also help reduce oxalic acid production in cases where there is a genetic cause.

Q: Can you use P5P instead of B6 therapy when glyceric or glycolic markers elevated?

A: Yes, that would be my own preference.

Q: Could a patient's worsening of Symptoms if supplemented with B6 or zinc or B1 be because the oxalates where dumped more?

A: Potentially.

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Chronic Candidiasis: Mechanisms of Pathogenicity and Laboratory Testing Options

By Kurt Woeller, DO

Chronic candida has been a well-recognized problem in functional and integrative medicine for many years. It too is a problem acknowledged in conventional medicine, although at times for different reasons, i.e., oral thrush or skin infections.

Candidiasis is defined as a fungal infection linked to any form of candida species. These infections can occur in various places on or inside the body from the mouth, esophagus, intestines, as well as on the skin and scalp. Oral candida overgrowth (a.k.a. thrush), evidenced by white patches on the tongue or other areas in the mouth, is common in immune compromised individuals, the elderly, but also infants. Oral candida can cause mouth sores and make it difficult to chew food and swallow which can be extremely detrimental to the elderly through reduced nutrient intake. Esophageal candidiasis can occur with advancing infection making swallowing even more painful. Systemic candidiasis can occur too leading to candidemia which is defined as a candida infection within the bloodstream. Candida albicans is the species of candida most common in chronic candidiasis, but there are other types in existence known to cause problems as well.

Gastrointestinal candidiasis (GC) is a well-known problem recognized by functional and integrative medicine providers but is an underappreciated condition by many conventional medicine practitioners despite decades of clinical research. In autism, for example, GC commonly causes or contributes to digestive symptoms, e.g., bloating, constipation, flatulence. GC also can contribute to the accumulation of various toxic compounds such as chemical aldehydes known to affect cellular function through various biochemical alterations.

There are multiple mechanisms of pathogenicity associated with chronic candidiasis. Two common occurrences through the production of a toxic organic acid called arabinose and candida’s ability to cause leaky gut will be discussed.

Arabinose, closely related to a sugar alcohol known as arabinitol, is a toxic aldehyde, which has been used for years as an indicator of invasive candidiasis. Aldehydes (-CHO) characterized by a carbon atom double bonded to an oxygen and single bonded to a hydrogen can be a reactive functional group involved in radical formation and oxidative stress. An article in 1995 by W. Shaw, Ph.D. detailing high levels of arabinose in twins with autism eventually led to further research into this compound and its prevalence to various other health disorders, e.g., Alzheimer’s disease. These conditions are often linked in part to chemical imbalances that are oxidative in nature.

Arabinose through its aldehyde group can bind with the amino acid lysine. This essential amino acid found in various proteins when complexed with arabinose can cross-link with the amino acid arginine. Arginine is involved in many physiological functions such as ammonia regulation, release of hormones, immune function, and wound healing. This interaction of arginine and the arabinose-lysine complex can alter normal biological function through the development of a toxic compound called pentosidine. Pentosidine, a glycation end-product, damages neuronal structures and has been linked to myelin damage, neurofibrillary tangle development, and Alzheimer’s disease.

Lysine is a functional component of many enzyme systems that depend on binding cofactors such as vitamin B6, lipoic acid and biotin. Therefore, high amounts of pentosidine formation being driven by excessive arabinose production from the invasive nature of candida may lead to functional vitamin deficiencies even when nutritional intake of these nutrients seems sufficient.

Invasive candida within the digestive system can lead to leaky gut (LG), a.k.a. increased intestinal permeability. This problem is brought about by invasive candida piercing through the apical membrane of an epithelial cell or damaging the tight junctions between these cells.

The lining of the digestive system is a complex network of epithelial structures that are involved in nutrient absorption, toxin neutralization, and mucosal immune function, a.k.a. mucosal barrier. When the mucosal lining is disturbed a leaky gut scenario can develop which allows gut toxins to breach the epithelial barrier and gain access to the lymphatic system and bloodstream. LG is known as a causative or contributing factor in various health conditions such as chronic fatigue, allergies, arthritis, autoimmune diseases/disorders, and other inflammatory diseases.

The detection of candida can occur from various laboratory methods such as serum antibody testing and stool analysis identification. Often a stool analysis may not show the existence of candida, but when organic acid testing is done the presence of invasive candida is recognized through the measurement of arabinose. Unfortunately, some conventional medicine practitioners overlook the existence of candida that may show up in stool testing and even push aside the existence of elevated immunoglobulin G analysis based on the notion that “everyone has candida in their body” (author’s emphasis).

Organic acids are metabolic compounds containing carbon, oxygen, and other atoms such as hydrogen, sulfur, and nitrogen. They are naturally occurring compounds linked to cellular metabolism and may be elevated because of problems in biochemical processing.

Many organic acids are produced by bacteria, candida, and other fungal organisms in the digestive system. These gut-produced organic acids get absorbed systemically then highly concentrate in the urine. They are measured through a laboratory profile called an Organic Acids Test (OAT). Certain organic acids from fungal metabolism represent overgrowth within the digestive tract, while the previously discussed arabinose is linked to the invasive nature of candida at the mucosal level. Arabinose is a prevalent marker seen on the OAT.

In the stool collection method, fecal samples are analyzed by microscopic visual appearance of yeast, as well as growth of the organisms in a culture medium. Being that candida and other forms of yeast are common to the digestive system, it is not unusual to see a positive finding on microscopy. This is commonly listed as “moderate” or “many” yeasts detected, but the actual type of species is determined by stool culture analysis.

The culture component is specific in isolating which type of organisms are present. For example, Candida albicans is the most common type of candida found in the digestive system, but the culture method may detect others such as Candida glabrata or Candida tropicalis.

One of the benefits of differentiating candida types through culture is the ability of the lab to provide sensitivity testing that can help determine which botanical or medication is most effective in eradicating the organism. As mentioned previously, stool analysis for candidiasis through culture is not 100% effective and miss detection even though an individual may be symptomatic of candida overgrowth. It is common to see elevated arabinose on the OAT, while the stool culture for candida is not detected.

Some labs provide polymerase chain reaction (PCR) analysis for candida detection. PCR technology helps make billions of copies of DNA accessible for study (13).  Unfortunately, PCR testing does not differentiate between non-viable (non-living, not capable of reproducing) from viable (capable of reproduction) candida. Other considerations regarding PCR testing are that it can detect multiple pathogens but may not differentiate the causative organism and it may show false positives if the stool sample is collected too soon after previous antifungal treatment.

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Chronic candidiasis can be a challenging condition for many individuals. Effective intervention requires reliable diagnostic testing, as well as understanding the various pathogenic mechanisms inherent to these sophisticated organisms. 

There are many testing options available for the detection of intestinal candida that can determine overgrowth and the degree of invasiveness. Candidiasis, defined as a fungal infection linked to any form of candida species that is detected via serum, stool or organic acid analysis does not necessarily indicate that a patient is suffering from candidemia which is linked to actual intact fungal organisms cultured from the bloodstream. Unfortunately, blood cultures for candida are often unreliable (14) but understanding the clinical application of the methods discussed in this article can provide specific data to help identify individuals clinically affected by candida overgrowth.

In short, the organic acids test is a preferred option because it shows mucosal reactivity to invasive candida even when a stool analysis reports no evidence of candida overgrowth. Often, a serum IgG test will report high levels of candida which may correlate with an elevated arabinose on the OAT.  However, this is not always the case. Therefore, my preference is to use the OAT as a primary test for candida assessment and incorporate stool analysis and/or serum testing as complementary methods.

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In May 2021, Integrative Medicine Academy will be hosting a comprehensive online course designed for health professionals on the topic of chronic candidiasis and related fungal infections as they relate to various chronic health conditions. This course will cover details on laboratory detection of candida, mechanisms of pathogenicity, and various treatment strategies. For more information, please visit Candida Mastery Course – https://candidamasterycourse.com.

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References

1. Candidiasis. Fungal Diseases. United States: Centers for Disease Control and Prevention. 13 November 2019. 
2. Candida infections of the mouth, throat, and esophagus. Fungal Diseases. United States: Centers for Disease Control and Prevention. 13 November 2019. 
3. Symptoms of Oral Candidiasis. cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. 
4. Candidiasis. cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. 
5. Martins N, Ferreira IC, Barros L, Silva S, Henriques M. Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment. Mycopathologia. 2014. 177 (5–6): 223–40.
6. Sell D, Monnier V. Structure elucidation of a senescence cross-link from human extracellular matrix. Implication of pentoses in the aging process. J Biol Chem. 1989;264(36): 21597-21602.
7. Kiehn T, Bernard E, Gold J, Armstrong D. Candidiasis: detection by gas-liquid chromatography of D-arabinitol, a fungal metabolite, in human serum. Science. 1979; 206(4418): 577-580.
8. Shaw W, Kassen E, Chaves E. Increased excretion of analogs of Krebs cycle metabolites and arabinose in two brothers with autistic features. Clin Chem. 1995;41(8):1094-1104.
9. Sell D, Monnier V. Structure elucidation of a senescence cross-link from human extracellular matrix. Implication of pentoses in the aging process. J Biol Chem. 1989;264(36): 21597-21602.
10. Smith MA, Taneda S, Richey PL, et al. Advanced Maillard reaction end products are associated with Alzheimer disease pathology. Proc Natl. Acad. Sci U S A. 1994; 91(12): 5710-5714.  
11. Mahler H, Cordes E. Biological Chemistry. 1966; Harper and Row, NY. Pgs 322-375.
12. Ludovic Giloteaux, Julia K. Goodrich, William A. Walters, Susan M. Levine, Ruth E. Ley, Maureen R. Hanson. Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome. Microbiome, 2016.
13. Saiki, R.; Gelfand, D.; Stoffel, S.; Scharf, S.; Higuchi, R.; Horn, G.; Mullis, K.; Erlich, H. Primer-directed enzymatic amplification of DNA with a thermostable DNA polymerase. 1988; Science. 239 (4839): 487–491. 
14. Cornelius J. Clancy and M. Hong Nguyen. Finding the Missing 50%” of Invasive Candidiasis: How Nonculture Diagnostics Will Improve Understanding of Disease Spectrum and Transform Patient Care, 2013-04-04 Oxford Journals, Medicine & Health, Clinical Infectious Diseases, Volume 56, Issue 9 Pp. 1284-1292.
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The MycoTOX Profile in Action - Elaboration from William Shaw, PhD

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 Master Practitioner Workshop, speakers shared detailed information on how the MycoTOX Profile, IgG Food MAP and Glyphosate Test can work for you. As well as gave additional information about markers in the OAT and GPL-TOX.

The following Q+A is a response to remaining questions Dr. Shaw was unable to answer during his 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.

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William Shaw, PhD

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

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.

Q: Could you explain a little bit about the process of testing the environment and mold removal techniques from home/car for patient tested positive?

A: Clients can choose from about 3 different choices of home testing. The ERMI, mold air sampling plates, and a home inspector are the most common options. Here is a resource for more info on all of these options.

Q: If the OAT is not to be used in place of the MycoTOX Profile, and a client cannot follow up with a MycoTOX Profile after findings of mold in the OAT test, should one address it in some way? I am guessing it is wise to do so.

A: If mold is showing up on the Organic Acids Test and the client cannot test the MycoTOX Profile further investigation of the home/workplace/car/school should take place. This will help you as a practitioner know if they are currently exposed to mold. This will guide your treatment in whether or not to address the fungus with antifungals right away or post remediation/removal of exposure source. Retesting should include at lest a MOAT/OAT and MycoTOX.

Q: Does eating mushrooms or using medicinal mushrooms contribute to mycotoxins in your body?

A: If the mushrooms are contaminated with mold, then they can contribute to mycotoxin exposure. Also, they would most likely need to be ingested at extremely high levels to cause substantial mycotoxin increases. It would be best to investigate a WDB exposure prior to saying it is just the medicinal mushrooms.

Q: If someone is doing a mold protocol and is getting inflammation in the joints how can you support these toxins from excreting properly do you support more of lymph?

A: Lymphatic support is beneficial. Also consider increasing the binder dose if the client’s bowels can handle it. Consider reducing detox support during flares. This may be an aggravation reaction of detoxing too quickly. Supporting oxalate reduction and increasing anti-inflammatory support will also reduce joint pain.

Q: If a patient has a furan-2,5 dicarboxylic value above the average (15), would you treat him with antifungals?

A: This is not a positive result and should be confirmed with a positive MycoTOX Profile. If after consistent detox there is a plateau of progress, antifungals can support healing. I am finding most often people must do antifungal therapy for full resolution in most cases.

Q: How do you gauge whether the oxalate level on the organic acids can be from food? Is there a range that dietary oxalates can fall into?

A: There is not a specific range for any one person. It would be dependent on oxalate food intake you may see from a diet diary or diet history during your intake. Also if fungal markers are elevated on the OAT then its more than likely from that unless they eat a high amount of oxalate rich foods.

Q: Any hypothesized connection between autism, vaccines and mold?

A: Mold and mycotoxins have been implicated in autistic children. There may be a possibility of potential immune alteration of mycotoxins potentially causing adverse effects after vaccination administration.

Register now for our upcoming events and workshops.

Q: How do you manage a patient with autism who has a severe herxheimer reaction during treatment with itraconazole? do you keep the same dose?

A: This is up to the you and client. If they aggravate where they cannot function you can give them permission to reduce or skip a dose until symptoms subside. You may find that some clients that herx give up due to being uncomfortable and not feeling they have any control over their treatment if it gets to be too much. Giving an option to reduce can increase compliance. Also consider increasing the binder dose if their bowels can handle it.

Q: A patient has low Pyroglutamic and Oxalic, but high Glycolic, Glyceric and N Acetylaspartic - what significance of that?

A: These values don’t directly have anything to do with each other at the levels described but, low pyroglutamic acid means glutathione is being made sufficiently. Low oxalic and elevate glycolic and glyceric may be from fungal overgrowth, collagen, or bone broth intake, genetic hyperoxaluria (rare), B6 deficiency. Elevated N-acetylaspartic is associated with Carnavan’s disease (rare) if severely elevated. If mildly elevated this is more than likely due to increased nutrient need and/or gut dysbiosis.

Q: How would one test well water for mold?  and wouldn’t you be able to smell or taste it?

A: Mold testing plates could be used. Just add you water to the plate and see if mold grows. Could have it analyzed by Immunolytics potentially.

Q: What botanicals work against aspergillus?

A: Many antifungal botanicals work against molds like oregano and garlic. Please see 5 Herbal Agents for Antifungal Therapy for more information.

Also check out www.nbnus.net for herbal supplements that will kill mold and fungus.

Q: To clarify, Dr. Shaw believes that no glutathione should be used before mycotoxins testing because the toxins will bind to the glutathione and not be assessed correctly by the mass spec?

A: Correct. We are looking at the toxin unbound NOT bound to glutathione. It will be missed if its bound.

Q: Dr. Shaw disagrees with Shoemaker’s refusal to use anti-fungal drugs. Presumably, this not for all cases? Which molds typically require drugs to kill the organism? Only cases where repeat testing shows returning toxins despite removal of contaminants?

A: If the person is not colonized, then anti-fungal therapy is not needed. However, if continued detox of toxins and removal from exposure source still populates toxin on the MycoTOX Profile, then more than likely this person is going to need anti-fungal therapy. Also, any mold, if colonized, typically needs antifungals to kill them. Pharmaceuticals are beneficial in killing almost all species of mold. There is no one mold that absolutely NEEDs drugs to be killed. Mold is susceptible to natural agents.

Q: Is the mold on cheese toxic? How about if you trim it off and eat the rest? Are some cheeses more prone to toxic molds?

A: Mold on cheese is typically penicillium. In the case of blue cheese mycophenolic acid, a mycotoxin from penicillium, is the main ingredient that gives the cheese its blue color. So yes, mold on cheese can be toxic. If you are to remove the visibly molded spots you are more than likely reducing your exposure but there is no way to rule out microscopic mold growth and mycotoxins that are not visible. If you are not mold toxic then it should not harm you to eat this, but you may want to avoid molded foods to not add to the toxic load.

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Q: Why do males have worse mycotoxin reactions than females?

A: I not sure this is a proven observation. There are many cases where men and women have the same exposure, and the woman has the worst reaction. All vice versa happens. It is more dependent on the individual and their susceptibility to the toxic effects of the mycotoxins.

Q: What is the glutathione challenge? and what were you trying to imply re it? To just not do before testing or you might not pick up the mycotoxins?

A: Glutathione challenge is giving the compound to provoke toxins prior to testing. GPL does not recommend doing this as the mas spec if not looking at the toxin bound to glutathione but unbound toxin. Bound toxin will be missed during sample testing.

Q: What over the counter antifungals were you referring to instead of the prescription ones?

A: Herbal and nutraceutical supplements. Check out www.nbnus.net for OTC anti-fungal options.

Q: Is there a marker in the OAT for actinomycetes?

A: No

Q: Just confirming the need to test liver enzymes twice a week? While on Sporonox.

A: Once a week is sufficient unless they increase and you want to assess sooner that that, then 2x that week would be warranted.

Q: And if mycotoxins are positive, how do you know which species of mold you have?  or does it even matter to know?  in other words, sporonox will treat them all?

A: You can evaluate which species of each genus excretes which mycotoxins to know which mold species you are directly dealing with or at least narrow it down. You could also do a sputum/nasal culture to determine which species is present. In the grand scheme of things, the specific species isn’t necessary to treat as Sporonox works on the ergosterol in the fungal cell wall to kill fungus in general.

Q: How likely are organic blue corn chips to be free of mycotoxins?

A: Not very likely. Corn is a commonly contaminated grain. Also, organic foods do not use pesticides so there is nothing there to kill the potential mold. In other words, organic food has an increased risk of being moldy due to the lack of fungicide use.

Q: What’s the research on seizure disorders and the testing?

A: Here is some info.

Register now for our upcoming events and workshops.

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Organic Acids, Mycotoxins & Heavy Metals - Common Questions

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 Master Practitioner Workshop, speakers shared detailed information on how the MycoTOX Profile, IgG Food MAP and Glyphosate Test can work for you. As well as gave additional information about markers in the OAT and GPL-TOX.

The following Q+A is a response to remaining questions Dr. Woeller was unable to answer during his 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.

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Kurt Woeller, DO

Functional Medicine
and the Organic Acids Test

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.

Q: How does viral genome interfere with this intracellular mechanisms - EBV for example?

A: Viral infections would likely trigger oxidative stress in the cell leading to mitochondrial damage. One of the reasons for high quinolinic acid is interferon production secondary to viral infection.

Q: What’s the difference between blood spot and blood serum vitamin d test?

A: Best to ask Great Plains directly From my understanding there is no difference when looking at 25(OH)D.

Q: Which stool test do you recommend?

A: The CDSA that Great Plains Laboratory has is very good. I also do the Doctors Data GI 360 Profile too.

Q: What markers could correlate with ALS and what other tests would be recommended?

A: No specific pattern for ALS. In anyone with a chronic degenerative condition like ALS I would personally be running the OAT, GPL-TOX, Glyphosate, MycoTOX and Hair Metals Test.

Q: If a patient comes to you with medications, antibiotics, etc. And you recommend doing the OATs. Do you suspend the medications to take the sample?

A: No. I do not have them stop their medications.

Q: Do you use botanicals for yeast overgrow instead of nystatin for some individuals who cannot tolerate Nystatin?

A: Yes, all the time.

Q: This is off the yeast/mold topic but now that Dr. Shoemaker believes that most of CIRS is due to Actinomycetes, is there a test you use that is specific to this bacteria?

A: Not that I know of.

Q: Do you compound this, or do you feel that pharmaceutically available is fine?

A: Usually, the regular pharmacy is okay, but I will compound for sensitive patients.

Q: What is wrong with higher doses, e.g. 100,000 BID?

A: Only the potential for die-off.

Q: Will these also bind helpful nutrients?

A: Yes. They can and should be taken away from supplements and medications by at least a few hours.

Q: To clarify will the zeolite etc.. also bind nutrients, how to avoid this?

A: Likely, it will. Separate by at least a few hours from other medications and supplements.

Q: Is isocitrate lyase a Candida enzyme that disrupts the Krebs Cycle?

A: It’s a enzyme within its own kreb cycle that produces oxalate. So, if you have candida in the gut it has the ability to produce oxalate in the digestive system.

Q: Can you give core biotics to young children? Age 2

A: I have, but conservatively like one capsule.

Q: I'm sure you have heard speculation that there may be correlation between glyphosate use in agriculture in our country starting in the 1950's (I believe) and increasing since that time. I understand that glyphosate is very inflammatory and is a microbiome disruptor.

A: It is a major toxin to the gut microbiome from my research.

Q: Can saccharomyces boulardi impact the arabinose marker?

A: It won’t cause the Arabinose or produce it. But, instead go after Candida that produces it.

Q: Do you test the glyphosate level in your patients with a lot of abnormalities on the OAT?

A: I combine that with the GPL-TOX Profile. I am always concerned about Glyphosate with recurrent clostridia.

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Q: What’s the significance of 5 hydroxybenzoic?

A: Could come from Paraben exposure.

Q: What was the name of the site for practitioners ?

A: Functional Medicine Clinical Rounds – https://functionalmedicineclinicalrounds.com.

Q: Can you speak about SIFO in relation to OATS test?

A: Could cause a lot of markers seen on page #1. But, in my experience the OAT only suggests SIBO/SIFO and is not absolutely diagnostic for it.

Q: I have used Geova neutraval for several years. Can you please comment on why OAT is "better" test?

A: The GPL OAT has the HPHPA and 4-cresol which are really important to obtain because of their significant toxicity. Also, it has the oxalate information which is also important to obtain.

Q: Can supporting these deficiencies (B-6 etc) cause dumping of oxalates into tissues, how to avoid?

A: It is not going to drive dumping, but instead help to divert substrate away from being converted into oxalic acid.

Q: Are there specific metals that may have a higher affinity to oxalates than others? Nickel for example?

A: I do not know of all metal specificities, but Lead and Mercury are certainly high.

Q: Can collagen 20 gram increase oxalates? What about High dose vitamin c at 25 GMs? All of this is possible.

A: The prevalence with regards to this happening I do not know specifically.

Q: So is this SNPs testing to know? Or is this on the OATS Test?

A: The OAT does not have the SNPS. The genetics for oxalates would have to tested through genetic testing.

Q: Any headaches associated with oxalate?

A: Yes. They could be.

Q: Does someone need to stay on a lifelong low oxalate diet or temporarily?

A: It depends on what is causing the oxalates to be high. If it is primarily genetic based then a low oxalate diet is going to be necessary. If the oxalates are from poor nutrients, e.g. B1, B6 and/or mold or yeast produced, then the diet is likely just temporary.

Q: Can you explain your take on fat malabsorption and oxalates? I believe it is important to aid fat digestion when dealing with high oxalates.

A: Fat maldigestion will cause increase oxalate absorption.

Q: What if a patient has high arabinose and oxalic acid, but is unable to tolerate B6 and B1 supplementation?

A: Then you have to work on reducing high oxalate foods in their diet and treat the yeast as best as possible. Hopefully, in time they become more tolerant of these B-vitamins.

Q: When you do the Epsom salts baths how long do you sit in it to be effective?

A: Could be done nightly or at least 3 to 4 times per week. 15 to 20 minutes is a bath is often sufficient.

Q: What kind of diet is suggested before taking OATS test? How many days previous?

A: There are no specific diets needed prior to testing.

Q: Also, I believe there is a Epsom salt cream. Is that effective?

A: It can be, but I think the baths work better.

Q: Do you recommend avoiding high oxalate foods in the days before collecting the oat?

A: No.

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Q: Do you know how phosphatidylcholine compares to CDP-choline? Is there a reason you prefer one over the other for PLA2 inhibition? Any thoughts on Choline Bitartrate?

A: The CDP-Choline combination is what lowers PLA2. Just choline with bitrate will not do it.

Q: If you have nigh arabinose, would you avoid taking extra Vitamin C?

A: No.

Q: What does HVA/VMA ratio means?

A: it is related to the ratio between HVA (dopamine) and VMA (norepinephrine). If the ratio is high than not enough dopamine is getting converted to norepinephrine.

Q: And HVA/DOPAC indicate?

A: Ratio between HVA and DOPAC.

Q: What do it mean when all markers of Beta-Oxidation are high?

A: Problem in fatty acid metabolism with the cell.

Q: Where is lithium listed on OATS, under which heading?

A: It is not in the OAT. It is measured in a Hair Analysis.

Q: What if you’ve been taking NAC (600 mg 2 times a day) and it is not showing up on the OAT test. Why would that be? Will taking glutathione be the next step?

A: That it likely is getting converted over to Cysteine. If the glutathione is still deficient than giving glutathione directly is the next best option.

Q: Oxo-4-methiolbutyric what would cause this to be high?

A: That is a rare genetic disorder linked to Maple Syrup Kidney Disease. Low levels could occur from consuming beets, blueberries and cashews.

Q: Any thoughts come to mind with consistent eye pupil dilation in a 23-year old with AU?

A: I would first start looking at heavy metal toxicity.

Q: Is serotonin syndrome clinically significant in patient on SSRI who wants and try L-tryptophan or 5-http?

A: I personally have never seen serotonin syndrome. It is always possible if too much tryptophan or 5-HTP were taken, but not common in my experience. There may be other doctors who have more experience with this.

Q: Can you say how long you need to treat candida with botanicals, Treatment duration?

A: At least two months. It may require longer.

Q: Do you find twice daily dosing work with Biocidin?

A: Not as great compared to three times daily, but for a low level infection that is not overly bothersome for someone twice a day can work. I have some people where twice daily did the trick.

Q: Do you have to get rid of mold in the environment before you do the antimicrobial treatment for clostridia?

A: No. It is always best to work on the mold, but I have people where I am treating them while they are doing remediation.

Q: What are you favorite soil-based probiotics brands?

A: I use a lot of CoreBiotic from Researched Nutritionals and Proflora 4R from BioBotanical Research.

Q: NADB since the west coast fires have been burning so much? Or is it elevated from rubber mostly? What happened to the RA when clostridia treated?

A: Improved.

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Q: What was the dose of Biocidin you used in the RA patient for 3 months?

A: From what I recall it was two capsules three times daily.

Q: Why test when additional testing with expected positive results will not change your treatment? Or how would you change the treatment if mycotoxins, chemicals were elevated.

A: Because if the person has high Mycotoxins they are going to need to figure out where the mold is coming from. Also, I have seen patients where all the mold markers are normal on the OAT, but they have very high levels of mycotoxins.

Q: What else to look at when #56 NAC is elevated, and Indicators of Detoxification are in the normal range?

A: It could be a deficiency of the enzyme that deacetylates the NAC. I do not know of a specific test for this though.

Q: How do you dose GI Detox, when and how many?

A: For adults I have them start at one capsule twice daily between meals with a range of 1 to 3 capsules as tolerated. If a person can handle three times daily that may be preferred in real bad mycotoxin scenarios. It is all based on tolerance and person must watch out for constipation. I would suggest contacting BioBotanical Research directly for more insight and their recommendations on dosing of their products.

Q: Regarding Small Intestinal Fungal Overgrowth, is there any OAT Info that would equate to diagnosing SIFO? Perhaps Arabinose marker, plus other marker?

A: In my experience, most people with SIBO and SIFO have underlying yeast and fungal problems. Sometimes, they have clostridia too. I always run the OAT on anyone with SIFO or SIBO or who is suspected of having these issues.

Q: If a patient cannot tolerate even one drop of Biocidin do to die off, who has problems with clostridium, candida, and mold, what do you do?

A: This would require a much larger discussion about the various things going on with the patient, their environment, history, etc. In some of these cases there are not easy answers. We developed a website called Functional Medicine Clinical Rounds – https://functionalmedicineclinicalrounds.com to help practitioners work through some of these details. Research the Cell Danger Response. This is likely what is happening with your patient.

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Benefits of Essential Oils

By JASMYNE BROWN, ND, MS

For years, essential oils have been touted for their wonderful healing properties. They are described as stress relieving, calming, good for hair and skin, and uplifting beyond other things. In addition, they are antimicrobial. Many of the plants the oils are extracted from are known for their great medicinal properties. As a rule, essential oils should not be taken internally or used topically without proper dilution or formulation with other herbal agents. In continuance with the previous discussion of fungal overgrowth and the agents that support their reduction, this post will look at antifungal essential oils. These herbs work well with herbs discussed in 5 Herbal Agents for Antifungal Therapy. Here, we will investigate five extraordinary essential oils and their benefit in fighting fungal overgrowths.

Melaleuca alternifolia, a very common essential oil, is known as tea tree. This oil has been used for years as a topical antimicrobial agent. For good reason, as tea tree oil is full of antibacterial and antifungal properties. It has been shown to have efficacy against E. coli, S. aureus, Candida, and Aspergillus.

Topically, it is also effective in killing Trichophyton mentagrophytes, the organism that causes ringworm. This plant works by inhibiting fungal growth and by directly killing the fungi. It has the ability to penetrate the organisms’ cell wall and cytoplasmic membrane. This compromise leads to cellular death of the fungi and bacteria.

Its active compounds are alpha terpineol and terpene 4-alcohol. These compounds work to cause leakage of the cytoplasm, distortion of hyphae, and spore distortion. This wonderfully antimicrobial herb works well against different mold species. It has been shown effective in killing Aspergillus species and Penicillium most readily. This herb would make a great addition to any antifungal topical or oral rinse. Tea tree oil can be harmful if ingested and should be limited to topical usage unless carefully formulated with other herbs in an oral formula. In cases of topical fungal overgrowth, tea tree oil is essential. For mycotoxins, the use of tea tree is beneficial. Not only is it going to kill the mold that produces the toxin, but it will also directly inhibit mycotoxin activity. Tea tree is beneficial in inhibiting zearalenone (ZEA) and deoxynivalenol (DON).

This essential oil is derived from one of my favorite spices, oregano. Also known as Origanum vulgare, oregano, is a well-known, often utilized antimicrobial agent. With its active ingredients of carvacrol and thymol this herb’s active against various pathogens stands the test of time.

Oregano has been well researched in its efficacy against various bacteria. Some common bacteria it is effective against include Staph aureus, Salmonella, Bacillus cereus, Listeria, and Campylobacter. Orally, this plant is efficacious against thrush caused by candida albicans.

Along with its active ingredients of carvacrol, thymol, 4 terpineol work by inhibiting the candida phospholipase enzyme activity. This inhibition stops growth of the fungi and leads to their death. When it comes to mold, this herb works by inhibiting the growth of mold in a similar manner as candida. It is fungistatic and fungicidal. Its inhibitory effect works efficiently for Aspergillus, Penicillium and Fusarium species of mold. Carvone and p-cymene are other active ingredients that work with the carvacrol and thymol for its mold inhibitory effect. The target is the ergosterol of the fungal cell wall. This herb and cinnamon can reduce up to 83% of the ergosterol. Most of its inhibitory effect has been seen in relation to fungal growth and mycotoxin synthesis. It is most effective for blocking aflatoxin and fumonisin B1 toxins. This herb is a classic that will most likely continue to stand the test of time in treating fungal overgrowths.

The next herb is my absolute favorite. Cinnamon! Cinnamon is such a wonderful herb. It is an antioxidant, blood sugar regulating, antimicrobial plus has many other medicinal properties. Because of its medicinal and flavor profiles I find myself adding it to my tea, coffee, meals, and healthy desserts. Other than its flavoring enhancing powers, cinnamon is, in my opinion, an under used antimicrobial. Its active ingredients are cinnamaldehyde, cinnamyl acetate, and cinnamyl alcohol. They work together to inhibit growth of Bacillus species, E. coli, Pseudomonas, and MRSA. Cinnamaldehyde is the main aldehyde responsible for its antimicrobial properties in various ways. By inhibiting cell wall synthesis, membrane function, and enzymatic activity of the microorganism’s cinnamon exerts its fungicidal effect. There has also been evidence of biofilm disruption properties from this herb. The same effect is exhibited on various fungal species. Most notably are Aspergillus, Penicillium, Fusarium and Candida. When it comes to penicillium, cinnamon works by disrupting carbohydrate metabolism. Approximately 14 genes associated with fungal glycolysis, Krebs cycle, cellulose hydrolyzation, and the pentose phosphate shuttle are downregulated. There is also a decreased carb consumption and accumulation with a down regulated ATP production by the fungal organism. This is the mechanism in which cinnamon destroys this organism. It has similar effects on Aspergillus. The cinnamaldehyde works by downregulating the following genes of the mold: polyketide synthase (pks), nonribosomal peptide synthase (nrps), and velvet regulating proteins (veA, laeA, and velB). These are needed for biosynthetic and regulatory processes for sustaining fungal life. They regulated the cell wall and plasma membrane synthesis, mitochondrial and other intracellular organelle presence and function. The pks and nrps genes along with cytochrome p450 monooxygenase and halogenase enzymes regulate ochratoxin A production. The velvet regulating proteins coordinate fungal development and secondary metabolism that can also lead to OTA production. Due to the multiple properties of cinnamaldehyde it not only kills the fungal organism but also downregulates the production of OTA before the organism is destroyed. The action against Fusarium mold is similar. It works by inhibiting mycelial growth and mycotoxin production by causing cytoplasmic leakage.  The direct antioxygenic effects work on the following toxins: OTA, Aflatoxin B1 (AFB1), DON, ZEA, Fumonisin b1.  These properties make cinnamon a great addition in any anti mold or anti-bacterial protocol.

Another commonly used essential oil is Eucalyptus. Many species of eucalyptus are antimicrobial. Globulus, citrodora, and camaldulensis are common species.  Commonly this herb is used for its calming effect and in nasal inhalations for sinusitis. The great benefit of this is that chronic sinusitis is one of the most common symptoms of mold exposure. Other common symptoms and conditions associated with antimicrobial overgrowths are keratitis, conjunctivitis, and other allergy symptoms. Eucalyptus has been shown effective in treating allergic type symptoms. Along with other essential oils like lemongrass this herb is a beneficial addition for those with allergies and upper respiratory conditions. This herb has shown efficacy along with tea tree oil in treating Fusarium keratitis. Dermophytes like, Trichophyton, are also affected by this oil. Eradication by topical application to nail and skin fungal overgrowths have been documented as well. The actual antimicrobial mechanism, unfortunately, is not very well studied. The active ingredients of eucalyptus oil are 1,8-cineole, limonene, p-cymene, γ-terpinene, α-pinene, α-terpineol, camphene, linalool, and ocimene. 1,8 cineole is the most active. Of the volatile component of the oil, up to 75-95% can be active antimicrobial components. This makes this oil very potent. The mechanism of action is thought to be due its targeting of the cytoplasmic membrane integrity leading to impair cell stability and permeability. This causes cellular leakage ultimately killing the organism. In a study that looked at the antimicrobial activity against Staph, Pseudomonas, Klebsiella, and Candida albicans. This study showed that while the extracted 1,8 cineole was beneficial in killing these organisms, most were better addressed with the crude essential oil rather than the extract alone. This shows us that the whole plant is necessary for the full antimicrobial punch that it packs. Another compound found in eucalypts is eucarobustol E. The compound works by inhibiting the yeast to hyphal transformation, causing a reduction of the hydrophobicity of the biofilm, making it more susceptible. It does this by inhibiting genes required for hyphal synthesis which include: EFG1, CPH1, TEC1, EED1, UME6, and HGC. The other way eucarobustol E works is downregulating genes involved in ergosterol synthesis. Ergosterol is the main fungal sterol that gives cell membranes their integrity. It is the cholesterol of the fungal world.  The inhibition of this sterol is another way that the fungal cell is destroyed.

The last essential oil on the list is lemongrass. Sometimes confused with lemon oil, which is extracted from the peel of lemon, lemongrass comes from a type of grass. Also known as Cymbopogon citratus, lemongrass is a commonly used essential oil. Its properties include antibacterial, antidiarrheal, cholesterol reducing, hypoglycemic, sedative, hypnotic, antifungal, and anti-inflammatory. This herb is full of active ingredients. They range from flavonoids and phenolic compounds to ketones and aldehydes. Specific constituents are luteolin, isoorientin2’-O-rhamnoside, quercetin, kaempferol, and apigenin to phytonutrients like citral alpha and beta, nerol geraniol, citronellal, terpineol, limonene, myrcene, and methylheptenone. The alpha and beta citral are what makes it antibacterial. These constituents work together to disrupt and inhibit the growth of fusarium mold. Due to this disruption it also works to block the biosynthesis of mycotoxins. When it comes to candida, lemongrass works to down regulate hyphal adhesion and the virulent factors candida possesses. It is also effective against Staph aureus. Against staph, lemongrass works by inhibiting the gene expression of quorum sensing peptidoglycan and fatty acid biosynthesis. In addition, it has been shown effective in treating aspergillus orally. Another action of attack is its effect as a biofilm disruptor. No matter what the bacterial or fungal overgrowth your patient would benefit with the addition of lemongrass.

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To wrap things up, natural agents can play a giant part in the correction of microorganism overgrowth. Whether they be your main treatment, adjunct to prescriptions, or even a nice topical support for dermal fungal overgrowths. Tea tree, oregano, cinnamon, eucalyptus, and lemongrass are great essential oils to begin with. Do not forget these other honorable mention essential oils: thyme, clove, lavender, clary sage, coriander, basil, rosemary, peppermint, anise, ginger, and sage. With positive OAT mold and yeast markers and positive MycoTOX Profiles these herbs make great additions to treatment. Many formulations take advantage of the antimicrobial nature of these herbs. Check out New Beginnings Nutritional’s for all your antimicrobial supplement needs and keep essential oils in your tool belt as they are highly efficacious.

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Mycotoxins (toxins from mold) are some of the most prevalent toxins in the environment. Mycotoxins are metabolites produced by fungi like mold, which can infest buildings, vehicles, and foodstuffs.

Our primary goals for this test were to design a test that would be more sensitive and accurate as well as more affordable than those currently on the market. We were able to achieve these goals with our state-of-the-art liquid chromatography mass spectrometry (LC-MS/MS) technology. Using this technology, we have a very sensitive test, which is important because mycotoxins can cause serious health issues even in small quantities.

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Discussions about the Amino Acid Metabolites on the OAT

By LINDSAY GODDARD, MS, RDN, LD

The amino acid section on the Organic Acid Test (OAT), which includes Markers 62.-75, often generates questions for practitioners new to the OAT. These metabolic metabolites are typically used by neonatologists, pediatricians, and geneticists to identify in-born errors of metabolism, so they are not necessarily common measurements. Inborn errors of metabolism are enzymatic defects in the metabolism of fats, carbohydrates, proteins, and/or the urea cycle, pyruvate or citric acid cycle, or the electron transport chain. For genetic abnormalities to occur on this part of the test, the elevations must be significantly elevated (meaning well above the second standard deviation). Mild elevations may have some importance, depending on the metabolite being measured, which is denoted in the generated interpretation, and low values rule out these genetic abnormalities. 

To explain the metabolites in this section, below will be a brief overview of the measured metabolites, and the related genetic disorder, or other reasons associated with elevations.

2-Hydroxyisovaleric Acid, 2-Oxoisovaleric Acid, 3-Methyl-2-oxovaleric Acid, 2-Hydroxyisocaproic Acid, and 2-Oxoisocaproic Acid- These metabolites are related to the conversion of branched-chain amino acids (BCAA) into energy in skeletal muscles. Slight elevations may result from lactic acidosis, episodic ketosis, or deficiencies of the vitamins thiamine or lipoic acid. Extreme or multiple elevations can signify Maple Syrup Urine Disease (MSUD). This disorder is defined by a deficiency of an enzyme complex called branched-chain alpha-keto acid dehydrogenase, which is required to metabolize the BCAAs. Below is a figure to help visualize the pathway.

Figure 1: Oxidative degradation of the BCAAs leucine, isoleucine, and valine. The transamination of BCAA is catalyzed by a single branched-chain aminotransferase (reaction 1). The oxidative decarboxylation of BCKAs is catalyzed by the single mitochondrial branched chain a-ketoacid dehydrogenase complex (reaction 2). The metabolic block at the second reaction results in MSUD.

**Adapted from “Lessons from Genetic Disorders of Branched-Chain Amino Acid Metabolism,” by Chuang DT, Chuang JL, and Wynn RM. 2006. Journal of Nutrition. 136. 243S-9S. 10.1093/jn/136.1.243S.

2-Oxo-4-methiolbutyric Acid- This metabolite may be elevated in inborn errors of methionine metabolism; examples include: S-adenosylhomocysteine (SAH) hydrolase deficiency, methylenetetrahydrofolate reductase deficiency (MTHFRD), methionine adenosyltransferase deficiency, and glycine N-methyltransferase deficiency. If suspected, genetic testing is warranted via plasma amino acids.

Mandelic Acid, Phenyllactic Acid, and Phenylpyruvic Acid- These metabolites are associated with the genetic disorder phenylketonuria (PKU), which is caused by a deficiency in the cofactor tetrahydrobiopterin (or BH4). In cases where very mild elevations occur, it may be caused by excessive intake of phenylalanine (dietary or supplementation). Insufficiencies or deficiencies of biopterin may be another potential. Figure 2 is a visualization of phenylalanine and tyrosine breakdown as it relates to PKU and biopterin defects.

Mandelic is also associated with PKU though not present on the figure, and not as well understood. It is believed to be formed from phenylpyruvic acid directly in large amounts. It is a marker that can also potentially reveal an exposure to styrene, measured on the GPL TOX test, when elevated, since it is generated in the metabolism of styrene.

Figure 2: Pathways of phenylalanine and tyrosine metabolism. Enzyme defects causing genetic conditions are depicted as horizontal bars crossing the reaction arrow(s). Pathways for synthesis of cofactor BH4 are shown in purple. PKU* refers to defects of BH4 metabolism that affect the phenylalanine, tyrosine, and tryptophan hydroxylases.

*Adapted from Defects in Metabolism of Amino Acids. Phenylalanine. 2015.

Homogentisic Acid - Homogentisic acid is elevated in the genetic disorder homogentisic aciduria (also known as, alkaptonuria). Homogentisic acid damages cartilage and heart valves, with the potential to precipitate kidney stones and stones in other organs. Symptoms typically occur after 30 years of age, but dark urine (almost black) is apparent at birth. Slight increases may indicate the heterozygous genetic carrier state of the disease.

4-Hydroxyphenyllactic Acid - Increased values are commonly associated with tyrosinemias, which can result from immature development of enzyme synthesis in infants or genetic deficiencies. Slight increases may be due to increased tyrosine intake, bacterial gut metabolism (potentially clostridia species), short bowel syndrome, or liver disease.

N-Acetylaspartic Acid - Elevated N-acetylaspartic acid is due to the genetic disorder Carnavan’s disease, a potentially fatal disease-causing spongy degeneration of the brain.

Malonic Acid - Associated with the genetic disorder malonyl-CoA decarboxylase deficiency or malonic aciduria with normal malonyl-CoA decarboxylase activity. Slightly elevated values in urine are unlikely to be clinically significant.

4-Hydroxybutyric Acid- Very high levels may indicate the genetic disorder involving succinic semialdehyde dehydrogenase deficiency. A decrease in this enzyme leads to an increase in GABA and GHB, especially in the brain and spinal cord, leading to a myriad of neurological disorders.

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In conclusion, these metabolites are measuring the functionality of enzymes associated with the body’s utilization of certain amino acid groups, going beyond digestion and absorption of amino acids. Therefore, low values do not indicate defects in breaking down or absorbing protein, rather the inference is the associated enzyme is functioning well because there is no backup of that metabolite. Due to the rarity of these genetic diseases, it is uncommon to see elevations in this section, rather, it is more common to observe low values. With that in mind, when elevations in this section do occur, it may be helpful to utilize the consultations services to help further investigate the potential need for genetic testing.

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References

1. Rare Disease Database. Maple Syrup Urine Disease. 2020. SOURCE
2. .Chuang, David & Chuang, Jacinta & Wynn, R.. (2006). Lessons from Genetic Disorders of Branched-Chain Amino Acid Metabolism. The Journal of nutrition. 136. 243S-9S. 10.1093/jn/136.1.243S.
3. Alfonso, I.  Neuroneonatology. Errors of metabolism; pg 72. Accessed 2/25/2021 SOURCE
4. Rezvani I and Melvin JJ. Defects in Metabolism of Amino Acids. Phenylalanine. 2015. SOURCE
5. Longo N. Disorders of biopterin metabolism. J Inherit Metab Dis. 2009 Jun;32(3):333-42. doi: 10.1007/s10545-009-1067-2. Epub 2009 Feb 9. Erratum in: J Inherit Metab Dis. 2009 Jun;32(3):457. PMID: 19234759.
6. Shintaku H. [Biopterin and child neurologic disease]. No To Hattatsu. 2009 Jan;41(1):5-10. Japanese. PMID: 19172809.
7. Godwin BL, Ruthven CR, Sandler M. Phenylpyruvic acid may be a direct precursor of mandelic acid without intermediate transamination of phenylalanine. Biochem Pharmacol. 1993 Dec 3;46(11):2109-10. doi: 10.1016/0006-2952(93)90656-h. PMID: 8267662.
8. Chuang, David & Chuang, Jacinta & Wynn, R.. (2006). Lessons from Genetic Disorders of Branched-Chain Amino Acid Metabolism. The Journal of nutrition. 136. 243S-9S. 10.1093/jn/136.1.243S.
9. Elia VJ, Anderson LA, Macdonald TJ, Carson A, Buncher CR, Brooks SM. Determination of urinary mandelic and phenylglyoxylic acids in styrene exposed workers and a control population. Am Ind Hyg Assoc J. 1980 Dec;41(12):922-6. doi: 10.1080/15298668091425879. PMID: 7468463.
10. Medline Plus and Genetic Home Reference. Succinic semialdehyde dehydrogenase deficiency. 2020. SOURCE

Elaboration on the Organic Acids Test

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 extolled the virtues of comprehensive metabolic tests like the Organic Acids Test (OAT) and the MycoTOX Profile to help with difficult-to-diagnose patients.

The participants heard ways of how to implement these tests along with other diagnostic assessments, as well as effective treatment methods.

The following Q+A is a response to remaining questions Dr. Woeller was unable to answer during his 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.

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Kurt Woeller, DO

Functional Medicine
and the Organic Acids Test

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.

Q: Is high fatty acids due to coconut oil in the diet clinically significant? Is that showing a problem or just a false positive?

A: It is not necessarily a problem that I know of that would cause toxicity at the cellular level. But, it does point out that our cells can only take up so much lipid at any given time to function effectively.

Q: If there is a problem with medium-chain fatty acid beta-oxidation, how does that manifest in omega-oxidized organic acids? Do all of 47, 48, 49 become elevated, or is there some other pattern to 47, 48 and 49?

A: The first two fatty acids are strongly linked to ketosis, but there is a relationship with poor cellular metabolism of certain amino acids like isoleucine, leucine, and valine metabolism. Other individual fatty acids are linked to other specific biochemical pathways that can from various enzyme defects or mitochondrial problems. The biochemistry is complicated, and we go into this extensively in Module #10 of our Advanced OAT Mastery course.

Q: What of add ADHD and yeast metabolism? Is it worthwhile to be doing the testing?

A: It is important to always do the OAT for ADD/ADHD. I also make sure to do the Hair Metals Test and Food IgG MAP from Great Plains Laboratory as initial testing too.

Q: I don't see, Avoid Vitamin C, Tryptophan, Coffee in manual. Should this food and supplements be avoided before test and how many hour?

A: No. I do not personally have people stop their supplements prior to testing.

Q: If you have only hydroxybutyric elevated and the patient is not on a keto diet what is the cause?

A: Need for additional antioxidants. The body is most commonly pulling things into the pathway for glutathione production.

Q: What chemical pathway did you say indicates aggravation of POTS?

A: Dopamine-Beta-Hydroxylase, which converts Dopamine to Norepinephrine.

Q: Is the inflation of the fatty acids a bad thing?

A: It depends on what is causing it. There are disease states that can inflate these numbers. The biochemistry is complicated, and we go into this extensively in Module #10 of our Advanced OAT Mastery course.

Q: Would the high markers that could be associated with high usage of coconut oil be a sign of food sensitivity?

A: Not that I know of.

Q: Please explain what is meant when all detox markers are elevated. What is happening metabolically with patient?

A: Let’s focus on Pyroglutamic and 2-hydroxybutyric. If those two are elevated the patient is glutathione deficient from some toxin or toxins. The 2-hydrobutyric is linked to glutathione production or the demand for more glutathione.

Q: Any other reasons for elevated glutaric in someone taking B complex supplements and other b vitamins normal?

A: There are many, but the most common is increased need for mitochondrial support and high levels of candida toxin acetaldehyde.

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Q: For patients not toilet-trained, try to capture a concentrated urine after how many hours?

A: First morning urine. The parents can have their child stand up in the bathtub and run warm water over their feet. This will usually trigger them to urination.

Q: Why is arabinose range of value on the lecture slides normal range <50? On my recent test it is <20. Did entire range get changed?

A: Range changes based on age and sex. Greater than 13 years old male and female, and less than 13 years old male and female, will have different reference ranges.

Q: How often should someone do an OAT?

A: At least once yearly as a screening assessment.

Q: Please explain again, how to interpret the nutritional markers that do not have an * (indicating possible deficiency if high).

A: The asterisk markers are only significant when elevated. If elevated, that means a deficiency of the respective nutrient. The non-asterisk markers are direct assessments. It gets tricky with NAC because levels are typically on the lower end of the scale which can be normal as NAC is converted to glutathione. Low levels of ascorbic are not valid for ascorbic acid determination since it is unstable in urine samples.

Q: How long do you have to avoid B12 supplements to get true/accurate picture of patients B12 status from MMA marker.

A: Good question. I am not sure exactly. It likely would only be a few days since B-vitamins like B12 are water soluble and the effects biochemically on the pathway linked to MM is constantly ongoing.

Q: 3 oxoglutaric acid. What is it? What is it correlated with?

A: It is an organic acid produced by various species of yeast organisms

Q: If a patient is highly positive for Aspergillus and is treated (Nystatin, N-acetyl L Cysteine, Acetyl Lcarnitine, activated charcoal, home remediation to eliminate mold) , do you expect markers to go down and what is timeframe? What is succerate?

A: Yes, the markers on the OAT should go down and could do so quickly within a few weeks. The same would be true of Succinic or other markers being influenced by yeast/mold toxins.

Q: Do you recommend following up a nutrition marker out of range with a blood test? How long refrain from supplements to get accurate test of nutrition markers on OAT?

A: I do not personally have people stop their supplements prior to testing. I typically do not have patient do follow-up blood testing for nutrients unless there was really strong clinical evidence to do so.

Q: How variable is microbial part of OAT day to day?

A: There may be slight fluctuations, but not dramatic unless there has been some massive surge in toxin production in the gut.

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The Evidence Behind Mycotoxins in Food

By LINDSAY GODDARD, MS, RDN, LD

Without a doubt, mycotoxins can be harmful to our health, especially if we are inundated with mold within closed home or office spaces. When it comes to food sources, however, questions arise as to whether certain foods should be eliminated to reduce exposure to mold, and if there are health implications to consuming foods with mycotoxins. Dietary restrictions should not be implemented frivolously, especially for individuals who may already be overwhelmed with nutrition interventions and eliminations. Documentation within the literature and through clinical practice has shown the demise of patients with regards to their nutritional status, microbiota function, and quality of life, due to restrictive diets. The decision to remove certain foods should be evidence-based, and a diet plan should present a clear benefit to the patient. Thus, the goal of this article is to provide substantiation for the idea that eliminating certain foods can reduce mycotoxin exposure in many situations. We begin by looking at the most relevant mycotoxins in our food supply, and then examining the data regarding mycotoxins frequently found in food, along with assessing the possible role of food mycotoxins in the development of mycotoxicosis.

Before we delve into a literature review of mycotoxins in foods, let us briefly discuss why these mycotoxins are pertinent to our health. Included are the most relevant of the common mycotoxins, along with their potential impact on biological systems.

Toxicity and carcinogenicity have been found in both human and other animal populations. High acute exposure can lead to death, while chronic exposure can cause immune suppression and even cancer. The liver is the main organ affected in several animal classes (fish, birds, rodents, and primates).

Nephrotoxic to all animal species, and in most animals, a hepatotoxic , immune suppressant, a teratogen, and a carcinogen. Primarily, its biggest impact seems to be inhibition of the enzyme involved in synthesizing the phenylalanine-tRNA complex, as well as, affecting ATP production in the mitochondria, and lipid stimulating peroxidation.

(ex: Deoxynivalenol, or DON): Cause various symptoms, from alimentary hemorrhaging and vomiting after high consumption, to dermatitis from smaller exposures. In several vertebrate organisms, studies have shown an impact on almost every major system, mostly associated with gastrointestinal, dermatological, and neurological symptoms.

Very toxic in high concentrations, but evidence of poisoning in a natural environment is still inconclusive.

A wide range of effects on various mammals have been observed, centering mainly on interference with sphingolipid metabolism. Studies have demonstrated leukoencephalomalacia in equines and rabbits, pulmonary edema and hydrothorax in swine, and hepatoxic and carcinogenic effects in rats.

Effects mainly involve hormone disruption. This mycotoxin’s structure resembles 17Beta- estradiol, as expected, it impacts estrogen levels, and ultimately fertility.

Nephrotoxic to all animal species, but the threshold of acute toxicity is highly variable among species. Simultaneous exposure to both Citrinin and OTA can depress RNA synthesis in kidneys.

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A glance back in history reminds us of the detrimental impact that mold and mycotoxins has had on our food supply: ergot poisoning from contaminated rye (“St. Anthony’s fire”, 1100 BCE-1800 CE); cardiac beriberi associated with Penicillium molds in rice (“yellow rice toxins”, 2006 in Brazil; 1937, 1948, and 1951 in Japan); and alimentary toxic aleukia associated with Fusarium molds on overwintered wheat, millet, and barley (USSR, World War II era).  In 1974, acute Aflatoxin poisoning from moldy corn in Western India caused 100 deaths, and evidence suggests that the adults may have eaten 2 to 6 mg of aflatoxin in a single day. This event led to the calculation of 10 to 20 mg of aflatoxins as the acute lethal dose for adults. In 2004, Aflatoxin poisoning fatal to 125 people occurred in Kenya from contaminated corn (estimated contamination rate ranged from >20 to >1,000 µg/kg). Continuing investigation of mycotoxin-contaminated food suggests that it is still quite common, but to a much lesser extent, at least in developed countries. The UN Food and Agriculture Organization (FAO) assessment indicates that 25% of global fodder crops are contaminated with mycotoxins. Shiratori N, et al. investigated penicillium contamination on rice in Thailand, and found that only 1 of 10 samples contained Aflatoxin B mycotoxin (5.9 μg/kg), although 7 of 10 samples did have trace amounts of Penicillium species isolates. A study conducted on Green Coffee Beans from Brazil found that 91.7% of the 60 samples were contaminated with mold isolates (mainly aspergillus), but only 33% had OTA (0.2- 7.3 μg/kg). Keep in mind, this is below the acceptable limit proposed by the European Union (<8 μg/kg), and below the US limit of <20ppb. So wait, it’s being monitored? Yes! To some extent.

Mold and mycotoxin contamination prevention have become part of the food and agricultural industry, which continues to work on monitoring and reducing it, in part by developing with regulatory standards. Aspergillus, Penicillium, and Fusarium are the most common molds affecting our food supply. Guidelines are in place for the most prevalent mycotoxins and the most common contaminated foods in order to prevent toxic levels.

** Beer, wine, dried beans, dried fruits, vegetables, spices, and fermented beverages have been found to be susceptible to OTA contamination, but the FDA does not mention these as potential sources.

Allowance levels differ based on the mycotoxin, the crop, and its destination. Below is a table that provides some information for the mycotoxin allowance in the United States. Please note, that this list is not exhaustive, but serves as a tool for insight into allowance levels.  As noted previously, the European Union is also monitoring, and may differ on amount allowance. For the scope of this article, US standards will be the focus.

MYCOTOXIN	FOOD	ALLOWANCE
Aflatoxin (Aspergillus flavus and A. parasiticus)			Action level/limits
	Corn and peanuts intended for beef cattle	300 ppb
	Corn and peanut products intended for swine greater than 100 lbs	200 ppb
	Cottonseed meal intended for beef, cattle, swine, or poultry (regardless of age, breeding status or finishing status)	300 ppb
	Corn and peanuts intended for breeding livestock	100 ppb
	Corn, peanut products, and other animal feeds and feed ingredients (excluding cottonseed meal), intended for immature animals	20 ppb
	Brazil nuts	20 ppb
	Foods for human consumption	20 ppb (Europe is 0.1-2 µg/kg)
	Peanut and peanut products	20 ppb
	Pistachios	20 ppb
Aflatoxin M1	Milk	0.5 ppb
Ochratoxin A (Aspergillus and Penicillium)	Rye flour, wheat flour, some corn products, barley (cereals), oats, both whole and cereals, dried beans, cornmeal, raisins, coffee, soy flour, soy based baby foods, and ground ginger	Less than 20 ppb does not require reporting, more tan 20 ppb needs to be sent off for evaluation by the FDA.
Deoxynivalenol DON (Fusarium)			Advisory Limits
	Corn and grains intended for immature animals and for dairy animals	1 ppm
	Corn and other grains intended for breast feeding beef cattle, breeding swine, or mature poultry	5 ppm
	Corn and other grains intended for finishing swine of greater than or equal to 100 lbs	10 ppm
Fumonisins			Action level/limits
	Foods for human consumption	2 - 4 mg/kg * (Max allowed set by FDA)
	Foods for animal consumption	1-100 ppm, depending on animals
Patulin (Penicillium, Aspergillus, and Byssochylamys)	Apple juice	50 ppb	Action level/limits

**1ppb = 1µg/kg

There is a difference between an action level and an advisory limit. If the mold level in a food is at or above the Action Level, the FDA will take legal action to remove the product from the market. If a food mold level meets an advisory limit, governmental recommendation indicates that it may be a potential health hazard.

Only corn and peanuts are tested for aflatoxin, per the FDA. They state that “nuts (almonds, Brazil nuts, macadamias, pecans, pistachios, walnuts, and hazelnuts) are susceptible to aflatoxin contamination, but samples of these nuts have been largely in compliance [less than 1% ] for several years. Per the FDA, OTA is being monitored and measured, but a limit for ochratoxin in the food supply has not yet been established. A sample is reported if the ochratoxin result is above a certain threshold (>20 ppb).

Statements from the US FDA conflict with the scientific literature; the FDA notes limited data on OTA while the literature contains a significant amount of data on ochratoxin effects, especially nephrotoxicity.  The International Agency for Research on Cancer (WHO) has rated OTA as a possible human carcinogen (Category 2B). The European Union Scientific Committee recommends the OTA be reduced to <5 ng/kg, but the allowance varies by country and by crop.  Because OTA appears to be less heat-stable than Aflatoxin or DON (which is extremely stable during food processing), the FDA considers it less of a threat for human consumption. A 2016 study out of the University of Idaho tested OTA levels at different temperatures, times, and pH conditions. The largest degradation of OTA (90%) was at 200°C (almost 400 °F), except for samples at a pH of 4. The US does not have contamination standards on zearalenone levels, but the EU requires < 75-350 µg/kg, depending upon the food category. Even a level of 1ppm has been shown to lead to hyperestrogenic syndromes in swine. The FDA categorizes it in a similar manner to OTA contaminated samples, and reports them to the Center of Veterinarian Medicine to determine if regulatory action is required.  Citrinin is not monitored, although it is known to be commonly associated with human food.

Organic foods deserve a special mention when considering mycotoxin avoidance. Quite a few studies support the claim that organic foods do tend to have more mycotoxin contamination, mainly due to use of less potent fungicides. In a 1995 study, conventional and alternatively grown rye and wheat were found to have to have a significant difference of DON mycotoxin levels.  Conventional rye had an average of 160 µg/kg, while the organically grown rye had an average of 427 µg/kg. Zearalenone in wheat was also investigated and found to have an average of 6 µg/kg in conventional, compared to 24 µg/kg in the alternatively grown crops. A French study comparing organic and conventionally grown wheat generated similar findings: the organic version had an average of 106 µg/kg of DON, whereas conventional wheat had only 55 µg/kg. Apples have also been investigated, with similar results; conventionally grown apples had a median of 35.85 µg/kg of patulin mycotoxins, while the organic apples had a median of 211 µg/kg. This presents a significant barrier to reducing mycotoxins in the diet, since organic foods are a large part of nutrition therapy in Integrative Medicine.

The scientific community is continuing to discover the intricacies of mycotoxins interactions with organisms, and their resulting impact on the food supply and on human health. To date, 300 mycotoxins (and counting) have been identified, although 100,000 mold species (still counting) have been discovered, requiring effort to understand how they affect us. Along with monitoring at least the highly susceptible food sources, considerable resources are expended to hinder food contamination.  Prevention seems to be the key aspect to reducing mycotoxins and mold in food. New and fresher solutions to lowering mycotoxins in food include earlier detection of fungus (i.e., biosensors), breeding host plants for greater fungal resistance or using genetic engineering to add antifungal genes, and even targeting genes that regulate mycotoxin synthesis in fungal species, along with the standard approach of applying fungicides at various stages of growth, harvesting, transportation, and sale of foodstuffs.  

In summary, we have discussed the most frequent sources of mycotoxin contamination, the most susceptible foods, and strategies in place for monitoring and preventing mycotoxins from entering our food supply, now, how do we apply this information to clinical practice?

It appears that some exposure to mycotoxins is almost inevitable, and a truly “low mycotoxin” or “low mold” diet would leave one with very few food options. Before embarking on a project to eliminate mold exposure from food, it is imperative to take in the entire clinical picture as individual reactions vary widely. Ranges for potential exposure have been developed based on available data and clinical observation . However, it is necessary to consider a person's; age, body composition, nutrient status, comorbidities, allergen sensitivities, genetics, current toxin burden, the effect of a combination of different mycotoxins, etc., etc., as all have shown to impact the severity of symptoms and their progression. A look into the literature suggests that some diseases may be associated with food mycotoxins, but the evidence is incredibly difficult to assess over a lifetime. For example, epidemiological studies have shown correlations with increased incidence of hepatic carcinoma in populations with higher dietary aflatoxin exposure in addition to diagnosis of hepatitis B. An overall strategy, particularly for high-risk populations may involve reducing or removing foods , likely to have fungal contamination, with the clear understanding that individual response to mycotoxin exposure is not predictable.

Dietary restrictions to avoid mold exposure should be decided between provider and patient, with the assumption that it is probably not possible to be completely free of mycotoxins in food.  The goal should be to reduce the load as much as is practical for the individual. We hope this evidence-based discussion will help in designing individual versions suitability of the “mold diet”.

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References

1. Ehling, G., Cockburn, A., Snowdon, P., and Buchhaus, H. (1997) The significance of the Fusarium toxin deoxynivalenol (DON) for human and animal health. Cereal Research Communications, 25: 443-447.

2. Khera KS, Arnold DL, Whalen C, Angers G, Scott PM. Vomitoxin (4-deoxynivalenol): effects on reproduction of mice and rats. Toxicol Appl Pharmacol. 1984 Jul;74(3):345-56. doi: 10.1016/0041-008x(84)90288-6. PMID: 6740683

Kuiper-Goodman T. Mycotoxins: Risk assessment and legislation. Toxicol Lett. 1995 Dec; 82-83:853-9. doi: 10.1016/0378-4274(95)03599-0. PMID: 8597153

Vanhoutte I, Audenaert K, De Gelder L. Biodegradation of Mycotoxins: Tales from Known and Unexplored Worlds. Front Microbiol. 2016; 7:561, Published 2016 Apr 25. doi:10.3389/fmicb.2016.00561

Horgan, J. (2020, July 17). St. Anthony's Fire. Ancient History Encyclopedia. Retrieved SOURCE

Shiratori N, Kobayashi N, Tulayakul P, et al. Occurrence of Penicillium brocae and Penicillium citreonigrum, which Produce a Mutagenic Metabolite and a Mycotoxin Citreoviridin, Respectively, in Selected Commercially Available Rice Grains in Thailand. Toxins (Basel). 2017;9(6):194. Published 2017 Jun 15. doi:10.3390/toxins9060194

Martins ML, Martins HM, Gimeno A. Incidence of microflora and of ochratoxin A in green coffee beans (Coffea arabica). Food Addit Contam. 2003 Dec;20(12):1127-31. doi: 10.1080/02652030310001620405. PMID: 14726276

Wan, J, Chen, B, Rao, J. Compr Rev Food Sci Food Saf. 2020; 1– 27.

U.S. Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health, National Institute of Environmental Health Sciences. Environmental Health Perspectives. Volume 107, 10/1999. Pg A515

Haschek WM, Voss, KA, Beasley VR. Handbook of Toxicologic Pathology (Second Edition), 2002. SOURCE

Bennett JW, Klich M. Mycotoxins. Clin Microbiol Rev. 2003;16(3):497-516. doi:10.1128/cmr.16.3.497-516.2003

Riches, E. Organic Food- The Hazard of Mycotoxins. CABI. 2003. SOURCE

Marx, H., Gedek, B. and Kallarczik, B. 1995. Vergleichende untersuchungen zum mykotoxikologischen status von ökologisch und konventionell angebautem getreide. Zeitschrift für Lebensmitteluntersuchung und –forschung. 201: 83-86.

Bhatnagar, D., Payne, G.A., Cleveland, T.E., Robens, J.F. Mycotoxins: Current issues in U.S.A. Proceedings of the 2nd Second World Mycotoxin Forum, February 17-18, 2003, Noordwijk, The Netherlands.

Guidance for Industry: Action Levels for Poisonous or Deleterious Substances in Human Food and Animal Feed. 2000. Food and Drug Administration. SOURCE

Brown, R. L., D. Bhatnagar, T. E. Cleveland, and J. W. Cary. 1998. Recent advances in preharvest prevention of mycotoxin contamination, p. 351-379. In K. K. Sinha and D. Bhatnagar, (ed.), Mycotoxins in agriculture and food safety. Marcel Dekker, Inc., New York, N.Y

Food and Drug Administration. CVM Annual Report on Mycotoxins in Animal Food Report for Fiscal Year 2016. SOURCE

Food and Drug Administration Office of Regulatory Affairs ORA Laboratory Manuel Volume IV Section 7. Mycotoxin Analysis. 2020. SOURCE

Sudhakar P, AswaniKumar YVV, Bodaiah B, Mangamu UK, Vijayalakshmi M and Renuka RM (2016) Mycotoxin Strategies: Impact on Global Health and Wealth. Pharm Anal Acta 7: 498. doi:10.4172/2153-2435.1000498

Mateo, R., A. et.al, 2007. Intl. J. Food Microbiol. 119 (1–2): 79–83. 11. Yin, YN et al., 2008, J Zhejiang Univ. Sci. B 9 (10): 787–92

Webinar Recap: Functional Medicine and the Organic Acid Test

By Kurt Woeller, DO

There are various laboratory tests useful in functional medicine. The Organic Acids Test (OAT) is one such profile which reveals a lot of important information that every integrative and functional medicine practitioner should learn how to interpret. This lecture will provide information useful for a new practitioner to the OAT and those more experienced in applying OAT information in clinical practice.

Functional Medicine And The Organic Acids Test (OAT) from The Great Plains Laboratory on Vimeo.

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During the course of the Webinar, individuals were able to ask questions of the speaker. Because of time constraints, not all the questions were able to be answered in real time. We are happily able to answer those questions below.

Q: Is this Lactic acid the same that is elevated with sepsis?

A: Yes. It could be elevated because of sepsis.

Q: Is there any relationship between aspartame metabolism and the production of acetaldehyde?

A: I am not sure. That would be an interesting thing to research.

Q: Will the OATS test aid in knowing about heavy metals?

A: Not specifically. You would need to do specific heavy metal testing like blood and/or hair analysis.

Q: Every time the need arises to be aware of CKD and filtration deficit - we have to know how to direct the OAT test to decreased GFR - but you have shrugged that off. How can we work with this kidney pandemic and OAT testing?

A: Great Plains Laboratory does creatinine correction method on their urine samples which can help offset some the issues in kidney disease. There may be specific types of kidney disorders that would need special attention. The lab would know the answers to these scenarios. My recommendation is contact GPL directly and speak to one of their lab scientists.

Q: Could you explain more about B5 role in this? Why would it be high for example?

A: Vitamin B5, pantothenic acid, is the precursor to Coenzyme A, which combines with an Acetyl group, to become Acetyl-CoA. The enzyme Pyruvate Dehydrogenase which converts Pyruvic Acid to Acetyl-CoA needs the actions of Vitamin B1, B2 and B5, along with Magnesium, Lipoic Acid and NAD+.

Q: Are migraine headaches a sign of possible vitamin B2 deficiency?

A: They could be one cause. I know there has been some use of B2 for migraines. Personally, do not know a lot about the research into this situation.

Q: Do you prescribe a B complex or individual B’s? any favorite brands of B vitamins?

A: Most of the time I am starting people on a multi-vitamin/multi-mineral and use B-complex to boost things up as needed. In some cases where a singular nutrient really needs support, e.g., B6, B1, I will use them individually. Check out the list of products at New Beginnings Nutritionals.

Q: Is there a reason why Clostridia and Candida would appear to be a indicator or problem on an OAT but not show up on a GI test?

A: This is common. Most labs are only looking for C. difficile associated toxins A &B on stool testing and there can be various of strains of C. diff. not associated with digestive system disease. Candida often does not culture on stool testing because of various unique evasive methods it has to become invasive at the mucosal level in the digestive system. Also, upregulation of immunity in the gut against Candida may impede its growth is stool samples.

Q: What would cause Aspartame to be high on an OAT if the person does not consume sugary foods or drinks and and has seizures and autism?

A: The markers 2-Hydroxyhippuric can occur from aspartame exposure, but things may elevate it too such as intestinal bacteria, aspirin consumption, artificial colors, and flavors in food.

Q: On a previous GPL workshop you mentioned if amino acids appear low is of no significance but pay attention if high. Too often I see amino acid levels very low - would this not signal poor protein absorption/assimilation, perhaps related to dysbiosis? Hypochlorhydria? etc.

A: The Amino Acid Metabolite section on the Organic Acids Test is related to inborn errors of metabolism where various enzyme systems are compromised leading to inflated metabolites of amino acid pathways. There can be multiple chemical conversion steps that take a particular amino acid to its metabolic end-product. An enzyme defect along that path will alter pathway end-products but will also cause elevations of chemicals preceding the defect. Most of these disorders are seen in rare genetic diseases in children.

Q: I am interested in how to use OAT & Mycotoxin tests for mold diagnosis that I have as a patient. Do you have information on this in your online library?

A: Great Plains Laboratory has a library of webinars on their website. If you would like to consult me directly I would suggest becoming a member of Functional Medicine Clinical Rounds. Inside the website, you can schedule consults with me directly through the Lab Advising service.

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.

From Mycotoxins to Mold, William Shaw, PhD Has Answers

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 extolled the virtues of comprehensive metabolic tests like the Organic Acids Test (OAT) and the MycoTOX Profile to help with difficult-to-diagnose patients.

The participants heard ways of how to implement these tests along with other diagnostic assessments, as well as effective treatment methods.

The following Q+A is a response to remaining questions Dr. Shaw was unable to answer during his presentation.

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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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.

Q: Are organic meats allowed to have mycotoxins?

A: Agriculture in the US have high standards for toxins. But realize organic food stuffs will have a higher risk of mycotoxins as there is no pesticides used in the growth/feeding of the food and thus more chance for mold growth and mycotoxin contamination.

Q: How does renal function influence accuracy of results of  MyCoTOX & OAT? Will a patient with impaired renal function benefit from testing? Do you know the minimum kidney glomerular filtration rate needed in order to get accurate results? If they can’t use urine tests, do you recommend different test(s)?

A: If renal function impairs your client to concentrate their urine, then the sample will be rejected and you will get a notice of this. There isn’t a set GFR. If the urine sample is not able to be used, consider the IgE Mold Test.

Q: Can Ochratoxin cause seizures?

A: The potential is there as this is a neurotoxin. Click here for more info.

Q: When treating mycotoxins, do you see further immune suppression on labs - neutropenia, thrombocytopenia, increase in autoimmune markers etc.? Is this d/t “reactivation” of these mycotoxins throughout the body?

A: You can see changes on lab work depending on the patient and their reaction to the toxins. This is because toxins are not harmless when they are coming out of the cells until they are bound by binders and glutathione. The reactivation is more of a release into the blood stream from storage in the tissue and fat cells for ultimate detoxification and elimination.

Q: If there are markers indicating candida and C. difficile and extremely high Ochratoxin A and Mycophenolic Acid, what do you treat first or do you treat simultaneously?

A: You would want to treat simultaneously. If the immunosuppressive and immune toxins are not detoxed it will be difficult to fully clear the candida and C. difficile. Just be sure the clients are aware of the importance of timing of the their binders, antifungals, and other supplements.

Q: Would it be more beneficial to take the binders before bed so as to bind mycotoxins dumped into the GI tract from the liver during detoxification through the night?

A: This is a good strategy and usually easier for clients to remember and to take away from other foods/supplements/meds.

Q: Can you address how bleach is not recommended as it can cause spores from penicillium to explode?

A: Bleach can only kill mold on impermeable surfaces some of the times. It can clear the color of mold growth, but this typically grows back. It is not guaranteed to kill mold in all cases and cannot penetrated permeable and porous materials like wood. This could cause a false sense of security in a home that isn’t truly mold free.

Q: How significant is citrinin elevation if all other markers have been cleared?

A: This depends on the level of citrinin. Citrinin can come from a variety of molds and a significant elevation of this marker could be indicative of an ongoing mold exposure.

Q: Do you provoke prior to testing, be it GSH, infrared sauna, etc? Recommendations for provocation protocol? Patients to consider provoking/not provoking?

A: We do not recommend provoking for the mycotoxin test. The LC/MS measures the mass of the toxin alone, not bound to GSH. The GSH molecule attached to the toxin during provocation will hide the toxin from the LC/MS as the mass is now changed from what we are assessing. For this reason patients, should be off of GSH/NAC/ binders for 1 week prior to sample collection.

Q: Gliotoxin adds to the same reduced-sulfur enzyme systems known to be inhibited in Alzheimer’s disease. Which drugs have mycophenolic acid?

A: Myfortic and Cellcept

Q: Does Mycophenolic Acid help with high histamine intolerance?

A: Mycophenolic acid is an immunosuppressant and would more than likely be a contributor to the cause of a histamine intolerance.

Q: What lab will test immune suppressant drug for Mycophenolic acid? Is it a contaminant in the drug, or included as an ingredient?

A: There are certain drugs, myfortic and cellcept, that are made with mycophenolic acid as its active ingredient. It is used due to its immunosuppression activity. These drugs are used to reduce rejection of a new organ like a kidney due to immune rejection.  I do not know of any labs that test drugs for mycophenolic acid.

Q: Could you please speak to treatment for children under 5? What are they able to take to treat mycotoxins

A: They can take binders, antioxidants, and antifungals just like adults. The dosing would need to be lower. The forms of the supplements/drugs would need to be child friendly so they can easily take them. Think of more powders and liquids over capsules.

Q: What percentage of mycotoxin in the urine is conjugated (phase-II) with glutathione, sulfate or glucuronic acid, and can you identify these by testing?

A: That percentage is difficult to determine as is varies from person to person, day to day based on detox capability. And, no, we do not identify these conjugates on the MycoTOX Profile.

Q: Has atrial fib been associated with mycotoxin exposure?

A: I do not have any direct research for a fib. But mycotoxins have been shown to be cardiotoxic. See more information here.

Q: You mentioned lactobacillus sp for fungal overgrowth/ mold - is there a favorite probiotic you have? Thoughts on spore forming probiotics like Megaspore for mold? also thoughts on serum derived immunoglobulins/SBI?

A: Spore probiotics can be helpful in inhibiting the growth of mold.

Saccharomyces boulardii has also shown efficacy in reducing mold.

Here are other studies of lactobacillus in the overgrowth of mold: HERE & HERE

Q: Is there literature to support the specific strain recommendation for probiotics: L. pentosus and L. beveris

A: This study is looking at the benefit of these two strains in adsorbing alflatoxin B1.

Q: Would Amoxicillin carry penicillium mold as it’s made from penicillin?

A: Penicillin and other derived antibiotics are made from a protein from penicillium mold. They do not contain the whole organism itself and no mycotoxins.

Q: A patient on OAT has a value of marker 2 (5-hydroxymethyl-2-furoic) 3037, and marker 4 the value is 759. Have you ever seen higher values?

A: Values of this level have been recorded. This isn’t a common occurrence, but it does happen.

Q: How does testing differentiate if the mold is colonized in the intestines or just passing through?

A: If it were passing through, we would see very minimal amounts of the furan compounds. When elevated this is evidence that the mold has colonized. To be 100% sure it has not passed on you can always retest and assess if it is still there prior to treatment.

Q: You mention 20-30 yrs, so if that much time has passed since the exposure is it unlikely for the person to be still colonized?

A: It is unlikely but the possibility is there. It is assumed that the body would have cleared the mold by then if the exposure was removed.  But if someone hasn’t had a mold exposure in 20 years, yet has elevated mold markers, it could be inferred that this was from 20 years ago.

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Q: Are antifungals the only way to kill off colonization? And can they be used at the same time as binders?

A: Antifungals are the most direct way to kill a colonization. Probiotics are a great adjunct. These can be used along with a binder but it should be taken 2 hours away from the antifungal and other supplements, meds, and foods.

Q: How do you treat sinuses directly if a patient is intolerant to nasal sprays and nebulized medications (severe discomfort, nose bleeding, severe pressure for days after)?

A: Oral antifungals and removal of moldy environment will help reduce irritation. This should be the beginning of the treatment. Detox with binders and antioxidants will reduce the toxic load. Slowly add in nasal sprays of saline to flush the area and then work up to antifungal nasal sprays. Go at the pace of the patient and their irritation.

Q: Are the treatment options in the order they need to be implemented on the patient infected by mold?

A: The treatment options listed are in order, yet after finding the source all these things should be implemented for full healing. They can be started simultaneously. But gauge your client and their ability to handle each part of the protocol. If they cannot get out of the exposure right away consider detoxing but holding off on the antifungals as the treatment will most likely need to start again after removal of the source.

Q: What about using NAC instead of glutathione?

A: If the person is making glutathione (assess pyroglutamic acid marker on the OAT) then NAC can be used. If they are glutathione deficient, consider investing in glutathione as the supplement of choice.

Q: Would you use the Antifungal if the patient does not have colonized mold?

A: Due to the lack of colonization testing for every mold it is difficult to determine if the person is or isn’t colonized even with the OAT. Because mycotoxins come from mold it is safe to assume mold is in the persons body if mycotoxins are being excreted, especially if they are no longer being exposed. If this is the case, or if the person plateaus in detox, antifungals are the next step.

Q: Are you saying you must use antifungal drugs with binders to rid the body of the mycotoxins that have colonized?

A: You must address the mold with antifungal therapy. It does not have to be drugs. You can use herbs and nutraceuticals.

Q: I have a case of an adolescent with autism. I have recently received the results of OATs with the results of markers of clostridium 15 and 18 elevated, elevated methylsuccinic, elevated ochratoxin and dihydrocitrine 1714, currently and after the oats presents constant fever, in sputum they found e coli. Other doctors have treated her with ciprofloxacin without being able to lower her fever. In this case, what do you treat first, clostridium, mycotoxins, e.coli?

A: If she still has a fever you may consider doing a blood culture for mold to be sure this isn’t a systemic infection. If not systemic, detox the mold toxins and address the bacterial overgrowths (clostridia/e. coli) with antimicrobials and probiotics (Core Biotic/ S. boulardii).  Get her out of her moldy exposure as soon as possible and then begin antifungal therapy. For more support with treatment options contact customer service for a complimentary consult with one of our qualified GPL consultants to review her results and case.

Q: You skipped over Chlorophyllin. How does this work with treating myco?

A: The chlorophyllin directly binds to the mycotoxins especially aflatoxin. See more information here.

Q: Can we get references showing effectiveness of your list of treatments of Mycotoxins?

A: Here are a few references. Please see the Great Plains Laboratory website for additional resources. Also on your MycoTOX reports the PMID after the interpretations are articles from PubMed you can reference for treatment.

See the following links for research based options for treatment of mold: HERE & HERE

Q: What is the best timing for when you prescribe the antifungals and then the binders during the day.  Biocidin dose is often TID, and the binder I have used BID.  My understanding is Biocidin is best away from meals - this leaves little time to get the binder in.  What times of day have you found is the best treatment?

A: You can consider taking the binder before bed, 2 hours after dinner, and/or first thing in the morning an hour prior to any other supplements/meals/ meds.

Q: What is a starting dose of Mg and Vit C (citrate?) to avoid constipation when using clays and charcoals for detox?

A: This depends on the clients and bowel history. But consider starting with 500mg of one and slowly adding the other agent at 500mg. then they can add more by 250-500mg until they have a proper bowel movement. Also check out these bowel supportive supplements: TruFiber and Oxy-Powder by New Beginnings Nutritionals.

Q: Could you clarify what foods (from where or in which states or countries) we can trust as having been tested for mycotoxins?

A: The FDA monitors food for mycotoxins. More research would need to be done on all other countries regulatory practices when it comes to monitoring mold.

Q: What is the recommended length of time to treat for mycotoxins once remediation has occurred?

A: At least 3-6 months, but treatment can take longer

Q: Where can we find dosing for children for MOLD/CIRS treatment? Supplements, rx, binders, etc.

A: New Beginnings Nutritional has many supplements for mold/CIRS and there is child dosing for many products.

Q: Do the charcoal, zeolite or bentonite clay or other binders not disrupt enterohepatic circulation similar to cholestyramine if taken in similar fashion?  It was my understanding that all the binders had that capacity.

A: They work by binding bile in the GI tract as does cholestyramine.  This stops the recirculation of bile through enterohepatic circulation. Bile production should be supported in long term use.

Q: How long is protocol for mold treatment before retesting?

A: 3-6 months

Q: Can a chronic mold infection be exacerbated with pregnancy? Can it be transmitted to the baby in utero? Or after through the breastmilk?

A: A chronic mold colonization and myotoxicity can be complicated by pregnancy. The mycotoxins can be transmitted to baby via placenta and breastmilk.

Q: What are the usual symptoms of mycotoxins?  I know typical allergy symptoms, but I would guess digestive symptoms as well

A: Top symptoms are chronic sinusitis, constipation, diarrhea, bloating, gas, nausea, vomiting, inability to lose/gain weight, etc.

Q: You mentioned that only 1% of labs you see are negative for ochratoxin A...are you referring to first tests only and not follow up testing, or do you mean ALL testing including follow up labs?

A: All tests that are run by GPL

Q: Are lipomas in people also a sign of mold issues?

A: They have been documented in mold toxic patients: HERE

There is also evidence of lipomas filled with mycotoxins in mold exposed dog: HERE

Q: can the lymphomas go away using mycotoxin binders after stopping grains?

A: If mycotoxins and mold are the sole cause for the lymphoma it is possible that it could resolve after mycotoxin detox and mold colonization treatment. This cannot be guaranteed if there are other causes stimulating the lymphoma.

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Q: If positive mycotox results for all family members living together aren’t shared, can you assume the source of mycotoxins is not the home but instead food or outside the home?

A: This could be implied but please be aware people all detox differently and release mycotoxins at their own rate and in their own pattern. The way to know for sure is by checking the home and culturing the molds growing there. If someone has mold toxins from an unidentified mold then you can assume it is from another source of exposure.

Q: If no fungal markers are elevated on OAT, would high Ochratoxin A (55) mean it came from penicillium most likely? Thank you

A: It could be assumed that is coming from penicillium but it could also be from aspergillus colonized in the lungs or nasal passages. Or it could be a combination of the 2 molds. Mold doesn’t have to colonize the GI tract to be an issue. Remember the OAT can only give GI colonization info. Cross reference with mold inspection of the moldy environment.

Q: Do you need to use a provoking agent before a mycotoxin test? Can a patient have difficulting detoxifying mycotoxins from their body that they may get a false negative test even if they are in symtomatic and living in a water damaged home

A: GPL doesn’t recommend provoking due to the nature of the LC/MS technology. It is specific to unbound toxins not GSH bound toxins. If there is concern about the patient not detoxing well, they can intermittently fast or exercise then night prior to collection to induce the release of toxins. Please remember this is not how the reference ranges were developed though. If someone is living in a water damaged building with visible mold a mycotoxin test is more confirmatory evidence of exposure and gives you a base line of toxic load. Similarly, with all lab testing, results should be taken in consideration with all the other information you have about the client.

Q: If you have a Fibro, Autsitic, ADHD or CFS patient would you start with OAT and Mycotox right away or wait to see what shows up on OAT first?

A: If you have evidence of a past or current mold exposure do both panels. If not start with the OAT and let it guide you to what tests to do next. Or start with the EnviroTOX Complete Panel: HERE

Q: Can you clarify--in pt w/ aspergillus colonization improved on nystatin--is the point that nystatin treats gut, doesn't get into blood stream, therefore is treating aspergillus in gut and eliminating the colonization, which is in the gut, is the explanation for improvement

A: Correct-aspergillus markers reducing when nystatin is given, provides us the conclusion it was in the gut, since nystatin is not absorbed through the mucous membranes or the GI tract. 

Q: I have many patients with multiple lipomas, do you suppose this could be a similar process to what happens in dogs?

A: It’s one possibility. You might find this article helpful; HERE

Q: Can the mold the dog is exposed to, expose the family to that mold?

A: There is the thought that mycotoxins can be in the dog’s fur, and then therefore one may be exposed in that manner. If that is true, there are dog washes that claim to neutralize them.

Q: Is chronic hepatitis and cachexia without symptom (negative autoimmune Hep A, B, C, no neurological issue, no fatigue) is it worth to check Mycotoxin?

A: If their clinical history alludes to mold in their environment, absolutely.  Mycotoxins are known hepatotoxins, and Chaetomium can cause unintended weight loss.

Q: I like the fact we are addressing when people are living in food insecurity there’s a tendency to still eat food contaminated by mold. How would you respond to someone who says- “Oh I just removed the moldy part of the food and use the rest in my cooking?”

A: It would be advised against since a lot of mycotoxins are heat resistant.

Q: Just an FYI, I did a consult with GPL for one of my pts mycotoxin test and was told that a low level did not matter.  Not true according to Dr. Shaw.

A: It is HIGHLY dependent on the entire clinical picture and situation.

Q: Would you please provide the citation for the recent study published in Nature you discussed about autistic children & their mothers found to have high antibodies to a mold?

A: HERE

Q: dosing guidelines for itraconazole and sporonox? adult and peds please

A: Sporonox: HERE

Intraconozole: HERE

Q: what are some antifungals that are non-prescription that a nutritionist can provide as a protocol?

A: The literature supports utilizing caprylic acid to target yeast and mold. Combination antimicrobials are best to prevent resistance. A recent article written by Dr. Brown illuminates other botanicals that function as antifungals. HERE

Q: any recommendations for collecting urine from non-toilet trained patients?

A: There are bags that fit over the penis that can be requested from the lab to help with urine collection. The Chinese method for potty training can also be a helpful tool.

Q: What is recommended to prevent further mycotoxin infection after successful treatment?

A: With regards to the environment post remediation, ensuring low humidity, areas kept clean and dust free, air purifiers suitable for filtering mycotoxins, sufficient lighting, increased air flow, and to be very cautious of water leaks. For the body, keeping the immune system and points of entry into the body (skin, nasal, mouth, and GI tract) strong and supported, as well as, supporting the body’s removal of toxins.

Q: Is there a test we can run to determine if the gastrointestinal tract is colonized?

A: The Organic Acid Test (Markers 2.,4.,5., and sometimes 6.)

Q: how do you know if the gastroinstenial tract is colonized? would this be something to do a stool test for? or are their spceific symtoms that a patient would be experiencing

A: The OAT can help determine if the GI tract is colonized (looking at Markers 2.,4.,5., and sometimes 6) . To date, no stool test to my knowledge can test for mold. Symptoms typically present similar to yeast overgrowth.

Q: Does the OATS show colonization of mold in the body vs. mycotoxin exposure?

A: The OAT can determine if mold is colonized, but does not always indicate mycotoxin exposure. If a colonization is present, one can assume there are mycotoxins, but it is not always evident mycotoxins are present based on the OAT alone when no mold markers are elevated. There are other markers on the OAT that can perhaps elude to mycotoxins, but it is best to run the mycotox if there is suspicion of mycotoxin exposure to get confirmation.

Q: Would an OAT on a dog be accurate or relevant the same way as the MycoTox test?

A: If you can apply the differences from human metabolism to canine metabolism, then potentially you could. I know of one veterinarian that utilize the OAT in their practice.

Q: What are good antifungals for Ochratoxin A and Mycolphenolic Acid?

A: Mycotoxins are not always indicative of colonization. The OAT should be done concurrently to confirm colonization. If high values are found for the specific aspergillus markers on the OAT, use of antifungals is warranted. If colonization is confirmed, nystatin, intraconozole, and/or caprylic acid or GSE have been shown to decrease aspergillus in the gut.

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Q: A patient tested for Myctoxins and it showed the Ochratoxin A is 17.87 and Mychophenolic Acid is 4397 - what would be the appropriate protocol for this patient?

A: It would probably be best to set up a consultation with the lab to further discuss this.

Q: since there are no food restrictions prior to mycotox collection, but food restrictions prior to OAT, can you please explain why those foods affect the OAT, but not the mycotox profile.

A: The OAT is measuring metabolic metabolites produced by humans and other organisms in the body. Arabinose is the main metabolite that is noted to be directly influenced by consuming specific foods. To ensure elevations are contributed to yeast overgrowth rather than food components, foods that contain arabinogalactans (which are partly composed of arabinose) should be avoided 48 hrs prior to testing. On the other hand, the mycotox test is measuring the specific toxin in the urine, and is not influenced by food components.

Q: Do you recommend a GSH challenge for 5 days prior to collecting the urine like Dr Nathan suggests?

A: No. The ranges are based on people who were NOT provoking, and therefore if a provocation was administered, the ranges are no longer comparable. Furthermore, when GSH is conjugated with the mycotoxin, it changes the structure of the compound, and due to the specificity of LC/MS, it reduces the ability for the mass spec to measure it.  

Q: Have you used medical ozone to remove the fungal infection?

A: No, but some practitioners have.

Q: if oxalates can form from intake of higher phenol foods, and estradiol is a phenol, could prescription HRT/estradiol therapy contribute to oxalates, histamine intolerance?

A: There is data that indicates that higher levels of estradiol in the system correlates with less calcium oxalate stone formation (HERE), and that estrogen intervention may actually decrease the risk of stone formation by lowering urinary calcium and calcium oxalate saturation (HERE)

I am not sure about histamine intolerance.

Q: did Dr. Shaw say a level about 50% is notable for toxic panel?

A: Above the 95% in a toxic panel is considered clinically significant.

Q: Does this include an interpretation or is there an option to hire someone to interpret?

A: The laboratory provides a free consultation with each test, to help with interpretation of the results.

Q: Is there an affordable lab that you would recommend for testing water from our taps for some of these chemicals?

A: www.watercheck.com- National Testing Laboratories Ltd.

Q: Do you know if there is any company producing phthalate-free tubing for IV treatments, reverse-osmosis water filtration systems,?

A: Not to my knowledge. Sounds like a good investigation.

Q: Have you heard of Relax Sauna brand, in which you sit inside but your head is outside? Wondering if still effective.

A: Inducing sweating is what is of most benefit, so anything that will accomplish this will be helpful.

Q: breast implant patients and saunas ok?

A: Dependent on status of implants, and tolerance.

Q: Are hot baths and/or exercise an option to saunas?

A: Yes. Hot baths tend to be used for heat sensitive patients, and some people can generate a significant amount of heat during exercise.

Q: Would the IR Sauna wraps be a good option?

A: As long as the patient is able to increase body temperature and sweat, it should work.

Q: Dr. Shaw. I have heard that IgG food allergy testing is not valid because if the person has leaky gut, then they will react to many things.  Is this the case?  Or you may show high levels in the foods you often eat.  This happened to me. I found it ironic that all the foods that showed up were foods I ate often in my diet.  How reliable is a mod/high IgG response in terms of correlation with patient improvement when said foods are eliminated?

A: Validity is not what is in question, but rather the potential reasoning for the inflammation. Often when you improve the gut (and the immune system), food intolerances improve.  As it relates to your question with increased levels with foods that are often eaten; perhaps there were more food antigens to bind to. In other words, inflammation was being caused by that food, but with more food antigens present, the peaks were higher on the results. There is a significant amount of data that shows relief of symptoms with elimination of high reactive foods, both clinically, and in the research literature.

Q: also I need information on the email for functional medicine rounds again please

A: HERE

Q: What could be the source of the high exposers to:

3-hydroxypropylmercapturic acid (3-HPMA), Diphenyl phosphate, Diethyl phosphate (DEP), 2-Hydroxyisobutyric Acid (2HIB) MTBE/ETBE, N-acetyl(3,4-dihydroxybutyl) cysteine (NADB).

Patients are older children, grew up on a mountain and drink bottled Fiji water and Arrowhead water, family is consumer conscientious about chemicals in products, and uses EWG shampoo/cleaners and cleaning products. Father drives diesel truck. Consumed very littler sugar or processed food. They also burn wood for six months a year for many years.

A: It is probably best to discuss this with a consultant.

Q: I am going to run your new IgG tests but I ran IGG testing through a different company and my kids showed high IGG to almost all of the 150 foods. Many of the foods they have never eaten. Thoughts?

A: It would be important to look at the immune function if a reaction is that high with GPL’s IgG testing as well. Something to also consider is the DPPIV enzyme levels.

Q: What is the relationship between blood testing for milk allergy and results from IgG testing? Could the traditional lab corp serum test show no problem, but the IgG food allergy be positive?

A: If you are referring to the IgE milk test they have, the two are not necessarily comparable. One can have an IgG reaction and not an IgE, or vice versa since they are two different type of immunoglobins, creating two different reactions in the body. If you are referring to their IgG test, it seems limited with only looking at milk, especially since the epitopes vary for dairy sources because of food processing manipulating the proteins, potentially yielding varying results for dairy- based foods.

Q: If someone shows as having a food sensitivity on the test, is it typically something that will be present for life? Meaning if they eat the food say ten years later the body will react?

A: Not necessarily. Depends on why the immune response is occurring.

Q: doesn't food change molecularly when cooked?  I have people that react to a food raw but not cooked.

A: Yes;  proteins can change, depending on the method of cooking. If it is higher heat and/or more acidic than the digestive environment, then it could manipulate the proteins enough to not cause a similar reaction. Also, consider the changes in fiber and nutrient release/degradation with cooking too.

Q: I know that Dunwoody Labs looks at IgE, IgG, IgG4 and complement. They claim that he complements reaction is very important to reduce the elimination. Why does your test give more data or can you clarify the differences?

A: GPL measures IgG1-4 for a more specific response.

This article can provide more details. HERE

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Glyphosate, Parkinson’s Disease & Mycotoxins Questions Answered

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 extolled the virtues of comprehensive metabolic tests like the Organic Acids Test (OAT) and the MycoTOX Profile to help with difficult-to-diagnose patients.

The participants heard ways of how to implement these tests along with other diagnostic assessments, as well as effective treatment methods.

The following Q+A is a response to remaining questionsour participating speakers were unable to answer during their 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.

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Evan Brand

Mold, Mycotoxins, Case Studies & Protocols

Evan Brand, CFMP, FNTP is a Podcast Host, Certified Functional Medicine Practitioner and Nutritional Therapist. He is passionate about healing the chronic fatigue, obesity, and depression epidemics after solving his own IBS and depression issues. His Evan Brand Podcast has over 7 million downloads and counting.

Q: please repeat info on companies that have lymphatic support supplements.

A: Beyond balance and wish garden have lymph supports

Q: With the legalization of marijuana, I have not heard anyone discuss the mold in marijuana.

A: I have heard of moldy cannabis; you could grind it up and put it on a mold petri dish to test it

Q: How can you detect mold in coffee which is drank daily for thousands?

A: It’s a very common issue.

Q: Can you talk about how to detox children under five from mycotoxins?

A: Would prefer to discuss this on a consult, but in general, gentle binders like liquid chlorella, small doses of charcoal mixed with applesauce. Email me at office@evanbrand.com if you need more help.

Q: Do the mycotoxins cross into the eggs produced by exposed poultry?

A: Sounds reasonable to me.

Q: Which markers on the OAT are indicative of mold toxicity? And what levels are considered high?

A: Page one shows mold colonization but the MycoTOX Profile is what looks at actual toxin levels.

Q: Where would we find a source for nebulizable glutathione and a protocol?

A: Thernaturals carries the one for the nebulizer, we mix it with 2-3ml of saline and 1 cap glutathione and put into nebulizer to breathe it in

Q: Are you not concerned with using medicinal mushrooms with mold and fungal overgrowth?

A: No, I’ve never found it to be an issue, even with those that have histamine issues.

Q: What do you think about treating heavy metals with mold? Do you have an order of operations with that? And what about with EBV as well?

A: The binders are broad spectrum and we likely fix both at the same time.

Q: Is it harder to treat mold when eating high histamine foods?

A: Histamine issues due to mast cell activation and mold issues are common, lower histamine diets can be helpful to lower the work.

Q: Are you familiar with Beth O’Hara’s work with Mast Cell Activation Syndrome?

A: Yes, Beth is a very nice woman and has done a great job of educating the public about mast cell and histamine issues

Q: What sauna do you recommend? If you can’t afford a big one, what about the portable one.  Is it effective?

A: I have the ClearLight, tell them Evan sent you for a discount. I don’t know much about portable ones but heard Therasage 360 is decent.

Register now for our upcoming events and workshops.

Q: For high dose choline, have you seen blood sugar problems increase?

A: Never

Q: Do you use either phosphatidylserine or phosphatidylcholine or use both at same time?

A: I use both at the same time for different purposes.

Q: What herbs did you use to treat H. Pylori?

A: My microbiome support 1 formula on auraroots.com

Q: Have you had much success in treating mycoplasma infection and what did you use?

A: I have success with mycoplasma using astragalus and cats claw.

Q: How did you do the test for babies from a distance? What company are you using for lyme and co-infection testing?

A: DNA connexions urine test

Q: I have a patient on binders and he can’t live without them. Given binders inhibit absorption of everything, how long can I keep him on them?

A: Forever. Ask Dr. Neil Nathan

Q: Can you state again the company you use for the petri-dishes?

A: Immunolytics

Q: Thoughts on ERMI home testing?

A: It is ok. I like petri dishes better.

Q: Herbs can be very powerful, are you concerned about doing damage to the microbiome?

A: No

Q: What have you researched to be the best HVAC filtering?  Do you recommend UV light in the HVAC system?

A: I recommend point of contact filters like Austin Air. UV is ok.

Register now for our upcoming events and webinars.

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Shanhong Lu

Glyphosate, Neuroinflammation Nation, & Parkinson’s Disease

Dr. Shanhong Lu, MD, PhD is a Internal Medicine Specialist in Mount Shasta, CA and has over 34 years of experience in the medical field. She graduated from Beijing Med University medical school in 1987.

Q: What are your best tools for detox of glyphosate?

A: Decrease exposure, Ultimate immune 8 a day, ultimate eaze 1-3 a day and OPC, with OR WITHOUT GLYCINE 4-5 GRAM TWICE A DAY- most of my 90 day data are based on 8 ultimate immune a day, please email drlu@drlumd.com for complimentary case discussions

Q: Does her approach / treatment help with epilepsy/seizure disorders patients?

A: Yes, please email drlu@drlumd.com for complimentary case discussions

Q: Cytokine storm Ebola virus works by this as probably SIDS from vaccine administration. No one has looked at routine vaccination but since vaccines with adjuvants produce a nonspecific immune provocation, wouldn’t that also be factor in Parkinson’s disease?

A: Vaccine injuries are not the cause of adult PDs because most of them have not received vaccines

Q: Even though organic foods are contaminated, do you recommend them as a better choice?

A: Absolutely

Q: Do you think an organic, plant based diet is safer overall than let’s say carnivore, with regard to levels of glyphosate?

A: I wish I could say that because I am a vegan and have been finding vegans are tested high in glyphosate (more often than meat eaters) but we have had less consequences … please email me drlu@drlumd.com since the keto people are more toxic with fat soluble toxins EDCs.

Q: Because glyphosate is a glycine mimic, would glycine supplementation help to detoxify by binding to its receptor and preventing glyphosate from binding? Do you prescribe supplemental Glycine to mitigate the effects of glyphosate exposure-injury?

A: In theory, but glycine alone will not be adequate

Q: What are your favorite tests to assess Toxic Burden?

A: The GPL-TOX Profile (Toxic Non-Metal Chemicals) and the Great Plains Laboratory Glyphosate Test.

Q: Would you name a few immune modulators please?

A: Muramyl peptide, beta glucans

Q: What lab/ tests do you use for total body burden & antioxidant SnPs? I use GPL and detox project and HRIlabs.org

A: GXsciences.com for SNPs and GPL-tox and GPL-glyphosate and oligoscan for tissue levels of minerals heavy metals and vitamins

Register now for our upcoming events and webinars.

Q: Is L-glutamine a concern for Parkinson. I heard it may pass the blood brain barrier.

A: Do you mean glyphosate? Yes glyphosate accesses the brain via BBB also the vagal nerve from the gut enteric plexus.

Q: You said heavy metals take forever to detox. What about kiddos with mouths full of mercury amalgam fillings? Thoughts about considering that fact?

A: ClearDetox pro for life and remove amalgam fillings

Q: More specifically, how do you activate PON1 for detox of glyphosate?

A: Email me drlu@drlumd.com

Q: What are your favorite detox methods?

A: WFPB organic diet+ A systemic core detox system please email or text me at 530-925-0565 drlu@drlumd.com and we can email you a recorded webinar

Q: How do we join the group?

A: Email me drlu@drlumd.com

Q: Since glyphosate is pretty much everywhere, even if we eat organic and minimize environmental toxins… how else can we counteract the effects of it?

A: Email me drlu@drlumd.com

Q: I don’t see glycine for detoxing from glyphosate. Where is it?

A: Glycine can replace glyphosate in theory but most of our data comes from glucarate 3000 mg a day and leaky gut and stress prevention

Q: I was wondering if glyphosate is also found in organic pea protein isolate? You mentioned it is present in the organic pea protein.

A: YES and that is why I take a regimen daily to prevent accumulation- I call a cellular shower) please email me drlu@drlumd.com

Q: Is it best Ca-d-glucarate on an empty stomach. Any suggestion dose wise. Once daily BID etc mg. please and thank you

A: 3000 mg a day with or without food in my experience and make sure Glutathione deficiency is corrected and Th1 and Th2 immune system is balanced (often time during detox Th1 switches to Th2 – cytokine storm)

Dr. Shanhong Lu is looking for participants to join a national and international detox project by first making toxins visible and gather data in relationship to clinical illnesses. If interested, please contact her at drlu@drlumd.com

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Suzanne Gazda

The Neurological Effects of Mold and a Look into Integrative Neurology

Dr. Suzanne Gazda, MD has uniquely combined a dedication to outstanding care with an authentic commitment to patients as people first. From this desire to find more ways to achieve wellness as a means of treating illness came Integrative Neurology, providing you with individualized solutions specific to your health.

Q: Do you incorporate Botanical anti-fungals in your protocols?

A: Yes, I love to use botanicals . But , like Dr Shaw, I believe in most patients, antifungal RX like Itraconazole is needed to fully remove fungal colonization but I can imagine that if we use antifungal botanicals (which can also boost immune health) .. long enough, patients can improve as well.

Q: What would be your sequence of evaluations for a child with ADHD and dysgraphia, tremors after testing w/ OAT, and MOAT?

A: The same as an AE patient : MRI, NQ , Lab, Cunningham panel and in some w/u for mold and lyme and heavy metals etc.

Q: Any good practical resources how to fight the mold? EMF exposure?

A: I will defer to Dr. Shaw on this one.

Q: I am a mother with five sons 2 of which have been diagnosed with Pans/pandas. One of those two have Lyme. According to labs, we have high levels of strep in the gut, how would you suggest to break the cycle?

A: This is such a complicated question. You are welcomed to email me so we can set up a time to speak about your sons.

Q: Small amount of Chitinase is endogenous to humans no ? Chitinase in CSF would mean the body is trying to break down fungi no?

A:I believe so in a certain subset of patients , especially those that we worry have mold exposure.

Q: Which lake in Shasta is high in aluminum?

A: HERE

Q: I see a lot of recommendation for chlorophyll and spirulina but I think there would be a potential risk of BMAA exposure by ingesting these?

A: Yes, I agree depending on the source.

Q: I am a physician in OK. How do i order the Cunningham and neuroquant tests?

A: You can ask Moleculera labs to send you some kits and for the NQ…go to the Core Techs website and send info and ask for a center near you that does NQ HERE.

Q: Do you get concerned with use of D-ribose and increased acetylated glycolic endpoints?

A: This is a question I will defer to Dr Shaw . Take good care!!

Q: More on the NeuroQuant please?

A: I am soon going to have a blog on my website about the NQ …. Check back within a couple of weeks. But, I already have quite a bit of info HERE.

Q: Is the neuroquant and MRI that needs to be ordered by a physician?

A: Since in most cases they are private pay (about 300 dollars ) I suspect anyone could order / not sure.

Q: are you working with MS patients doing plasmalogen replacement?

A: I am excited to explore more and am doing that now. In my experience, so much of what we would like to do in FM…well, the patients just can’t afford to do it all. I hope that changes one day.

Q: which is Dr. Dan Goodenowe's plasmalogen replacement work?

A: The data is strong. Check back with me in a few months after I have had a few patients try this.

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Great Plains Laboratory Profiles for Dermatology

By JASMYNE BROWN, ND, MS

Our skin, the largest organ, is the outer layer in which the world first encounters us. This holds true not only in social or professional impressions, but also health impressions made by practitioners. The skin is often a window into someone’s internal health complications. It helps to express dysfunction in a visual and even tactile manner. By visible rashes, lesions, the sensation of dryness and pruritus we can get an understanding of what may be happening or not happening properly in the body. Through the practice of functional medicine, we understand the role of nutrition, underlying gastrointestinal dysbiosis and overgrowth, and the potential for toxin exposures as underlying causes in the precipitation of dermal symptoms.

The Great Plains Laboratory offers a myriad of lab testing options. These options can assist in the determination of dermatologic underlying causes. Various tests we offer will give clues and answers to why one may be dealing with eczema, psoriasis, acne, etc. 

In many cases of dermatologic conditions, various nutrients play a role in healing. Due to the nature of the human body, a wide array of vitamins and minerals are necessary for normal skin health and integrity. In times of depletion, our skin can tend to become dry, flaky, easily wounded, slow to heal, etc. With many following a standard American diet, a lot of individuals are naturally nutrient deficient. Considering the following profiles for testing can shed some light on where people need to supplement. Some of the most beneficial tests we offer include the Omega 3 Index Complete, the Advanced Cholesterol Panel, a Pyrrole test, the OAT, and metal testing profiles.

First, let's look at the benefits of assessing omega fat status. Fatty acids are the building blocks of cell membrane formation of the stratum corneum. When the cell membrane is properly formed and functioning, there is selective permeability. This allows for nutrients to get in and discernment of entrance to other foreign molecules. Without adequate fatty acid balance, the skin’s selectivity decreases. This decrease leads to a loss of nutrients and an increase of foreign substances. Also an increase of the wrong fatty acids can make the cell membrane less fluid and supple.

The Omega 3 Index assesses not only omega 3 status but also omega 6 and 9 status. Some individuals have adequate fatty acids in the body, yet the incorrect amounts of specific types that encourage health. Too many omega 6 and 9 fatty acids in relation to omega 3 encourage inflammation and skin barrier dysfunction. Knowing what the fatty acid profile is composed of can help practitioners adequately counsel on diet and supplementation. Trans fats are also tested. An increase of these leads to stiffness, photoaging, and increased damage from UVR. this may be beneficial in someone with skin cancer or a family history of skin cancer, and even in those living in a high UVR area with elevated exposure rates. Having adequate omega 3 fatty acids has been shown to reduce symptoms of psoriasis, eczema, acne, rosacea, and increases quality of life for these individuals. 

Another test that looks at the benefit of fat in skin health is the Advanced Cholesterol Panel. Cholesterol seems to have had a bad reputation for a while now due to its inflammatory nature when it accumulates. One thing about it is that in the right amounts it is very beneficial and necessary, especially for our skin. Cholesterol partners with fatty acids and ceramides in the stratum corneum to protect and maintain skin barrier function. With the lack of cholesterol and these other products, the transepidermal water loss (TEWL) is increased. This leads to dryness, scaling, and irritation as often seen in atopic dermatitis and other inflammatory skin diagnosis.  Individuals with atopic dermatitis have been shown to have lower amounts of cholesterol in the skin.  By testing cholesterol, we can understand if the person isn't able to make enough cholesterol. This could be why they are experiencing their skin condition. By increasing cholesterol rich foods and potentially topical cholesterol, the skin barrier can be restored. On the other hand high blood cholesterol is also detrimental. Various inflammatory conditions including acne, psoriasis, and atopy have been associated with dyslipidemia. The profile seen is elevated total cholesterol, LDL-C, VLDL-C, and triglycerides are seen with a decrease in HDL-C. This increase in more inflammatory cholesterol shifts the immune system to a Th2 immunity more prone to immunoglobulin production and inflammation. So assessing a cholesterol panel is beneficial in any dermatologic condition and should be considered.

Nutritionally, we also need to consider vitamin and mineral status for skin health. Many B vitamin deficiencies lead to very visible skin signs. Cheilosis, dry, cracked lips are signs of riboflavin (B2) and pyridoxine (B6). Due to these visible signs, having an OAT profile is a great way to understand someone's need for supplementation. B6 deficiency also internees with proline synthesis and thus collagen this leads to pellagrous changes in the skin, most commonly associated with niacin deficiency. Another vitamin to consider when viewing an OAT is vitamin C. Vitamin C is key in the role of wound healing and collagen synthesis.

Other nutrients to consider for collagen synthesis and normal skin elasticity and production are copper and zinc. Copper is necessary for the production of collagen along with vitamin C. Zinc on the other hand, has many more roles in skin strength. This mineral is antioxidant, plays a role in skin cell formation, cell wall stability, cell division, and protects from UV radiation damage. Zinc has shown great efficacy as a treatment for various skin diagnoses. A common, major diagnosis of acne is well documented in successful treatment with zinc. Psoriasis, keloids, pruritus, anti-aging, vitiligo, keratosis, melasma, basal cell carcinoma, alopecias, eczema, and rosacea have all been successfully treated and supported with zinc addition. A great way to assess zinc status, especially in relation to copper, is via the GPL Copper/Zinc Profile. This profile measures serum zinc and copper, plus additional ceruloplasmin and copper/zinc ratio. This will assist practitioners in dosing zinc and copper without disrupting their delicate balance with one another. The Krytptopyrrole profile is another great test to consider. Pyrolurias are crucial to rule out when someone is depicting B6 and zinc deficiencies despite supplementation. If positive, this could explain why the person doesn't have adequate B6 and/or zinc as the pyrroles are binging so they are not available for use. Higher doses would be necessary to support one with a pyrrole disorder. Also reducing any stress or other triggers of pyroluria is helpful in increasing vitamin status.

Additional nutritional tests to consider are a vitamin D test, iron profile, and essential metals via hair, blood, or urine. Vitamin D is important to test for as it protects against UVR and regulates immunity. With decreased immunity, there's an increased risk of infection or dysbiosis that can lead to dermal symptoms. Along with iron it’s also required for epidermal proliferation and differentiation. Iron additionally is needed for adequate red blood cell formation and perfusion. In anemic states, if RBCs are lower there is less oxygen and nutrients getting to the periphery of the body. This nutrition decrease leads to deficient epidermal cells that can lead to dryness, cracked skin, etc. Testing for other essential elements is also crucial. Nutrients like chromium and vanadium being deficient may be the cause of blood sugar dysregulation leading to changes in skin like ulcers and poor wound healing. Other essential minerals are cofactors of collagen and skin cell production and being deficient could be the catalyst for skin dysfunction. Understanding one’s nutritional needs may be the answer or one of many answers that aid in healing.

Another body system highly associated with skin symptoms is the hormonal system. In women, oftentimes an imbalance of estrogen, progesterone, and even testosterone are stimulants to acne. In teens, during puberty, a classic sign of hormonal changes is facial, chest, or back acne. Fluctuations in hormonal cycles can make acne cyclical in its eruptions. Stress and increased cortisol levels will also stimulate skin eruptions. Prolonged increases in cortisol have been shown to lead to immunosuppressive outcomes. It leads to increased antigen presentation and antibody formation, increased cytokine release, increased lymphocyte proliferation, and an immunity shift from Th2 to Th2. This shift has been associated as a driving force in many skin conditions. Due to the connection of adrenal and sex hormones on skin barrier function and immunity assessing the GPL Saliva Hormones Panel will round out your assessment.

In the event of increased toxic load the body will use all eliminatory organs. This includes the skin. In order to protect vital organs from toxic effects the skin is a large, easy route of elimination. In those that are more prone to skin disturbance due to allergies and or an upregulated Th2 immunity, the skin is a targeted resource for additional detox support. During an exposure, the liver and kidney can get overtaxed and overburdened while trying to remove toxins so the skin may be recruited to assist. Also consider toxins in those that are nutritionally deficient. Without proper nutrition the integrity of the skin is decreased making it weaker and more porous.

Contact dermatitis to certain toxins is a common cause of dermal symptoms. Think of nickel allergies or hives due to certain detergents and the chemicals they may contain. Assessing a heavy metal exposure test and a GPL TOX can assess various exposures through water supply or other industrial processes or products. Mold and their toxins also shouldn't be excluded. Mold toxins themselves can be immune altering. Due to their immune altering nature B and T cell activity is impaired. Natural killer cells are inhibited. This immune dysregulation leaves the affected susceptible to infection and dysbiosis that can trigger a shift to Th2 immunity. Also consider Glyphosate testing. 54% of the human microbiome has been shown to be sensitive to glyphosate. This is a potential reason for dysbiosis. Ruling out toxic exposures can be a simple way to uncover an often hidden trigger of dermatologic conditions. Plus detoxification support can be a good way to begin relieving irritation.

Other stimulants or triggers of dermal symptoms are immune activation and dysbiosis. Often these two go hand in hand. The most common immune activation is IgE. This allergic type reaction is usually quick to occur when the offending substance is encountered. Consider evaluating the IgE inhalant and Food panels we offer. Recently we have rolled out a new IgE panel that assesses allergic reaction to  various species of mold. As stated before mold toxins can stimulate dermal symptoms. The MycoTOX Profile, OAT, and IgE Mold panel are a wonderful trio of assessments to use simultaneously to see what a mold exposure may look like and how it is affecting your client’s health. 

With a dysbiotic microbiome, there is a potential for increased inflammation and potential for GI permeability. This permeability can lead to antigens, especially food getting into the bloodstream and triggering antibody production. The resulting inflammation is commonly perceived as a rash, eczema, acne, rosacea, etc. Assessing for IgG, or delayed reaction, to foods can be helpful in eliminating offending triggers from the diet. Eggs have been shown to be a common, strong trigger for eczema in particular. This may not completely relieve all dermal symptoms, but avoidance will definitely help to reduce flares. This will also aid to reduce inflammation in the GI tract. Elevated GI inflammatory markers have been associated with common conditions like eczema, psoriasis, and acne. Other conditions include hidradenitis suppurativa (HS), erythema nodosum (EN) and pyoderma gangrenosum (PG). A good amount of these conditions have been shown to be a comorbidity to a diagnosis of IBD. The consideration of a Comprehensive Digestive Stool Analysis (CDSA) is prudent in assessing the cause of almost any condition. It tests for GI inflammatory markers as mentioned above and also micro organisms in the stool. Understanding the bacterial, fungal, and parasitic terrain of the gut can pinpoint what is causing inflammation and areas that can be addressed effectively. Our profile also will provide a sensitivity to various prescription and non prescription agents to address any dysbiotic flora. This can be helpful in the treatment of excessive overgrowths.

The other benefits of the CDSA include the digestive markers. When these are showing low pancreatic enzymes and/or food fibers in the stool there is reason to believe that the client is not doing a great job of breaking down food and absorbing nutrients. Even a healthy diet can’t fully help someone with an absorption issue, and this could be the underlying cause of their symptoms. The short chain fatty acid section (SCFA) is also beneficial. Various skin conditions have been linked to low SCFA and improved with the increase of them. They are helpful in reducing inflammation and improving the integrity of the epithelial layer of the GI tract. One more beneficial secion is the assessment of secretory IgA (SIgA). In too low or too elevated amounts have both been associated with increased inflammation and expression through the epidermal layer. By understanding the immune response, it can either be supported when low or investigations of why it is low can be determined when there is pathogenic or dysbiotic flora populating and a larger immune response is expected. This CDSA profile is comprehensive and informational for anyone dealing with dermal complaints. On the profile, expected bacteria section is also beneficial to know what need there is for good bacteria like Lactobacillus. Many studies have shown the benefit of this probiotic in reducing dysbiotic flora and reducing dermal symptoms. For the intestinal microbiome also consider running a urine OAT panel. Marker 1, citramalic, can be produced by Propionibacterium acnes. This organism has been directly correlated with acne. Evaluating the OAT in addition to a CDSA, will round out your investigation with specific mold and fungal markers, as well as specific clostridia markers.

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Overall, dermatologic conditions can be elusive. Sometimes it is difficult to name one cause of their existence. Our wide array of testing makes finding the cause or causes of dermal symptoms much more comprehensive and feasible. Considering combining urine tests is great for simple sample collection for anyone. This is a great technique for beginning your inquiry for narrowing down root causes of dermatologic complaints. From there other blood, serum, stool testing can be done for a collective look at your clients.

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References

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Bioidentical Hormone Replacement Therapy (BHRT) Options - Revisited Q+A

Tracy Tranchitella, ND

Bioidentical Hormone Replacement Therapy (BHRT) can be an effective method for replacing diminished sex hormones such as estrogen and testosterone. This lecture by Dr. Tracy Tranchitella will discuss modes of delivery (e.g. oral, transdermal), best absorption, follow-up testing and more.

The full webinar can be viewed here:

Bioidentical Hormone Replacement Therapy (BHRT) Options - Revisited from The Great Plains Laboratory on Vimeo.

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During the course of the Webinar, individuals were able to ask questions of the speaker. Because of time constraints, not all the questions were able to be answered in real time.

Q: Would it be possible to get a list of truly qualified practitioners for BHRT in each state?

A: I don’t have that, but you might go to the Institute for Functional Medicine website to look for qualified practitioners. The have a “find a practitioner” application on the site that lists practitioners by state who have been through functional medicine training. Not all of them do BHRT but you can research their background.

Q: What are the differences in effectiveness between birth control and BHRT for women who have had a hysterectomy with a Single Salpingoophorectomy?  What are the side effects of Birth Control vs side effects of BHRT?

A: BCPs are synthetic hormones while BHRT uses bio-identical hormones meaning they have the same molecular structure as the hormones you make endogenously. Side effects of birth control pills are usually listed on the packet insert that they come with and there are several different formulations. They are taken orally so you get a first-pass through the liver and an increase in binding proteins. Refer back to the “cons” of oral hormones in the lecture. BCPs suppress your own hormone production because it is replaced with the synthetic version. BHRT, if not taken orally, is much easier on the liver and is generally given in physiological dosages to mimic the amount your body makes naturally. If you are in surgically induced menopause, long term BHRT would be preferred as you are at no risk of getting pregnant and you still have one ovary that, depending on your age, may still be able to produce hormones.

Q: Wondering if there’s any way to convert subQ pellet doses into oral doses?

A: I would not advise oral hormones other than micronized progesterone. If you are on subQ pellets for estrogen, you might want to transition to an estradiol patch. You would have to speak to your doctor who does the SubQ hormones to determine dosage.

Q: Already sounds like you are pro SubQ form. Any recommended training for this?

A: I am pro-whatever works and is safe administration and dosage. I do not provide SubQ hormone pellets in my practice, but you might look into American Academy of Anti-Aging Medicine to see if they have any training programs.

Q: Do menopausal women need to take breaks with progesterone?

A: It really depends on dosage, delivery and duration of use. That being said, if you can get your patients to take a break for 3 days a month, it does help to maintain receptor sensitivity.

Q: For pcos what days would you take progesterone and how do you track ovulation/the luteal phase if periods are irregular?

A: I would recommend the Menstrual Cycle Mapping profile through ZRT that will measure estrogen, progesterone and LH. This test can reveal if you are ovulating and, if so, where in your cycle it is occurring. Knowing this is important so that you do not use progesterone too early which might have the effect of inhibiting ovulation. You should also look at thyroid and adrenal markers as well as fasting glucose, HbA1c and fasting insulin – most can be done through blood spot and saliva. Here is a link to Lab Tests Plus for the Menstrual Cycle Mapping profile. You can also read more about it and other blood spot testing on the ZRT Lab website.

Q: Could you please go over some OTC options (brand names) for these different delivery options?

A: The only OTC options for hormones are going to be for transdermal progesterone. You can find some topical and SL products through some of the large supplement distributors like Emerson and Fullscript. BioMatrix – Est-Adapt and Pro-Adapt.

Q: Does scrotal testosterone exacerbate testicular atrophy?

A: Testicular atrophy usually occurs with excessive testosterone dosing that inhibits endogenous production. Testosterone should only be used in men who are deficient and then it should be given in physiological dosages while monitoring levels and metabolites. This article with Abraham Morgentaler, M.D. provides a good overview.

Q: I have heard that you cannot use urine with BHRT, is that incorrect?

A: That’s a good question – because urine is an excretory fluid, it is likely that you will only find measurable levels of hormone in the urine if the dosages are high enough to warrant elimination. If we are looking to get hormone levels to a measurable level in the urine test, we could risk giving too much. There is definitely debate on the issue.

Q: Is normal circadian rhythm of testosterone important to emulate for men?

A: As you seem to know, testosterone is usually highest in the morning in men under 40. After 40, the difference in morning testosterone and afternoon tends to be insignificant. For the sake of convenience and having the benefit of higher testosterone during the active part of the day, exogenous use would be better in the morning.

Q: How long should you stay off all hormones before testing to get a good base-line test?

A: It depends on the form you are using and how long you have been using it. The slower they metabolize the longer hormones can stay in your system. If someone has been using high dosages of topical progesterone daily for 2 years, it could take at least a month for it to wash out. If someone has already been on hormones for a while and they are well-managed, I would just test for adequacy of dosing at that point and assess thyroid and adrenal markers.

Q: Is it beneficial to administer progesterone without estrogen vaginally in postmenopausal women?

A: It is really the estrogen that helps to restore the vaginal tissue. If you are administering progesterone vaginally to have a systemic effect, you do need some estrogen around to prime the progesterone receptors. Both hormones are needed to optimize the benefits of each of them.

Q: Is it possible to work with LabTests+ out of Canada? How would shipping cross borders work?

A: Yes – we can ship anywhere except New York. I would advise going to the website and email your questions. You should receive an answer within 24 hours.

Q: What is the ZRT chart you stated you could get on their website that was in a table form?

A: Click on the second link in the article just above the video: Review Our Guide to Accurate Testing Method…This is a downloadable document.