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Glyphosate is in our Air, Water, Foods and the Patients in Your Lobby

Homeowners spray gallons of herbicides in their yards to kill and stop the growth of weeds. Municipalities spray millions of gallons of herbicides to banish weeds from public parks, schools, and along highways. Farmers spray billions of gallons of herbicides, predominantly Round Up, to prevent weeds, insects and grasses from reducing their crop yields.

The main ingredient in herbicides is glyphosate, a molecule that prevents plants from making proteins, so they die. Glyphosate kills the broadleaf weeds and grasses that compete with crops. More than five billion pounds is sprayed worldwide, which ends up in our air, water, and soil, according to Zach Bush MD, a triple board-certified physician with expertise in Internal Medicine, Endocrinology and Metabolism, and Hospice/Palliative care. You can hear Dr. Bush’s full explanation of the decline of our ecosystem because of poisonous herbicides in an interview with Jon Gordon of Positive University.

Today, glyphosate is in 75% of rainfall, 75% of air, and 80% of Americans, according to a 2022 CDC study. The level of glyphosate in our system has grown from trace levels in Europeans to 1.75 milligrams per kilogram of body weight in Americans. The increased use of glyphosate and the increase of common chronic illnesses such as digestive issues, asthma, Autism Spectrum Disorder, Parkinson’s, Diabetes, Alzheimer’s, and kidney failure is not a coincidence, according to Shanhong Lu, MD, PhD, a frequent Great Plains Laboratory Academy instructor. To better understand the correlation of glyphosate exposure and disease, watch Dr. Lu’s presentation “A Silent Pandemic: Neurotoxicity, Neuroautoimmune Cytokine Storms and Parkinson’s Disease” below.

The importance of testing for glyphosate should become as routine as a yearly wellness exam.
— Shanhong Lu, MD

Why Should Practitioners Care that Glyphosate is Present in their Patients?

After medical research and practicing medicine for the past 34+ years, Dr. Lu understands conventional medicine has made tremendous advances in crisis and chronic disease management. The overall lack of interest in the root causes of most illnesses have kept most people living declining and expensive life.

Dr. Lu firmly believes that environmental toxins and stress are not only the blocks to cure but also often the primary drivers of chronic diseases, relapses and crisis. By identifying the main root causes, and helping people unload the burdens of accumulated toxins, and stress, and restoring their neuroendocrine immune system, people are most likely to experience sustained long term healing, health and vitality.

Dr. Lu believes it is the responsibility of health providers to identify and unload poisonous herbicides from their systems.

Environmental toxin and Glyphosate testing is inexpensive and easy to administer at home by collecting a urine sample. Extra diagnostics, such as the Organic Acid Test, can be ran with the same urine test too.

The bottom line is any levels in food, water and air are potentially impacting lives of all ages and at all levels of illness.

“The importance of testing for glyphosate should become as routine as a yearly wellness exam,” says Dr. Lu.

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Organic Acids Testing Strategies: Q&A With Kurt Woeller, DO

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

The following Q+A is a grouping of responses from the Day 1 workshop presentations. Click each presentation title to expand the answers from each speaker.

The material contained within this article is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the following portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.


Day 1 Q+A: Organic Acids

Kurt Woeller, DO

Introduction To The Organic Acids Test and Why It Is So Important In Clinical Practice / The Link Between Invasive Candida and Various Health Issues / The Link Between Clostridia Bacteria Toxins and Various Health Issues / The Link Between High Oxalate and Various Health Issues / Neurochemical Imbalances and Quinolinic Acid Toxicity / Additional Case Studies: Lab Reviews and Treatment Options

Q: I have a patient who has extreme elevated markers for aspergillus. His markers show in the red zone on two different Organic Acids Tests. Yet he insists there is no way that it could be environmental exposure in his home. With markers this elevated on two different tests, is there any possibility this could be coming from diet?

A: Unlikely to be from diet. Many people deny the existence of mold. Other sources of mold exposure are other buildings, e.g., work, school. Cars can sometimes be a source of mold.


Q: How often is 2-Hydroxyhippuric elevated due to high salicylate foods? Is it rare, unusual or common?

A: Very common


Q: Please explain how Clostridia or yeast markers can be high but the stool microbiome testing does not show these?

A: Stool is often normal for these organisms, particularly yeast. Yeast does not always actively shed in the stool. Clostridia difficile is detected through toxin A and B, but there are various strains of clostridia that produce other toxins other than A and B.


Q: What's the benefit of the OAT over blood testing for vitamins and stool for candida and bacteria?

A: Stool is often normal for clostridia. There can be benefit to blood testing for nutrients. The OAT conveniently provides some markers through urine, but, blood testing can play a role too.



Q: I have a patient who has concerns about her neurologic status. She is on Lexapro, Wellbutrin and Depakote for maintenance. She would like to wean herself off, but is afraid of ramifications. When doing the OAT, will these meds interfere with the results of the neurotransmitters or any other markers?

A: Yes. These medications can influence the neurotransmitter metabolites. Take this into account when interpreting the OAT results.


Q: Besides Biocidin or drugs like vancomycin, are there any herbs/compounds that you use to treat clostridia infection in toddlers and in children?

A: I always use probiotics and particularly soil-based organisms too with antibiotics and/or botanicals. Research other botanical products if you find an individual allergic to something in the Biocidin.


Q: If arabinose is elevated (slightly above 2nd SD) and the patient has no candida overgrowth symptoms, do we still treat it?

A: I would personally still address it even if it was with probiotics.

 

Q: Is there a follow-up test for current candida infection if there is an elevation in arabinose/ tartaric acid? It doesn't seem like the candida antibodies test (IgG, IgM and IgA) gives an absolute answer as to the current infection?

A: The follow-up test I do for these markers is another OAT or Microbial OAT.


Q: Any studies or opinions as to the efficacy of nystatin or Diflucan vs botanicals for candida. Do you dose daily or every few days to prevent mutations to other forms of candida?

A: For Candida, I dose daily. I recommend researching for botanical studies for efficacy information.


Q: How important is diet with respect to candida treatment? If important, which diet?  

A: Diet is always important. There are many different diets, so you need to research various candida diets to see which one best fits your patient’s condition.


Q: When do you use Cholestyramine to treat for mycotoxins and mold?  

A: This medication is for mycotoxins. It is helpful and can be used right away, but it can be a challenge for some people to take long-term, particularly children.


Q: How many times a day do you want a patient to have a bowel movement while on binders? What do you use in addition to magnesium citrate for BMs?  

A: At least one bowel movement daily. Slippery elm herb, fiber supplements, hydration, phosphatidylcholine (to help with bile flow), bitter herbs (e.g., Swedish Bitters).


Our Organic Acids Test includes markers for vitamin and mineral levels, oxidative stress, neurotransmitter levels, and is the only OAT to include markers for oxalates, which are highly correlated with many chronic illnesses.


Q: Why do people get clostridia? Is it due to diet or toxin exposure or genetic susceptibility?

A: We are all exposed or potentially exposed. Toxins can certainly impact the environment of the digestive system making clostridia problems worse.

Q: What do you think about saccharomyces boludia supplement for C. Diff toxins? Do you have concerns about using it for yeast infection as it is a fungal product?

A: It may work, but some people are sensitive to it. However, it can be effective for various bacteria and yeast. Personally, I would not rely on it as the only intervention.

Q: Do you treat any other things at the same time as Clostridia or wait until you complete Clostridia treatment? Also, would you wait for the repeat mOAT before starting treatments for other infections?

A: With botanicals and probiotics you can often treat multiple things at the same time. The mOAT is to help recheck the clostridia, mold and/or candida markers, but other treatments can be started while you wait for results in my experience.

Q: You mentioned that Niacin inhibits IDO. I was wondering if high-dose supplementation would also push tryptophan into the serotonin pathway simply because the tryptophan would not be needed to make niacin.

A: It does not inhibit IDO specifically, but it can lead to its reduction if niacin is deficient. A niacin deficiency can lead to IDO activation.

Q: Would you expect to see high oxalate on patients who do ProLon (fasting-mimicking diet) that implements glycerin intake for 4 days of the diet?

A: This might occur. I don’t have any firsthand knowledge.

Q: Does P5P work better than pyridoxal hydrochloride? What about activated B6 makes it better? Or does pyridoxal hydrochloride become P5P in the body and then broken back down to pyridoxal hydrochloride?

A: Not necessarily. The body converts pyridoxine into P5P. There is some speculation that the P5P taken orally just gets dephosphorylated across the GI membrane and then phosphorylated again.

Q: Is it appropriate to use Biocidin concurrently for example if a patient has taken another doctor's advice to do Prednisone and Methotrexate for a month? He has high candida, Aspergillus, and high HPHPA and above the mean 4-cresol. He just started the pharmaceuticals. Very likely mold issue in a home with high Ochratoxin. He is getting his house checked next week, but symptoms have been very severe now.

A: I have not seen any issues with Biocidin and other medications.

Q: What are the problems with PCR stool testing?

A: PCR is not inherently a problem and can be useful to detect the existence of pathogens in the digestive system. The difficulty is in the PCR spin cycle (too high is oversensitive) and interpretation of active infection.



Learn new ways to help patients with difficult-to-diagnose and chronic health issues.

The tests discussed throughout each workshop are all used to help identify exposure sources and biochemical imbalances in individuals with chronic health conditions. The Organic Acids Test (OAT) contains multiple markers which may be influenced by environmental and mold toxins. Often, the combination of the OAT, MycoTOX Profile, and GPL-TOX Profile can be used to help identify how a patient might be getting exposed, as well as assist with correlating their symptoms back to these sources. Determining the underlying causes of chronic illnesses for patients is the key to integrative medicine, not just treating the symptoms. The Great Plains Laboratory continues to find new ways to detect these causes of many illnesses and study the correlations between the results and conditions.

Registration includes:

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

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

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

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

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

Common Parasites, Detection Methods, and Intervention Considerations

The Centers for Disease Control (CDC) defines a parasite as “an organism that lives on or in a host organism and gets its food from or at the expense of its host” (1). This includes a broad-spectrum of parasitic organisms from distinct classes, all of which can cause human disease: protozoa, helminths, and ectoparasites.

Protozoa are microscopic one-celled organisms that can live freely in the environment or be parasitic in nature (2). Common examples of protozoa seen in clinical practice include giardia and cryptosporidium, and less commonly encountered strains of entamoeba such as E. histolytica. 

Tapeworm, roundworm, and flukes make up the bulk of parasitic worms in the category of helminths. These are multicellular organisms visible to the naked eye and can be free living in the environment or parasitic in nature. Helminths are less commonly encountered in clinical practice compared to protozoa.

The last group of human parasites are called ectoparasites. This group includes the common malaria carrying mosquito. From a parasitic infection standpoint, malaria is a serious public health pathogen in certain regions globally where the infection leads to hundreds of thousands of deaths every year (3).

In this article I highlight specific parasites often encountered in a general integrative and functional medicine clinical practice: Blastocystis hominis, Cryptosporidium parvum, Dientamoeba fragilis, Entamoeba histolytica, and Giardia lamblia.

Blastocystis hominis

There are many different species of Blastocystis that can infect humans (4) with B. hominis being most common. The medical condition blastocystosis is caused by a Blastocystis infection. Blastocystis is a worldwide pathogen transmitted through fecal-oral exposure and can be a contaminate of certain water supplies.

The B. hominis and others are protozoal, single-cell parasites that can invade and inhabit the digestive system and lead to various gastrointestinal problems, including irritable bowel syndrome (5).

Symptoms linked to Blastocystis infection, including B. hominis (6), can vary from mild to severe. Most commonly, the presence of B. hominis can lead to abdominal pain, anal itching, constipation, diarrhea/loose stools, and flatulence.

Cryptosporidium parvum

Cryptosporidium parvum (C. parvum) is one of the most important waterborne pathogens seen in developed countries and has been responsible for large disease outbreaks. It is one of several species of Cryptosporidium parasites to cause cryptosporidiosis (7).

Within the digestive system it can lead to significant mucosal damage as it behaves as an intracellular pathogen migrating into and out of epithelial cells. In some cases, diarrhea can be extreme with up to 10 to 15 episodes per day. There is a concern for electrolyte loss and dehydration, particularly in individuals with immunocompromised disease. Abdominal pain, nausea, vomiting, and loss of appetite are common too.

Dientamoeba fragilis

Dientamoeba fragilis is a single-celled parasite sometimes found in the gastrointestinal tract and seen on comprehensive digestive stool analysis. The infection of D. fragilis called dientamoebiasis. It can be associated with chronic diarrhea, traveler’s diarrhea, fatigue, and even failure to thrive in children (8).

Literature descriptions of D. fragilis are conflicted in that some list this organism as harmless and some list it as a pathogen (9).

Entamoeba histolytica

Entamoeba histolytica is another single-cell parasite called an amoeba, which moves by a bulging of cytoplasm called a pseudopod and can alter its shape. It is part of the parasite amoebozoan group called entamoebas, which also includes Entamoeba dispar that is often confused with the more pathogenic E. histolytica because of their similarity under microscopic analysis (10).

There is a significant difference in pathogenicity between E. dispar and E. histolytica with histolytica known to infect between 35 to 50 million people globally leading to more than 55,000 deaths annually (11).  

E. histolytica causes tissue destruction within the intestinal tract which leads to clinical disease, e.g., inflammation. One of the biggest concerns over E. histolytica infection is its ability to become invasive in the body. Abscess formation can occur outside the liver, including the lungs, brain, and spleen. Fortunately, E. histolytica infections are rare compared to the other pathogens discussed in this article.    

Giardia lamblia

Giardia lamblia is a flagellated protozoan because of its characteristic flagella (tail-like structure) it uses to mobilize. There are approximately 40 different strains of Giardia that have been isolated from various animals (12).

It causes most of its problems within the small intestine with intense symptoms being diarrhea, bloating and excessive gas, cramping, urgency, nausea, and greasy stools. Because of its prevalence within the small bowel, the villi become damaged with atrophy and flattening. This leads to poor digestion of carbohydrates, fats, and proteins leading to malabsorption. Lactose intolerance can persist even after successful eradication of Giardia (13).


Detection Methods

Parasitic and Comprehensive Digestive Stool Analysis (CDSA)

The common ova & parasite (O&P) detection method (aka parasite fecal exam) is done through microscopy. This method takes a fecal sample, concentrates it, stains it for enhanced visualization of parasite cell structures, and examines under microscope. This type of stool analysis is considered low in technology compared to other methods such as antigen detection or polymerase chain reaction (PCR) but can be highly accurate for a wide range of parasites (14). The accuracy of this test is largely dependent on the skill and experience of the technician. One of the major upsides of this method is being able to differentiate between past and current infections.

Comprehensive Digestive Stool Analysis (CDSA) tests are popular because they provide various markers for overall digestive system assessment and function, e.g., inflammation, digestion imbalances, normal bacteria. They are also comprehensive in evaluating for various pathogenic bacteria, parasites, and fungal species.

Many laboratories will perform the O&P fecal examination through microscopy, in addition to antigen (immunogenic substance) detection, while other labs will profile their analysis via PCR. Some labs provide a combination of methods.

Antigen Detection

An antigen is a substance, e.g., protein, usually foreign to the body, that stimulates an immune response (15). Many things can be antigens such as endogenous or exogenous toxins, bacteria, and foreign cells. Parasites with their unique cellular configurations such as cell membranes, etc. can be antigenic (16).

Many of the parasite antigens are found on the surface of cells and are highly specific to each individual parasite. An example would be the antigenic variability between Entamoeba dispar (non-pathogenic, relatively) and Entamoeba histolytica (pathogenic). Both have similar appearance as seen through microscopy but are more easily differentiated by antigen analysis (17).

Polymerase Chain Reaction (PCR)

PCR is involved in amplification of DNA sampling in blood, feces, and urine (18). The process helps to identify unique genetic sequences linked to various pathogens, including bacteria, parasites, fungus, and virus.

One of the potential drawbacks to PCR analysis is difficulty in differentiating between an active infection or past exposure to a parasite with genetic information retained in the system, but the infection being resolved. Therefore, with any test it is always important to correlate the test findings with the clinical presentation of the patient and this is especially true of PCR.

Other Parasite Testing Methods

There are other testing methods for parasite detection. Typically, these are not considered as sensitive as stool microscopy, antigen analysis, or PCR. Here are some additional options:

  • Blood serology – this method measures for antibodies (19) to a parasite(s) often through IgG immunoglobulin. Some laboratories only have a limited number of parasites they test for through antibodies. IgG can be reflective of a past infection and not necessarily an active problem. Additional antibodies such as IgA and IgM can be utilized to assess for more of an acute problem.

  • Saliva antibodies – some laboratories provide saliva antibodies such as IgA in the detection of parasites.

  • Blood smear – this method is important for blood-borne parasites like malaria (20) but is not useful for primary digestive system parasites like Giardia lamblia or Cryptosporidium parvum.


Intervention Options with Examples

Metronidazole (Flagyl)

This antibiotic is commonly used for various parasitic infections, including Giardia lamblia and Entamoeba histolytica. It also has effectiveness against other pathogens such as Fusabacteria, Bacteroides, and Clostridia difficile (21, 22).

It is commercially available in both capsule and oral suspension form from most pharmacies, and the safety profile, ease of use, and recognition and coverage from most insurance companies make it an attractive antibiotic for various parasitic infections, e.g., Giardia lamblia. Pediatric use is common using the oral suspension.

The typical dosage amounts of metronidazole for adults are 250mg to 500mg three times daily for 5 to 7 days. Pediatric amounts calculated using 5mg/kg per dose are often used for the same time frame.

Nitazoxanide (Alinia)

Nitazoxanide is a broad-spectrum antibiotic primarily used for acute Giardia and Cryptosporidium infections, but it does have broader application as an anti-helminthic and antiviral (23, 24). Approved for generic use in the United States in 2020 (25), The availability of Alinia for more than just acute diarrheal disease from protozoal parasites has gained wide acceptance.

The standard dosing for Alinia based on age, as well as oral tablet form or oral suspension is as follows:

  • Adults (and children 12 years and older), 500mg orally twice daily for 3 days

  • Children (4 years to 11 years), 200mg orally twice daily for 3 days

  • Children (1 year to 3 years), 100mg orally twice daily for 3 days

  • Alina oral suspension comes in 100mg/5ml

Botanicals

Botanicals for the use of eradicating various parasite infections have a long history of use in herbal medicine. The same is true of bacterial and fungal infections, and there is considerable overlap in a botanical’s ability to adversely affect the survivability of various pathogens.

Either the whole plant or components of a plant may contain various compounds, e.g., active substances, that provide antimicrobial properties, i.e., either inhibitory (fungistatic or bacteriostatic) or killing (fungicidal or bacteriocidal). Many of the “static” and/or “cidal” effects of botanicals (e.g., whole plant or components) are also applied against parasitic pathogens.  

Black Walnut

Black Walnut

Black walnut (Juglans nigra) is a type of walnut (American walnut) that contains a compound called juglone that is reported to be cytotoxic to various parasites (26). Its primarily mode of action is through expelling various parasitic worms, although it does have inhibitory enzyme activity against parasite cell metabolism.

Bilberry

Bilberry

Bilberry is an edible fruit from the plant species Vaccinium myrtillus. The berry has similarities to the American blueberry and goes by various names such as “wimberry”, “wortleberry”, and European blueberry (27). Much of the beneficial effects of bilberry extract focus on its antioxidant and circulatory properties for improved cardiovascular function. However, the phenolic properties of bilberry extract are known to affect the growth of certain bacteria such as Clostridiaand H. pylori (28). Because of its diverse nature, this botanical has also been shown to adversely affect various parasites like Giardia and Cryptosporidium (29).

Goldenseal

Goldenseal

Goldenseal is a perennial herb that flourishes in the eastern regions of the United States and Canada (southeastern). As an antimicrobial, an interesting characteristic is a proposed efflux pump inhibition effect (30). Efflux pumps are intracellular mechanisms of various organisms that allow it to excrete antimicrobial chemicals that are transported or diffuse into the cell.

As an anti-parasitic botanical, Goldenseal appears to have activity against various protozoan parasites, including Blastocystis hominis, Entamoeba histolytica, and Giardia lamblia (31). 

Oregano

Oregano

Oregano, aka Origanum vulgare, is in the mint family of plants. It too has been used in traditional folk medicine for centuries and as an oil extracted from the oregano plant it is used extensively in dietary herbal supplements with a good safety profile (32).

Its antimicrobial properties are diverse, but much of it comes down to two polyphenols called carvacrol and thymol (33). Other medicinal constituents of oregano oils are various terpenes which also contain antimicrobial properties.

Like many botanicals, oregano has been shown to adversely affect the ability of various parasites to survive, including Blastocystis hominis and various entamoeba species (34).

Many other botanical remedies like wormwood (Artemisia absinthium), echinacea, tea tree oil, etc. found in combination botanical products such as Biocidin (from BioBotanical Research) seem to play a supportive role overall for digestive health with pathogen reduction, including many parasites.

Regardless of which intervention option is used, it is always important to confirm eradication of parasitic pathogens. Therefore, repeating a stool analysis that initially detected the presence of a parasite should be done approximately 2 to 3 weeks after completing the course of treatment. If using antibiotics, most dosing regimens are relatively short lasting about 3 to 14 days depending on which antibiotic is being used such as Alinia versus Metronidazole, respectively. If using botanicals there is often not an exact set time frame for usage, but on average between 6 to 8 weeks is often sufficient. If attempting to eradicate E. histolytica with botanicals it is strongly recommended to also implement antibiotics because of the potentially invasive nature of the pathogen.


Kurt Woeller DO

Kurt Woeller, DO
Founder of Integrative Medicine Academy and Functional Medicine Clinical Rounds
Kurt N. Woeller, DO has been an integrative medicine physician and biomedical Autism specialist for over 20+ years. He is an author of several health books including Autism – The Road To Recovery, Methyl-B12 Therapy For Autism, Methyl-B12 for Alzheimer’s Disease and Dementia, and 5 Things You MUST Do Right Now To Help With Your Rheumatoid Arthritis. He is an international speaker, educator, and practicing clinician offering specialized interventions for individuals with complex medical conditions. His health consulting practice for Autism alone is multinational with families from various countries. Dr. Woeller serves as a clinical and lab consult for Functional Medicine Clinical Rounds, as well as provides educational seminars for Great Plains Laboratory. He is co-founder of Integrative Medicine Academy (www.IntegrativeMedicineAcademy.com), which is an online training academy for health practitioners learning integrative medicine.

References
  1. About parasites, Centers for Disease Control - https://www.cdc.gov/parasites/about.html
  2. About protozoa, Centers for Disease Control - https://www.cdc.gov/parasites/about.html
  3. Ectoparasites, malaria, Centers for Disease Control - https://www.cdc.gov/parasites/about.html
  4. Noël C, Dufernez F, Gerbod D, et al. Molecular Phylogenies of Blastocystis Isolates from Different Hosts: Implications for Genetic Diversity, Identification of Species, and Zoonosis. Journal of Clinical Microbiology, 2005. 43 (1): 348–55.
  5. Rostami, A.; Riahi, SM.; Haghighi, A.; Saber, V.; Armon, B.; Seyyedtabaei, SJ. The role of Blastocystis sp. and Dientamoeba fragilis in irritable bowel syndrome: a systematic review and meta-analysis. Parasitol Res, 2017. 116 (9): 2361–2371.
  6. United States Centers for Disease Control and Prevention. What are the symptoms of infection with Blastocystis? 2014.
  7. Centers for Disease Control and Prevention. Surveillance for Waterborne-Disease Outbreaks-United States, 1993-1994. 
  8. Windsor JJ, Macfarlane L.  Irritable bowel syndrome: the need to exclude Dientamoeba fragilis. Am. J. Trop. Med. Hyg, 1995. 72 (5): 501.
  9. Dientamoeba fragilis: A harmless commensal or a mild pathogen? Paediatr Child Health, 1998. 3 (2): 81–2.
  10. Rawat A, Singh P, Jyoti A, Kaushik S, Srivastava VK. Averting transmission: A pivotal target to manage amoebiasis. Chemical Biology & Drug Design, 2020. 96 (2): 731–744.
  11. Shirley DT, Farr L, Watanabe K, Moonah S. A Review of the Global Burden, New Diagnostics, and Current Therapeutics for Amebiasis. Open Forum Infectious Diseases, 2018.
  12. American Water Works Association. Waterborne Pathogens. American Water Works Association, 2006. ISBN 978-1-58321-403-9. 
  13. Meyer E.A.; Radulescu S. Giardia and Giardiasis. Advances in Parasitology, 1979. 17: 1–47.
  14. Parasites.org - https://www.parasites.org/stool-test-for-parasites/
  15. MedlinePlus. “Immune system and disorders" US National Institute of Medicine. 28 September 2020.
  16. Restif, Olivier; Reece, Sarah E.; Webster, Joanne P.; Brown, Sam P. (2013). "Life in cells, hosts, and vectors: Parasite evolution across scales". Infection, Genetics and Evolution. 13: 344–347.
  17. Tachibana, H., Kobayashi, S., Cheng, XJ. et al. “Differentiation of Entamoeba histolytica from E. dispar facilitated by monoclonal antibodies against a 150-kDa surface antigen.” Parasitol Res 83, 435–439 (1997).
  18. 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. 
  19. K. Abbas, Abul; Lichtman, Andrew; Pillai, Shiv (2018). “Cellular and molecular immunology” (Ninth ed.). Philadelphia: Elsevier. p. 97.
  20. Krafts K, Hempelmann E, Oleksyn B (2011). "The color purple: from royalty to laboratory, with apologies to Malachowski". Biotech Histochem. 86 (1): 7–35.
  21. Metronidazole". The American Society of Health-System Pharmacists. Archived from the original on 6 September 2015. 
  22. McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. (March 2018). "Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)". Clinical Infectious Diseases. 66 (7): e1–e48.
  23. White CA (2004). "Nitazoxanide: a new broad spectrum antiparasitic agent". Expert Rev Anti Infect Ther. 2 (1): 43–9. doi:10.1586/14787210.2.1.43. PMID 15482170.
  24. Rossignol JF (October 2014). "Nitazoxanide: a first-in-class broad-spectrum antiviral agent". Antiviral Res. 110: 94–103.
  25. First Generic Drug Approvals". U.S. Food and Drug Administration (FDA). Retrieved 13 February 2021.
  26. Dama L.B.; Jadhav B.V. (1997). "Anthelmintic effect of Juglone on mature and Immature Hymenolepis nana in mice". Riv. Di Parassitol. 2: 301–302.
  27. Bilberry: Science and Safety | NCCIH". Nccih.nih.gov. Retrieved 2018-03-19.
  28. Puupponen-Pimiä R, Nohynek L, Alakomi H.-L, Oksman-Caldentey K.-M. Bioactive berry compounds-novel tools against human pathogens. Appl Microbiol Biotechnol. 2005a; 67:8–19.
  29. Anthony JP, Fyfe L, Stewart D, McDougall GJ, Smith HV. The effect of blueberry extracts onGiardia duodenalis viability and spontaneous excystation of Cryptosporidium parvum oocysts, in vitro. Methods 2007; 42(4):339-348.
  30. Ettefagh K.A., Burns J.T., Junio H.A., Kaatz G.W., Cech N.B., "Goldenseal (Hydrastis canadensis L.) Extracts Synergistically Enhance the Antibacterial Activity of Berberine via Efflux Pump Inhibition", Planta Medica 2010.
  31. Sun, Y., Xun, K., Wang, Y., & Chen, X. (2009). “A systematic review of the anticancer properties of berberine, a natural product from Chinese herbs.” Anti-cancer drugs, 20(9), 757–769).
  32. L Pradebon Brondani, et. al. “Evaluation of anti-enzyme properties of Origanum vulgare essential oil against oral Candida albicans.” J Mycol Med. 2018 Mar;28(1):94-100.
  33. Yin, D., Du, E., Yuan, J. et al. “Supplemental thymol and carvacrol increases ileum Lactobacillus population and reduces effect of necrotic enteritis caused by Clostridium perfringes in chickens.” Sci Rep 7, 7334 (2017).
  34. Force M, Sparks WS, Ronzio RA. “Inhibition of enteric parasites by emulsified oil of oregano in vivo.” Phytother Res. 2000 May;14(3):213-4.

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

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

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

The material contained within this article is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the following portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.


Day 2 Q+A: Advanced Organic Acids


Kurt Woeller, DO

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

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

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


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

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


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

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

 

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

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

 

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

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


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

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


Q: What is the significance of low aconitic?

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


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

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

 

Q: Do PPIs for GERD affect the mitochondria?

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


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

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


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

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


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

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


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

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


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

A: Yes. I feel they should be.


Q: What is the dose for PTERIDIN-4?

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


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

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



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

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


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

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


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

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


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

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


Joseph Pizzorno, ND

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

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

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


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

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


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

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


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

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


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

A. I am not aware of any convincing research.

 

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

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


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

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


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

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

 

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

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


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

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


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

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


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

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


Bob Miller, CTN

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

 

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

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

 

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

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

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

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



Learn new ways to help patients with difficult-to-diagnose and chronic health issues.

The tests discussed throughout each workshop are all used to help identify exposure sources and biochemical imbalances in individuals with chronic health conditions. The Organic Acids Test (OAT) contains multiple markers which may be influenced by environmental and mold toxins. Often, the combination of the OAT, MycoTOX Profile, and GPL-TOX Profile can be used to help identify how a patient might be getting exposed, as well as assist with correlating their symptoms back to these sources. Determining the underlying causes of chronic illnesses for patients is the key to integrative medicine, not just treating the symptoms. The Great Plains Laboratory continues to find new ways to detect these causes of many illnesses and study the correlations between the results and conditions.

Registration includes:

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

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

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

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

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

Mycotoxin, Glyphosate & IgG: Q&A With Elena Villanueva, DC, Shanhong Lu, MD, William Shaw, PhD & Lindsay Goddard, RD

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

The following Q+A is a grouping of responses from the Day 3 workshop presentations. Click each presentation title to expand the answers from each speaker.

The material contained within this article is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the following portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.


Day 3 Q+A: Toxin Exposure and More


William Shaw, PhD

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

Q: Why not add Volatile Organic Compounds to your MycoTOX Profile?

A: Volatile organics would have to be extracted by a different method than mycotoxins. 

 

 

Q: Farmed chickens are fed corn. Do you think chicken meat may contain mycotoxins?

A: Very likely, unless corn feed is tested for mycotoxins.

  

 

Q: Do you use 240 mg/kg/day to calculate the dosage of cholestyramine for children or how do you calculate pediatric dosage? Would you use cholestyramine in infants as well?

A: The usual dosage in children (0-17 years) is 240 mg/kg of body weight per day of anhydrous cholestyramine resin taken in 2 to 3 divided doses. Most children won’t need more than 8 grams per day.

 

 

Q: Which medication or herbal combinations are best for both Candida and Aspergillus simultaneously?

A: The big problem is that there is a lack of published studies for herbals used as antifungals. Amphotericin and itraconazole have been used for both Candida and many molds, but there are resistant strains that require other drugs.

 

 

Q: For children with liver toxicity due to Sporanox, how do you approach that? Maybe half dose for twice as long?  Do you have ideas for alternatives for Itraconazole/ Sporanox?

A: I would recommend oral nystatin, if there is evidence of liver toxicity with Sporanox. This is because nystatin is not absorbed from the GI tract.

 

 

Q: Why do some people get so sick when exposed to mold? Could it be the genetic component HLA gene possibly? 

A: All of the mycotoxins are extremely toxic and may be fatal. The dose of mycotoxin is likely the main factor determining the degree of illness. Neil Nathan, MD states that he found HLA testing of little use in mold treatment.

 

 

Q: What may be the other likely causes of mold exposure for adults apart from damp houses?

A: Food or water damaged buildings are the most common causes of mold exposure. Food is unlikely source in USA and EU where food testing is required for foods commonly mold contaminated.

 

 

Q: I was told that you should not use bleach because it causes the mold spores to open up and release the mycotoxins and that hydrogen peroxide is a better option. Can you comment on this? 

A: Chlorine bleach can help eliminate mold on hard non-porous surfaces like sinks, bathtubs, tiles, or glass. This is because the roots of the mold do not penetrate through this surface and so it is easily wiped off.

However, when mold grows on a porous material like wood or drywall, it spreads its roots deep into the material to reach more nutrients. So when you apply bleach to such a surface, you are merely changing the mold’s color on the surface. Bleach quickly dries off on the surface and will not reach into the deeper part of the material to the mold’s root. So, in a few days or weeks, the mold regains its color and grows back to become even worse than it was before you applied the bleach.

I would suspect that hydrogen peroxide would also be ineffective on these porous materials which is why replacement of these materials is the most effective treatment.

 

 

Q: Recently, it was suggested that we could use effective microorganisms (EM) to kill mold on the walls. Using good bugs to kill bad bugs. What are your thoughts on this?

A: I don’t know. Never saw articles on such treatment.

 

 

Q: If there is only an elevation of tartaric acid in the Organic Acids Test, can we be confident that the patient is definitely affected by Aspergillus?

A: Several pharmaceuticals contain tartaric acid salts in their drugs so you need a complete drug history before you can conclude that Aspergillus is the cause of high tartaric acid.

 

 

Q: If you are only treating the GI tract, why not use amphotericin, which isn't absorbed?   I use itraconazole nasal spray as I find colonization is usually cured by treating sinuses. 

A: Amphotericin B is comparable to itraconazole for several molds and may be preferable since it is not absorbed from the GI tract so will not cause liver toxicity. However, amphotericin B may be liver toxic when administered intravenously rather than given orally. I know one physician who lost his medical license because of his use of amphotericin given orally. His medical board did not appreciate the difference in toxicity between oral and IV administration.

 

 

Q: Shoemake and Heyman have indicated that the mold smell had a higher correlation to the bacteria actinomycetes than mold. Could that explain inconsistencies at times?  Have you seen WDB with actinomycetes and have you treated it any differently than you would mold, i.e. antibiotics, and which one?

A: I would not use smell to determine mold contamination. The best way is to use a professional mold inspector who uses laboratory testing.



Lindsay Goddard, RD

Food to Treat: Using the IgG to Help Your Patients | Speaker Panel

Q: Is a dried blood spot (fingerstick) sample as accurate as a blood draw?

A: Yes. The accuracy is the same. The option is given to accommodate patients who blood draws are more complicated.

 

Q: In your clinical experience, do people who have candida or aspergillus overgrowth react badly to saccharomyces boulardii?

A: That has not been my overall clinical experience. There have been patients that have reacted poorly to it, but not the majority. Since it is not consistent, it is one of the benefits to running the test, to understand how an individual might respond based on their own individual immune response.


Q: Is there any way to get the OAT and /or MycoTOX Profile covered by insurance?

A: The OAT can sometimes be covered by Medicare or TRICARE (military), but the MycoTOX Profile is rarely covered.

 

Q: Is it of benefit to also check peptide level reactions to food in addition to whole blood protein?

A: Testing the peptide levels makes a case by eluding that they are measuring individual parts of the protein versus the whole protein. However, they are still measuring IgG4 and IgA, which do not induce complement, and therefore not inflammation.. I was not able to find any studies showing the efficacy of this method in the literature. If you find any independent studies on this methodology, I would be very interested to see them.  

 

Q: Can you see certain trends in OAT markers for Long Covid patients?

A: Not specifically. Quinolinic acid is often elevated in the beginning, and/or recently post infection or vaccines. There are times the mitochondria are also stressed.  



Shanhong Lu, Md

Glyphosate and GBH as an EDC, a Slow, Multisystem Corruptor to Hormone Optimization and How to Become Glyphosate Resilient

Q: Thank you for your mineral connection (i.e. mercury and iodine). You mentioned Hyper Zinc. What should I be thinking with high zinc if there is no obvious source? Or high ferritin, if there is no obvious HFE or fatty liver?

A: A complete mineral profile will be extremely important and also GPL-TOX Profile and Glyphosate Test will also help to determine where the excessive zinc comes from as many pesticides use zinc as a carrier. 

Q: Can glyphosate pass to cow's milk which is sold to humans?

A: Yes

 

Q: If we see neuroinflammatory symptoms when we give patients glutamine, should that excessive glyphosate exposure be on the differential diagnosis?

A: Absolutely – I have tested so many people with autoimmune, cancers, ALS MS PD and endocrine disruption and elevated SHBG. Glyphosate is always present.

 

Q: When should we suspect a glyphosate problem and do a glyphosate test?

A: I recommend getting that test done right away along with a mineral heavy metal profile and genomic test. Do an environmental workup, if supplements do not work.

 

Q: In your experience, when you removed glyphosate load from the Parkinson's/ dementia patients, do their symptoms reduce substantially?

A: With immune – depolarization, removing glyphosate as soon as possible absolutely improve symptoms. One patient with PD over 10 years on triple drugs improved walking down stairs and started riding horses and hiking. Neuroinflammation in the brain is definitely a result of M1 M2 polarization.

 

Q: How do you determine Individual Tolerant Level?

A: I look at genetic (such as methylation, PON1, COMT, SOD, Dopamine receptors, Vitamin D receptor IL6 TNFa) plus their hormonal age (adrenal sex thyroid and pituitary) people with traumatic brain injuries are more sensitive also.

Q: Do you recommend intermittent fasting as a way to trigger autophagy and a means to help the body become more resilient?

A: I no longer recommend fasting because it causes more stress. Many women are genetically in-between-meal eaters, compliance is low, and the pituitary is not working well when fasting.

 

Q: What do you do for patients that are deficient in glutathione synthetase?

A: I use systemic detox binders (cleardrrops www.zoiglobal.com/drlumd and practitioners with a license can apply professional detox pro), Ca-D-glucarte 2000 mg a day and skip the conjugation relying glutathione pathway, which is not strong for BPA metals and so on.

 

Q: Could you explain once more how to increase/support phase 1 detoxification of the liver?

A: Metals and glyphosate both block phase 1 cytochrome P450 and drugs too. Decreasing exposure and systemic detox support is the key. Genetic studies on cytochrome P450 and PON1 are important.

Q: Is there a way that you can perform the OligoScan on somebody that is not in your presence? (e.g. via some sample of skin or something?)

A: Unfortunately no. A pathologist is needed for biopsies and I recommend going to www.theoligoscan.com to find providers. Feel free to text me at 530-925-0565.

Q: It seemed that you were saying in your presentation that PON1 acts on phase 1 intermediates. Did I hear that correctly, and if so, is PON1 considered a phase 2 enzyme? 

A: For water soluble pesticides (organophosphates ) PON1 is much needed to render the intermediate substrate nontoxic – still phase 1 process. 

Q: Which nutrigenomic software do you use?

A: I use puregenomic from pure encapsulation the most and I also use gxsciences.com.

Q: Since you listed X39 and AEON in association with stress control and other products that balance the branches of the ANS, does that mean you find that they help to balance the ANS? I use them but had not known of a mechanism that would affect the ANS aside from reducing oxidative stress.

A: X39 has been studied to balance blood flows in various regions and enhancing GABA Dopamine and Otropin has been tested by MAX pulse machine using HRV.   We have found over 90% people with significant improvement of SNS vs PSNS balance-parasympathetic improvement with 3 minutes after 4 sprays of Otropin.

Q: What do you use as an immune modulator?

A: I use ultimate immune (containing a patented formula muramyl peptide beta glucan and Glucarate). Please email me drlu@drlumd.com and we can open an account for you.



Elena Villanueva, DC

Managing the Complex Patient: Using the GPL-TOX and OAT in Clinical Practice | Mycotoxins: Considerations, Case Studies and Protocols

Q: What are the top three mind therapies that you have found to be most effective for healing? 

A:  It really depends on what is going on with the individual as to which tools and modalities will be the most effective. If we are looking at how to down regulate the SNS using mind-based therapies, tools like QTT (quantum time therapy), perceptual positions exercises, resonance repatterning, hypnosis, hypnobreath therapy, and meditation exercises can be super beneficial.  

If a client has dis-ease that is rooted in unresolved trauma or unprocessed emotions, incorporating a sequence of a combination of both mind and body therapies is how I see the best outcomes. For example, first teaching the client awareness of how their thoughts, emotions, trauma can effect their physiology and mental health. Then teaching them to master their own down regulation of their SNS and how to activate their PNS using tools like breath therapy, yoga breath therapy, EFT tapping, bilateral touch, and watching their stress metrics improve as they master their own 'circuit board'. Then moving into teaching them awareness around their conscious and unconscious mind, their thoughts, and what tools are available to address and resolve their unprocessed emotions and unresolved trauma using tools like somatic experiencing, QTT, parts integration, P positions, language, light, color, sound therapy, etc.

Q: What are the top three spiritual therapies that you have found to be most effective for healing? 

A: Teaching awareness of who we are as humans has been very powerful with my clients. 'Who we are' being a mind, body, and a spirit with both a conscious and an unconscious mind. And teaching our clients how to integrate their 'parts' so they can speak and live their authentic truth without shame, fear, anger, etc.

Helping them become aware also that they are living a human experience and that all they experience is happening for them, not 'to' them; that THEY are the ones creating their realities through their thoughts, stories, beliefs, and actions. The power for them to heal comes from within them more so than anything outside of them.  

I wouldn't say that we teach spiritual therapies, but rather we teach awareness of the power they have within ourselves to master our own minds, and ultimately our own realities. We focus on empowerment and awareness of their sovereignty. 

Q: How long do your patients/clients typically stay on maintenance? How often do they return for visits? 

A: Once our clients are back to 'baseline' with their health, we start teaching them about longevity and anti-aging and how to biohack for higher performance without compromising their long-term health. We encourage them to do their full functional blood labs, and hormones annually and we encourage them to do their toxins labs every other year to ensure they are not unknowingly building up and re-exposing themselves to toxins. They typically see us 2 to 3 times per year for their wellness programs with us. 



Learn new ways to help patients with difficult-to-diagnose and chronic health issues.

The tests discussed throughout each workshop are all used to help identify exposure sources and biochemical imbalances in individuals with chronic health conditions. The Organic Acids Test (OAT) contains multiple markers which may be influenced by environmental and mold toxins. Often, the combination of the OAT, MycoTOX Profile, and GPL-TOX Profile can be used to help identify how a patient might be getting exposed, as well as assist with correlating their symptoms back to these sources. Determining the underlying causes of chronic illnesses for patients is the key to integrative medicine, not just treating the symptoms. The Great Plains Laboratory continues to find new ways to detect these causes of many illnesses and study the correlations between the results and conditions.

Registration includes:

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

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

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

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

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

Webinar Q+A: Autoimmune Disease and Fungal Infections

On May 19, 2022, The Great Plains Laboratory hosted Autoimmune Disease and Fungal Infections webinar with Kurt Woeller, DO. Fungal infections of various types can initiate immune dysfunction leading to systemic infection and serious disease. The overuse of antibiotics and subsequent microbiome disruption, along with other factors, e.g., nutrient imbalances, mucosal surface damage, can increase the potential for autoimmunity and related diseases. Various immune cells and their cytokines are intimately involved in regulating mucosal reactivity to opportunistic fungus. It is the dysregulation of these factors which create the potential for fungal related autoimmunity. This webinar will explore these details and more.

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


Webinar Attendee Q+A

Q: Should I be concerned about fungal resistance to fluconazole?

A: There is the potential for resistance to any antifungal or antibiotic. However, for the most part it still works well against many yeast species, including Candida.

 

Q: What factors make a fungal infection chronic and persistent, prone to relapse?

A: There are many including poor overall health, lack of microbiome diversity, ongoing inflammation, particularly in the digestive system, chemicals like glyphosate, mold and mycotoxin exposure, poor diet, etc.

 

Q: What are the implications of a leaking breast implant and how that affects thyroid autoimmune and inflammatory autoimmune, and would this eventually help to cause fungal infection/candida?

A: Fungus could certainly take advantage of a situation like this. You will need to research the specific mechanisms involved regarding breast implants, but I am sure it involves immune dysregulation involving Th1, Th2, and Treg cells.

 

Q: Can systemic candida infections be the root cause of seborrheic eczema, dermatitis, and dandruff?

A: I am sure they could be or at least play a role. Do some research into this area as this would be worth knowing more about.

 

Q: I have sometimes seen slightly high chloride in serum of my patients.  Does the hypochlorous acid release during the Neutrophil activity ever account for the finding of slightly high Chloride in serum of patients with CFS and Candidiasis?

A: Good question, but I do not know. Most likely is it not a major factor as the hypochlorite ion is acting at a local area.

 

Q: How can the Innate immune system have a memory component?

A: I am not aware of innate immunity with regards to memory cells, but certain B-cells, specifically B-1 B cells (from the spleen, bone marrow, and peritoneum) and MZ B cells (spleen), produce natural antibodies like polyreactive IgM or Natural IgM (nIgM). Perhaps there is a recall mechanism in place for these nIgM? The role of nIgM is significant, including in the assistance of phagocytic cell activity in engulfing an apoptotic cell. Other mechanisms include complement cascade activation against pathogens, e.g., bacteria and direct pathogen neutralization, e.g., virus. Check out the article by Panda and Ding titled Natural Antibodies Bridge Innate and Adaptive Immunity in the Journal of Immunology, September 2021.

 

Q: What is an example of a genetically susceptible individual?

A: Certain types of human leukocyte antigen (HLA) patterns are genetic linked. For example, HLA-B27 is associated with increased risk for reactive arthritis secondary to certain gut bacteria. Ankylosing Spondylitis is another disease where the immune system attacks the spine and is linked to cross-reactivity to various PAMPs in B27 individuals.

 

Q: Does the website https://candidamasterycourse.com/ go over protocols for overcoming candidiasis?

A: Yes. We go into intervention, testing, pathogenicity mechanisms and much more in the Candida Mastery Course.

Q: Can you link here the website to get the bonus sheet?

A: https://integrativemedicineacademy.com/webinar-bonus/

 

The material contained within this article and webinar is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.



Kurt Woeller, DO

FOUNDER OF INTEGRATIVE MEDICINE ACADEMY
Kurt N. Woeller, DO, has been an integrative medicine physician and biomedical Autism specialist for over 20+ years. He is an author of several health books including Autism – The Road To Recovery, Methyl-B12 Therapy For Autism, Methyl-B12 for Alzheimer’s Disease and Dementia, and 5 Things You MUST Do Right Now To Help With Your Rheumatoid Arthritis. He is an international speaker, educator, and practicing clinician offering specialized interventions for individuals with complex medical conditions. His health consulting practice for Autism alone is multinational with families from various countries. Dr. Woeller serves as a clinical and lab consult for Functional Medicine Clinical Rounds, as well as provides educational seminars for Great Plains Laboratory. He is co-founder of Integrative Medicine Academy (www.IntegrativeMedicineAcademy.com), which is an online training academy for health practitioners learning integrative medicine.

Mycotoxin Properties and Metabolism: Part 2

This blog is a continuation of Mycotoxin Properties Part 1. Here, we discuss the less common, but arguably some of the more toxic mycotoxins that may come up on the MycoTOX Profile (Mold Exposure).


As a mycotoxin classified under the Aspergillus category, Gliotoxin has an average elevation range for people who are suspicious of mycotoxins between 200-2000 ng/g of creatinine. More extreme cases have been shown to be in the 20,000-25,000 ng/g of creatinine range. Although Aspergillus (particularly the fumigatus species) and Penicillium have been shown to produce Gliotoxin, some yeast can as well, particularly Candida (1). A study that looked at A. fumigatus strains from silos contaminated with mold found only 11% of the cultures to be gliotoxin producers (2). On the other hand, a study performed at MD Anderson Cancer Center, found 93% of A. fumigatus strains from respiratory and tissue samples produced gliotoxin (3). Other studies that compared environmental versus clinical A. fumigatus producing gliotoxin, have not only found geographical variations, but overall as the evidence suggests, it is found more commonly as the result of internal colonization rather than contaminated environmental sources (4). Gliotoxin is also commonly found in the soil, but in that case, it is most commonly produced by Trichoderma virens to support competition among the other fungus and bacteria (4). 

Toxicology

Gliotoxin has been shown to inhibit phagocytosis by neutrophils and transcription factor NF-kB, causing immunosuppression, which can potentially further influence cytokine production and mast cell degranulation (5,6). Apoptosis in monocytes and dendritic cells has also been observed. Research has also demonstrated that gliotoxin can inhibit NADPH oxidase and Glutaredoxin enzymes, influencing the system’s ability to tolerate oxidative stress (7). Other studies on laboratory mammals have found that gliotoxin exposure causes a decrease in blood pressure, gastrointestinal hypermobility, and altered sleep patterns (8,9). It has also been identified as a potent antiviral, antibacterial, and anti-fungal agent (e.g. Rhizoctonia solani, Botrytis cinerea, Colletotrichum spp., Pythium ultimum, Fusarium spp (10). 

Properties

Gliotoxin is a compound from the epipolythiodioxypipeazines family, which includes an internal disulfide bridge. It is this disulfide bridge that allows the cross-linkage with cysteine residues, which produces reactive oxygen species (11). It can be produced by A. fumigatus near the temperature of the human body at around 37 degrees Celsius (98.6 degrees Fahrenheit), which is unique for mycotoxin production (12). Gliotoxin has a melting point between 200 °C and 202 °C (392-396 °F) and has a solubility of 0.5-5 mg/L depending on the solvent, where organic solvents increase the solubility (13). Stability increases in acidic, dry environments, but Gliotoxin is extremely unstable and degrades quickly in alkaline and neutral environments with high moisture. There is little literature regarding the half-life of gliotoxin, however, a soil study found the half-life is highly variable and dependent on pH and moisture. In acidic conditions (pH 4), gliotoxin was stable for >30 days, but in alkaline water (pH 7.5), only 35% was stable on the 10th day of measurement. However, when in dry soil versus moisture-rich soil, regardless of pH, gliotoxin was completely degraded on the 10th day (10). 

Metabolism

There is limited data on the pathways utilized by gliotoxin in the human system. However, we do know that it can enter the cytoplasm of the cell, which can arrest the cell cycle possibly by interfering with DNA (9). Its oxidized disulfide structural form allows for glutathione conjugation which reduces it to the dithiol form. This is how it is taken up into the cell and increases its accumulation (9, 14). This reduced form is how it is generally found in the cells, and there is a maximum concentration allowance dictated by cell density. When glutathione levels decrease, the oxidative intracellular toxin creates an increased outflow from the cells, allowing for minimal amounts to have more of an impact (14). As it moves through the system, through the kidneys for elimination, it has been documented to be highly cytotoxic to renal epithelial cells at lower concentrations (9). 

Similar in structure to aflatoxins, particularly B1 (15), Sterigmatocystin (ST) is most commonly produced by Penicillium and Aspergillus (mainly A. Versicolor and A. nidulans), but can also be produced by FusariumBipolarisand even Stachybotrys and Chaetomium (16, 17). It is not currently monitored in food due to the lack of occurrence. Stored cheese and grains are the only documented contaminated circumstances and there have been no outbreaks associated with ST reported to date (16). It is mostly associated with being a potent liver carcinogen (18). The data was limited on ST, and information was difficult to obtain. 

Toxicology

ST has been found to be highly carcinogenic because it can easily react with DNA and be highly mutagenic. However, this only applies to the exo-epoxide formed post conjugation through phase II detoxification. The endo-epoxide has been shown to be less reactive (18). This is one reason it is said to be less toxic than Aflatoxin B1. It has been documented in mice to be hepatotoxic, with chronic and consistent exposures, and with mutagenic actions (16). Also known to increase production of reactive oxygen species, with enhanced lipid peroxidation (16). 

Properties

ST contains a dihydrofurofuran core, with a xanthone nucleus, and an attached bisfurn structure (16,18). It is insoluble in water, with a half-life in plasma of 46.5 to 55.8 hours and a melting point of 246 °C (474 °F) (19).

Metabolism

ST goes through cytochrome P450 oxygenase systems, which produces endo and exo-isomers. They are incredibly unstable, and so they are difficult to isolate from biological systems, hence measuring the toxin itself is likely more efficient than measuring the metabolites generated from metabolism (18). Human studies are limited. However, rodent studies have found the greatest tissue distribution resided within the gastrointestinal tract tissue with 100% elimination in 96 hours, 80% excreted in the first 24 hours in urine (19). Although, when tissue accumulation was compared to blood levels, they remained significantly higher in the tissue, though still with decreasing levels by a factor of 8 over 96 hours. This makes sense because ST also goes through enterohepatic recirculation via the bile, which is likely why tissue amount is extended over serum and urine (19). 

Both Roridin E and Verrucarin A mycotoxins categorized under the Stachybotrys mold, are relatively similar, though differences will be discussed as they arise. Roridin E is produced by Fusarium, Myrothecium, Trichothecium, Stachybotrys, and less commonly, the Betula cordifolia (the mountain paper birch tree) and the Podostroma cornu-damae mushroom (20, 21). Verrucarin A is also produced by Fusarium, Myrothecium, Trichoderma, and Stachybotrys, but differs in that Trichothecium, Cephalosporium, and Verticimonosporium can also produce it. Though not as common to come up positive on the testing, these are some of the more toxic mycotoxins measured. When exposed to trichothecenes the effects can be quite toxic. For Roridin E; irritation of the skin, mucosal layers of the intestines, and the nasal passage have been observed, sometimes leading to blisters and bleeding.  Ocular symptoms have been described as burning, blurred vision, conjunctivitis, and pain. Hypotension, nausea, vomiting, and potentially shock have also been documented (22).  Symptoms can be variable for Verrucarin A, but can be extreme and have cascading effects. The symptoms include bone marrow damage, nervous disorders, cardiovascular alterations, hemostatic derangements, immunodepression, gastric inflammation and lesions, anorexia, and dermatological lesions potentially leading to necrosis (23,24).

Toxicology

Trichothecenes are different than other mycotoxins in that they do not require metabolic activation, rather they react with biological systems, directly. Exposure can be through oral, dermal, inhalation, and parenteral routes, and once absorbed, they are able to move across the plasma membrane freely (22,23). Roridin has been shown to inhibit receptor tyrosine kinase, impact glucose-6-ph,osphatase in liver tissue, and also deplete glutathione (20, 25). One of the major components of Verrucarin A’s toxicity is their ability to bind to ribosomes, particularly at the 3’ end of large 28S ribosomal RNA. This inhibits initiation, elongation, or termination steps, therefore influencing protein synthesis and polyribosomal disaggregation (23). These mycotoxins can alter membrane structure, influencing the mitochondria, and have also been noted to inhibit RNA and DNA synthesis along with mitosis. Verrucarin A is known as a potent antibacterial and antifungal (23). 

Properties

Trichothecenes, including these two mycotoxins, contain a distinct 9,10 double bond, and a 12,13 epoxide ring, with an additional hydroxyl or acetyl groups at certain positions (20, 22,23, 26). They are lipophilic in nature but have a relatively short half-life. It is estimated that trichothecenes, in general, have a half-life of minutes to hours (27, 28). Both have low water solubility, with Roridin E at 0.01 g/L and Verrucarin A at 0.043 g/L (22, 23). There is no data on melting points for either one of these toxins.       
                                                                                                                                                                                                                                                                

Metabolism

Once absorbed into the system, they are metabolized in the liver by cytochrome P-450 enzymes and trichothecene-specific carboxylesterases. Through phase II detoxification, the major pathway utilized is glucuronidation and deepoxidation (22,23, 27). They are mainly excreted through urine and feces, but additional data beyond these pathways was difficult to find. One study that was done on a similar trichothecene produced by S. Chartarum, Satratoxin G, found that it was detectable in the blood of the mice being exposed intranasally from 5-60 min after exposure (26). Noting that the clearance from plasma was rapid and single compartment kinetics was observed. The highest concentrations were found in the nasal passage (480 ng/g), then the kidneys (280 ng/g), lungs (250 ng/g), and spleen (200 ng/g) had the next elevated amounts. Interestingly, the liver did not have as high of a concentration (140ng/g). The half-lives were variable in the tissues as well, with 7.6-10.1 h in the nasal passage and the thymus, and 2.3-4.4 hours in the other organs. When the urine and feces were evaluated, the cumulative excretion over 5 days was 0.3% of the total dose administered. The two mycotoxins were difficult to compare but do give some insight into the biochemical pathways of these toxins (26). 

Ennaitin B comes from the fusarium species, and though it is common in foods due to its resistance to food processing techniques, and being unregulated, it has also been found in water damaged buildings (29). It has been shown to be more toxic than Ennaitin A, and just as common in our environment (29). Research has shown it acts as an antibacterial (particularly to certain species of Escherichia, Enterococcus, Salmonella, Shigella, Listeria, Yersinia, Clostridium, Psuedomona, and Staphylococcus), and antifungal (Beauveria and Trichoderma) (29, 30).  

Toxicology

ENN B is most commonly known to inhibit acyl-CoA and cholesterol acyl transferase activity, which will inherently influence lipidemic levels, particularly with decreased free fatty acid availability and triglyceride biosynthesis (29). EEN B has also been shown to affect the mitochondria directly by influencing potassium uptake and decreasing calcium retention capacity of the matrix. This can cause the mitochondrial membrane potential to collapse. Cell cycle disruption, and apoptotic death, have also been observed with the presence of ENN B (31). Adrenal endocrine influences via reducing progesterone, testosterone, and cortisol have been noted even in smaller amounts (29, 32). Higher concentrations (10 µM) were noted to reduce testosterone and estradiol (33). It has been shown to be a potent cytotoxin in several human and animal cell lines, even at very low levels. This is amplified when other mycotoxins are present (29). 

Properties

ENN B is a cyclohexadepsipeptides that is composed of mostly valine, isoleucine, and leucine residues, and three hydroxy acids, usually hydroxyisovaleric (29, 31, 34). It is lipophilic in nature, giving it the ability to incorporate into the phospholipid bilayers of the cell membrane. They are ionophores, which allows them to have a lot of other variabilities in their activity (29). This leads to its ability to influence the selectivity of the pores and disrupt cation levels. Also, it has the ability to form complexes with alkali metal ions, with selectivity in the following order: K+ > Ca2+ ≥ Na+ > Mg2+ > Li+. Solubility is 0.018 g/L in water (31). With regards to half-lives, a study that evaluated the degradation rate within a human gastrointestinal tract model found a degradation rate of 79 ± 5% within the GI tract, with even more degradation of enniatin B in the colon after 24 hours (35). The melting point is 229°C (444 °F), which is the main contributing factor as to why it is not affected by food processing (31).  

Metabolism

ENN B enters the system via oral, dermal, or inhalation route. From the aforementioned study on the GI model and ENNs behavior, they found metabolites from ENN were adsorbed within the GI tract (more than the parent compound) and observed moderate blood-brain-barrier crossing (35). It has been noted to bioaccumulate in the lipid tissue in rats and disseminate throughout the tissue in chickens (29). It utilizes the P450 enzyme CYP3A4, which to note, is one of the main enzymes that metabolizes numerous drugs, and other contaminants (31,36). 

Chaetoglobosin A is one of the most toxic mycotoxins on the test with even small amounts being deadly. It is very common in water damaged buildings, and in fact, one study that looked at the prevalence found that out of 794 water- damaged building material, 49% had isolated Chaetomium species (37). Chaetoglobosin A is one of the major mycotoxins produced by the Chaetomium species (mainly Chaetomium globosum) and some Penicillium species (38, 39). There are 18 natural chaetoglobosin mycotoxins that have been identified and have been known to be an antimicrobial agent with some neocicidal and antifungal influences (40, 41). Unfortunately, the literature is sparse on this mycotoxin, and details regarding properties and metabolism were limited. 

Toxicology

Chaetoglobosin A has been shown to influence cell division by inhibiting cell movement, cytoplasmic division, and multinucleation (40). It has also been found to be a P450 inhibitor and influence apoptosis (40, 42). Research has shown it to be quite toxic to mammals. In rats, exposure by injection caused necrosis of the thymus and spleen, and degeneration of the spermatocytes (40). Evidence also suggests it to be cytotoxic, particularly in cancer cells, and influences the cytoskeleton, accompanied with apoptosis (40 and 41). There is evidence of it being teratogenic in mice fetuses, with documented skeletal malformations, micromelia of the forelimbs, fused ribs, and death (43).

Properties

Chaetoglobosin A is a member of the cytochalasan-type (48).  All 8 types have a similar 13-member macrocycle and perhydroisoindole skeleton, with an indolymethyl substituent on C-3, but vary in oxidation level, C-11 and C-12 methyl substituents additions (40). They have a melting point of 165°C-170°C (329°F - 338°F), but no data was available on solubility or half-life at this time (40).

Metabolism

The data is very limited on the metabolic pathways of Chaetoglobosin A in the animal system, with in vitro studies very much lacking in the literature. A dated study in 1978 found higher toxicity load through parental exposure versus oral dosing in rats and mice, alluding to low oral absorption (44). In this study, when the rats were injected with this mycotoxin, death was observed 10 minutes to 2 hours post-administration, with visceral congestion noted on autopsy (44). At lower injection doses, 36% mortality rate was observed in 6-48 hours accompanied by necrosis throughout the spleen, decreased thymocytes, spermatocyte degeneration, and pulmonary congestion. The other 64% that recovered, after 3 days, the only effects were on the thymus and testes, with no histological abnormalities after 7 days (44). In another study where the rats and mice were fed an oral diet contaminated with a 50% concentration of Chaetoglobosin A for 10-15 days, decreased weight was observed (38). 

This concludes the evaluation of each mycotoxin on the MycoTOX Profile. Hopefully, it helps in the understanding of these mycotoxins in nature, and potentially in our bodies. 

 

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  33. Kalayou S, Ndossi D, Frizzell C, Groseth PK, Connolly L, Sørlie M, et al. An investigation of the endocrine disrupting potential of enniatin B using in vitro bioassays. Toxicol Lett (2015) 233(2):84–94.10.1016/j.toxlet.2015.01.014
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  36. Ivanova L, Denisov IG, Grinkova YV, Sligar SG, Fæste CK. Biotransformation of the Mycotoxin Enniatin B1 by CYP P450 3A4 and Potential for Drug-Drug Interactions. Metabolites. 2019;9(8):158. Published 2019 Jul 27. doi:10.3390/metabo9080158
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LINDSAY GODDARD, RDN, LD/N

Lindsay Goddard is a Registered and Licensed Dietitian (RDN, LD/N), with a Masters in Nutrition, and a Bachelor's in Biology with a concentration in Human Physiology and Ecology. Her background allows for a comprehensive understanding of the connections and interactions between the body, the environment, and nutrition. Her experience consulting in functional medicine practices and hospital settings (Tampa General Hospital, University of Arkansas for Medical Sciences), has enabled her to take the biochemical information and apply it clinically, while bridging the gap between conventional and functional perspectives. She is excited to be a part of the GPL team, and hopes to support your mission in greater knowledge.

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

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

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

The material contained within this article is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the following portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.


Day 1 Q+A: Organic Acids

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

Introduction to the Organic Acids Test | Kurt Woeller, DO

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

Invasive Candida and Various Health Issues | Kurt Woeller, DO

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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

High Oxalate and Various Health Issues | Kurt Woeller, DO

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




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




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




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




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




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




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




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

Neurochemical Imbalances and Quinolinic Acid Toxicity | Kurt Woeller, DO

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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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


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

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

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

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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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




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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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




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



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



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



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



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



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



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



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



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



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



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



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



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



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

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

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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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

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

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



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



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



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



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



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



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




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



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



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



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



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



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



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



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



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



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



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



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

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

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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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

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

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



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



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



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


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

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

Environmental Toxins and Prenatal Care | Joseph Pizzorno, ND

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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


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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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


Learn new ways to help patients with difficult-to-diagnose and chronic health issues.

The tests discussed throughout each workshop are all used to help identify exposure sources and biochemical imbalances in individuals with chronic health conditions. The Organic Acids Test (OAT) contains multiple markers which may be influenced by environmental and mold toxins. Often, the combination of the OAT, MycoTOX Profile, and GPL-TOX Profile can be used to help identify how a patient might be getting exposed, as well as assist with correlating their symptoms back to these sources. Determining the underlying causes of chronic illnesses for patients is the key to integrative medicine, not just treating the symptoms. The Great Plains Laboratory continues to find new ways to detect these causes of many illnesses and study the correlations between the results and conditions.

Registration includes:

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

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

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

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

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

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

Low Cholesterol: Is There a Neurologic Link?

“Should I eat eggs?” “Are eggs good for me?” “Do eggs have a lot of cholesterol?” If you are a healthcare professional, you've probably heard at least one of these questions. Or if you're a health-conscious consumer, you've probably thought about these questions or asked them yourself. With the slew of research regarding cholesterol levels and its effect on health, it's understandable why these questions arise. The biggest concern with cholesterol is having too much. High levels of cholesterol have repeatedly been linked to poor cardiovascular health outcomes. But what about low cholesterol? Are there situations that may warrant a higher level of cholesterol? This post aims to sort through some of the research linking cholesterol levels and neurologic conditions. On your search to identify total cholesterol levels, look to the Advanced Cholesterol Profile offered by GPL. 

In the human body, cholesterol is synthesized through a complex series of biochemical reactions. Acetyl CoA molecules are converted to HMG CoA via a series of thiolase and HMG synthase enzymes regulated by the supply of cholesterol (7, 8). HMG- CoA, also known as 3-hydroxy-3-methylglutaryl coenzyme-A (4), is then reduced by HMG CoA reductase to create mevalonate. This is the rate limiting step in cholesterol synthesis (1). This enzyme is an important hub in cholesterol and CoQ10 synthesis. It is also heavily studied as the main enzyme inhibited by statin drugs. After HMG CoA is reduced and mevalonate is produced, a series of reactions creates Farnesyl-PP. This is the branching point for cholesterol synthesis or CoQ10 synthesis (1, 4). From here, farsenyl-pp can become squalene that then becomes cholesterol or geranylgeranyl-pp to become ubiquinone (CoQ10) (10). Since the regulatory enzyme in this process is HMG CoA reductase, when it is inhibited by prescriptions or supplements, like statins and red yeast rice, it will cause a decrease in CoQ10 production. This also means cholesterol is lowered.  Great Plains Laboratory offers a urinary Organic Acids Test that contains a marker for this enzyme function. This is marker #55 or 3-Hydroxy-3-methylglutaric acid. This is the urinary organic acid for HMG CoA. In the presence of excess in this marker, we know that mevalonate is not being made and the HMG CoA reductase enzyme has decreased functioning. This informs us of a need for CoQ10 supplementation. Information from this marker may also lead you to look at total cholesterol levels, especially in those on statin drugs or anyone presenting with neurologic conditions associated with lowered cholesterol levels.

In the human brain, cholesterol plays an important role. The brain contains 25% of the body’s cholesterol, making it the most cholesterol rich organ (6, 15). Cholesterol is necessary for normal function and is made de novo in the brain tissue (15). Most of the cholesterol is found in the myelin which makes up about half or so of the white matter (11). Cholesterol plays a great role in creating the nodes of Ranvier. These are the periodic gaps in the myelin on the nerves (3, 12). These gaps allow for increased nerve impulse conduction through a process called saltatory conduction, which causes the action potential to jump from node to node (3, 12). In genetic conditions like Smith-Lemli-Optiz syndrome, there is a defect in 7-dehydrocholesterol-7-reductase. This causes cholesterol to be replaced by 7-dehydrocholesterol leading to a common symptom of this condition, intellectual disability (11). This genetic origin of a lowered state of cholesterol synthesis gives rise to stark neurologic dysfunction. So, what other conditions are linked to lowered cholesterol levels

A common mental health diagnosis has garnered attention when looking into the correlation with cholesterol levels. In various studies, lowered cholesterol levels have been associated with increased diagnosis of major depression. Women with total cholesterol levels less than 160 mg/dl, scores on anxiety and depression scales were at 35% vs women with normal levels only score high at a rate of 19% (17). In psychiatric populations, low levels of cholesterol were linked to major depression, while low HDL-C was linked to suicidal ideation (6). Postpartum depression in a subgroup of depression linked to the development of depressive symptoms in the first 6 weeks post-delivery. Common factors related to PPD are troubles sleeping, preterm birth, infant gender dissatisfaction, prenatal anxiety, fear of labor, and mode of nursing with formula or breast/formula feeding. Along with these factors, lowered median serum levels of TC and HDL-C were associated with increased depressive symptoms and suicidal ideation in this population (14). Anxiety, although not as studied, has shown an inverse correlation with TC levels (16). This is important as anxiety and depression often occur simultaneously. 

In relation to aggression and violence, low cholesterol has been researched as a potential biomarker. Unfortunately, most of the research focuses on the mental health community diagnosed with schizophrenia and/or bipolar disorder. These studies haven’t shown a strong enough correlation to use total cholesterol as a biomarker for aggression and violent suicide, but non-statistical low levels were seen (5). In the few studies completed on humans and non-human primates, there was a correlation between lowered total cholesterol and violence (16). Though this isn't strong enough to use as a biomarker, it should be evaluated as a contributing factor along with other underlying causes. 

In the pediatric world, the diagnosis of Autism Spectrum Disorder (ASD) has significantly increased. According to the CDC, 1 in 44 children are diagnosed with being somewhere on the spectrum (2). Research has begun to look at the connection between inadequate cholesterol levels and ASD prevalence. Some studies conducted have shown correlations with children on the spectrum having low levels while their unaffected siblings did not (9). Also, maternal and paternal dyslipidemia was associated with offspring with an increased incidence of ASD (9). This may be a strategy to help fertility clients to correct prior to conception as a method of prevention. Other studies have linked an increased ASD risk with genetic conditions associated with low cholesterol like Rett syndrome and Smith-Lemli-Opitz syndrome (13). These correlations and links make cholesterol levels a new and exciting potential biomarker to optimize in the population. Further research would be needed for it to be more of a diagnostic marker. Also, note that ASD was seen in individuals on lipid-lowering drugs, but more commonly in those who were not (13).

With all this information there is a link between low cholesterol and neurologic function. How could there not be? With the brain being made of 25% cholesterol, this substance is quite important. The research is still needed to improve the diagnostic power of TC but in any neurologic condition, it should be assessed. In cases where cholesterol is suboptimal, consider replenishing these levels with food like fatty fish, shrimp, or eggs. After three months, reassess your progress with the client and lab work. Even though more research needs to be completed to make this a household test for neurological diagnoses, TC is a promising piece to various health puzzles. 

 

 

 

References
  1. Bank, G., Kagan, D., & Madhavi, D. (2011). Coenzyme Q10: Clinical update and bioavailability. Journal of Evidence-Based Complementary & Alternative Medicine, 16(2), 129–137. https://doi.org/10.1177/2156587211399438 
    
  2. Centers for Disease Control and Prevention. (2021, December 2). Data & statistics on autism spectrum disorder. Centers for Disease Control and Prevention. Retrieved March 10, 2022, from https://www.cdc.gov/ncbddd/autism/data.html 
    
  3. Encyclopædia Britannica, inc. (n.d.). Node of ranvier. Encyclopædia Britannica. Retrieved March 8, 2022, from https://www.britannica.com/science/node-of-Ranvier 
    
  4. Friesen, J. A., & Rodwell, V. W. (2004, November 1). The 3-hydroxy-3-methylglutaryl coenzyme-A (HMG-COA) reductases - genome biology. BioMed Central. Retrieved March 4, 2022, from https://genomebiology.biomedcentral.com/articles/10.1186/gb-2004-5-11-248 
    
  5. Hjell G;Mørch-Johnsen L;Holst R;Tesli N;Bell C;Lunding SH;Rødevand L;Werner MCF;Melle I;Andreassen OA;Lagerberg TV;Steen NE;Haukvik UK; (n.d.). Disentangling the relationship between cholesterol, aggression, and impulsivity in severe mental disorders. Brain and behavior. Retrieved March 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/32681586/ 
    
  6. Hussain, G., Wang, J., Rasul, A., Anwar, H., Imran, A., Qasim, M., Zafar, S., Kamran, S. K. S., Razzaq, A., Aziz, N., Ahmad, W., Shabbir, A., Iqbal, J., Baig, S. M., & Sun, T. (2019, January 25). Role of cholesterol and sphingolipids in Brain Development and neurological diseases - lipids in health and disease. BioMed Central. Retrieved March 10, 2022, from https://lipidworld.biomedcentral.com/articles/10.1186/s12944-019-0965-z 
    
  7. Kumari, A. (2017, November 17). Cholesterol synthesis. Sweet Biochemistry. Retrieved March 4, 2022, from https://www.sciencedirect.com/science/article/pii/B9780128144534000078 
    
  8. Liscurn, L. (2004, January 7). Chapter 15 cholesterol biosynthesis. New Comprehensive Biochemistry. Retrieved March 4, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S0167730602360174 
    
  9. Luo Y;Eran A;Palmer N;Avillach P;Levy-Moonshine A;Szolovits P;Kohane IS; (2020, September 26). A multidimensional precision medicine approach identifies an autism subtype characterized by dyslipidemia. Nature medicine. Retrieved March 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/32778826/ 
    
  10. Marcoff, L., & Thompson, P. D. (2007, June 5). The role of coenzyme Q10 in statin-associated myopathy: A systematic review. Journal of the American College of Cardiology. Retrieved March 4, 2022, from https://www.sciencedirect.com/science/article/pii/S0735109707010546 
    
  11. Meaney, I. B. and S., Björkhem, I., Ingemar Björkhem From the Division of Clinical Chemistry, Meaney, S., Steve Meaney From the Division of Clinical Chemistry, & Björkhem, C. to D. I. (2004, February 5). Brain cholesterol: Long secret life behind a barrier. Arteriosclerosis, Thrombosis, and Vascular Biology. Retrieved March 8, 2022, from https://www.ahajournals.org/doi/full/10.1161/01.ATV.0000120374.59826.1b 
    
  12. Orth, M., & Bellosta, S. (2012). Cholesterol: Its regulation and role in Central Nervous System Disorders. Cholesterol, 2012, 1–19. https://doi.org/10.1155/2012/292598 
    
  13. Pesheva, E. (2020, August 17). Autism-cholesterol link. Autism-Cholesterol Link | Harvard Medical School. Retrieved March 10, 2022, from https://hms.harvard.edu/news/autism-cholesterol-link 
    
  14. Pillai, R. R., Wilson, A. B., Premkumar, N. R., Kattimani, S., Sagili, H., & Rajendiran, S. (n.d.). Low serum levels of high-density lipoprotein cholesterol (HDL-C) as an indicator for the development of severe postpartum depressive symptoms. PLOS ONE. Retrieved March 10, 2022, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0192811 
    
  15. S;, O. M. B. (n.d.). Its regulation and role in central nervous system disorders. Cholesterol. Retrieved March 8, 2022, from https://pubmed.ncbi.nlm.nih.gov/23119149/ 
    
  16. Suarez, E. C. (1999). Relations of Trait Depression and Anxiety to Low Lipid and Lipoprotein Concentrations in Healthy Young Adult Women. Europe PMC. Retrieved March 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/10367605/#:~:text=Conclusions%3A%20In%20healthy%20young%20adult,known%20to%20influence%20lipid%20concentrations. 
    
  17. Women with low cholesterol may be at risk for depression and anxiety. Duke Health. (n.d.). Retrieved March 10, 2022, from https://corporate.dukehealth.org/news/women-low-cholesterol-may-be-risk-depression-and-anxiety#:~:text=In%20a%20study%20of%20121,normal%20or%20high%20cholesterol%20levels. 
    


Jasmyne Brown, ND

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

Webinar Q+A: The Many Biochemical Influences of Magnesium

On April 13, 2022, The Great Plains Laboratory hosted The Many Biochemical Influences of Magnesium webinar with Kurt Woeller, DO. Magnesium is an important mineral for many biochemical reactions in the human body. Much attention is given to its influence within the digestive system or cardiovascular activity. This lecture will explore these and other aspects of the various biochemical influences of this important mineral.

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


Webinar Attendee Q+A

Q: Can you discuss the enemies of Mg such as glyphosate, diuretics, heavy metals and especially copper? 

A: This is a great topic for a lecture. I will be discussing copper and ceruloplasmin later this year. 

 

Q: Can you discuss how a Mg deficiency can lead to a refractory K deficiency to get the K back into the cell it needs the AT passes/pumps which is Mg dependent? 

A: This was discussed in part. A broader discussion could certainly be looked at in the future. Good question for you to research too. Perhaps take what I presented in my lecture as a jumping-off point to investigate this further.

 

Q: How much did you increase the mag? 

A: I increased my daily intake to 800mg. This is close to my weight using the 5mg/lbs in milligram daily. Please keep in mind that this is a dose I chose for myself which include magnesium from multiple sources, e.g., multivitamin. Currently, I take between 400mg to 600mg daily total. Each person needs to pay attention to symptoms of excess magnesium (discussed in the webinar lecture), and it is certainly appropriate to start low and use less for sensitive individuals. 

 

Q: Do you think Magnesium deficiency may have a role in post-COVID fatigue? 

A: Yes, absolutely. Post-covid and post Covid vaccination. Both are a major stressor on the body for many people. 

Q: How much Magnesium supplementation is too high? 

A: Depends on the person. I use the 5mg/lbs per day as a guide with magnesium taken orally. This is what I do, and it seems to work well. Personally, I needed to take a higher dose to help resolve some muscle spasm issues that greatly affected me. However, I make recommendations for patients based on the individual and not just as a blanket recommendation for everyone regardless of their health history. Each person needs to pay attention to symptoms of excess magnesium (discussed in the webinar lecture), and it is certainly appropriate and necessary to start lower and use less for sensitive individuals.

 

Q: During residency, I remembered we were told that there is a narrow safety window for Serum Magnesium. 

A: It is certainly possible to get too much magnesium. Look back in my lecture for the symptoms linked to magnesium excess.

 

Q: Would Mg cause issues with POTS? Lowering BP. 

A: Excess magnesium can lead to hypotension. However, there can be many reasons for POTS, including dysautonomia linked to mitochondria dysfunction, which can be worsened from magnesium deficiency.

 

Q: What lab measurement is the best indication of Mg deficiency? 

A: GPL has a urine magnesium and calcium test which is useful. There are intracellular measurements too through some lab profiles.

 

Q: Will magnesium citrate also bind phosphate from calcium phosphate crystals? 

A: Good question. I am not sure, but magnesium appears to bind to phosphate in general, so it is likely. Do some additional research on this topic specifically. 

 

Q: Calm supplement changed from mag citrate to mag carbonate.  Would you say that was a good decision? 

A: I personally do not use magnesium carbonate and typically only use magnesium citrate for oxalate problems.There are better forms of magnesium for general body use that was discussed during my lecture.

 

Q: When is it best to take Mg Threonate, am or pm? 

A: Anytime is fine and may help someone be more focused during the day. However, it can be helpful at night for sleep too. Tailor the dosing of this form of magnesium to specific needs of your patient and see how they respond. 

 

Q: Do you recommend that we check serum Mg or RBC Mg to monitor when supplementing with Mg? 

A: Only in certain circumstances in very sensitive patients or debilitated individuals on multiple medications, e.g., diuretics. However, I make recommendations for patients based on the individual and not just as a blanket recommendation for everyone regardless of their health history. Each person needs to pay attention to symptoms of excess magnesium (discussed in the webinar lecture), and it is certainly appropriate and necessary to start lower and use less for sensitive individuals. I mentioned an example of oral dosing of 5mg/lbs. (approximately), which is something I used for myself to help resolve some back issues. This dose has been appropriate for some others too with similar issues. But, it can be too high for some and may trigger loose stools, diarrhea, lethargy, etc. This is particularly the case if people are taking high amounts all at once. It is critical to be selective in recommending higher amounts of magnesium and that individuals and be followed closely. The main emphasis of my webinar was to highlight the importance of magnesium in many biochemical systems, and that it is a mineral often deficient in people with ongoing stress and chronic illness. Like everything in nutritional medicine, it does not exist or function in isolation, so individual dosing is essential.

 

Q: Do you know if any bioavailability issues with mg citrate gummies? 

A: Not sure. However, I would presume it is the same at capsule magnesium citrate.

 

The material contained within this article and webinar is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.



Kurt Woeller, DO

FOUNDER OF INTEGRATIVE MEDICINE ACADEMY
Kurt N. Woeller, DO, has been an integrative medicine physician and biomedical Autism specialist for over 20+ years. He is an author of several health books including Autism – The Road To Recovery, Methyl-B12 Therapy For Autism, Methyl-B12 for Alzheimer’s Disease and Dementia, and 5 Things You MUST Do Right Now To Help With Your Rheumatoid Arthritis. He is an international speaker, educator, and practicing clinician offering specialized interventions for individuals with complex medical conditions. His health consulting practice for Autism alone is multinational with families from various countries. Dr. Woeller serves as a clinical and lab consult for Functional Medicine Clinical Rounds, as well as provides educational seminars for Great Plains Laboratory. He is co-founder of Integrative Medicine Academy (www.IntegrativeMedicineAcademy.com), which is an online training academy for health practitioners learning integrative medicine.

Webinar Q+A: The Organic Acids Test With A Focus On The Bacterial Metabolite Section

On March 16, 2022, The Great Plains Laboratory hosted The Organic Acids Test With A Focus On The Bacterial Metabolite Section webinar with Kurt Woeller, DO. Digestive bacterial markers on the Organic Acids Test (OAT) do not typically get as much attention compared to the clostridia toxins such as 4-Cresol and HPHPA. However, there are some important clinical considerations to pay attention to when markers in the Bacterial Metabolite section of the OAT show up elevated.

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


Webinar Attendee Q+A

Q: Can the Hippuric levels be an indicator of mold mycotoxins? 

A: Not that I am aware of.

 

Q: Can Hippuric acid result from Lyme and other co-infections - bartonella, mycoplasma. i.e. Is this a non-discriminate marker? 

A: I am not aware of any information showing these infections directly generating hippuric acid. 

 

Q: What was it that indicates bacterial overgrowth? 

A: Elevated levels within the Bacterial Marker section of the Organic Acids Test, particularly markers #10 - #13.

 

Q: High level of vanilmandelate can be due to ochratoxin? 

A: Ochratoxin A is a known inhibitor of phenylalanine hydroxylase which could lead to low dopamine. Low dopamine could lead to low homovanillic acid (HVA). Low vanillylmandelic acid (VMA) is often seen with dopamine beta-hydroxylase (DBH) inhibition by clostridia bacterial toxins. A mycotoxin from fusarium mold called fusaric acid is a DBH inhibitor. 

 

Q: My DC interpreted my high bacterial markers as bacterial overgrowth and suggested I avoid probiotic supplementation. However, I don't have any signs of overgrowth in small intestines, and there are so many benefits to probiotics. What would you suggest? 

A: The elevated bacterial markers on the Organic Acids Test (OAT) are often benefitted with probiotic use. Each person is different with regards to their reactivity to probiotics. For example, some people with small intestine bacterial overgrowth (SIBO) do not tolerate probiotics early on in their treatment, but this does not mean everyone needs to avoid probiotics who have elevated OAT bacterial markers.

 

Q: If hippuric acid is elevated, should I tell patients not to drink coffee for 3 days? So, it can be ruled out and hone in on toluene as the cause of elevation and not from coffee? 

A: It is more than coffee consumption that could generate high hippuric. There are lots of vegetables and fruits containing chlorogenic acid that get converted into hippuric acid. My recommendation is to follow the directions in the organic acids test urine collection instructions. It will provide a list of foods to avoid.

 

Q: Any significance of extra low hippuric acid? 

A: Not entirely sure. Maybe it could be linked to poor glycine conjugation and/or very low consumption of chlorogenic and/or benzoic acid containing foods?

 

Q: Could high 4-hydroxyhippuric also be due to eating daily blueberries? 

A: Yes

 

Q: Does high tartaric and arabinose come from mold? Can it resolve with probiotics? 

A: High tartaric is associated with aspergillus mold. Arabinose is linked to candida. Probiotics may be helpful in improving diversity of the microbiome which can help against overgrowth of fungus. However, it typically requires more than just probiotics to reduce or eliminate overgrowth of fungal species in the digestive system for many people. For example, the use of antimicrobial botanicals and/or prescription antifungals like Nystatin may be necessary. 

 

Q: Do you find many issues in these bacterial markers in cases of atopic dermatitis? I have a case of a 14-month-old with severe eczema, and hadn’t yet considered an OAT for him, but now, I might. 

A: This condition can certainly be linked to underlying digestive problems and toxins. I would strongly recommend doing an OAT, as well as a comprehensive digestive stool analysis, and food sensitivity assessment. There may be more tests needed, but these are a good place to start. 

 

The material contained within this article and webinar is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.



Kurt Woeller, DO

FOUNDER OF INTEGRATIVE MEDICINE ACADEMY
Kurt N. Woeller, DO, has been an integrative medicine physician and biomedical Autism specialist for over 20+ years. He is an author of several health books including Autism – The Road To Recovery, Methyl-B12 Therapy For Autism, Methyl-B12 for Alzheimer’s Disease and Dementia, and 5 Things You MUST Do Right Now To Help With Your Rheumatoid Arthritis. He is an international speaker, educator, and practicing clinician offering specialized interventions for individuals with complex medical conditions. His health consulting practice for Autism alone is multinational with families from various countries. Dr. Woeller serves as a clinical and lab consult for Functional Medicine Clinical Rounds, as well as provides educational seminars for Great Plains Laboratory. He is co-founder of Integrative Medicine Academy (www.IntegrativeMedicineAcademy.com), which is an online training academy for health practitioners learning integrative medicine.

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

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

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


Webinar Attendee Q+A

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

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

 

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

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

 

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

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

 

Q: Which probiotics are low in histamine? 

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

 

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

A: I have not looked into this.

 

Q: What does PQQ mean?

A: Pyrroloquinoline Quinone – stimulates mitogenesis


The material contained within this article and webinar is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.



Kurt Woeller, DO

FOUNDER OF INTEGRATIVE MEDICINE ACADEMY
Kurt N. Woeller, DO, has been an integrative medicine physician and biomedical Autism specialist for over 20+ years. He is an author of several health books including Autism – The Road To Recovery, Methyl-B12 Therapy For Autism, Methyl-B12 for Alzheimer’s Disease and Dementia, and 5 Things You MUST Do Right Now To Help With Your Rheumatoid Arthritis. He is an international speaker, educator, and practicing clinician offering specialized interventions for individuals with complex medical conditions. His health consulting practice for Autism alone is multinational with families from various countries. Dr. Woeller serves as a clinical and lab consult for Functional Medicine Clinical Rounds, as well as provides educational seminars for Great Plains Laboratory. He is co-founder of Integrative Medicine Academy (www.IntegrativeMedicineAcademy.com), which is an online training academy for health practitioners learning integrative medicine.

Is the Honolulu water contamination crisis affecting your health?

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

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

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

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

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

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

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

Indicators of Detox: 2-Hydroxybutyric Acid

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

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

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

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

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

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

 

 

 

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


Jasmyne Brown, ND

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

Webinar Q+A: The Important Role of Vitamin D - Beyond Immune and Bone Support

On January 19, 2022, The Great Plains Laboratory hosted The Important Role of Vitamin D - Beyond Immune and Bone Support webinar with Kurt Woeller, DO. Vitamin D is an essential nutrient well known for its role in immune function, bone metabolism, and reduction in cardiovascular diseases. However, there are other less-known effects of vitamin D that this lecture will explore, including its influence on cellular metabolism linked to mitochondrial activity and neurochemical regulation within the nervous system.

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


Webinar Attendee Q+A

Q: What to do if serum vitamin d level is really high, in 400’s for example?

A: You need to check their sources of Vitamin D and look to cut back. Just because the levels come back high like this does not automatically mean the individual is toxic, but the longer times goes on it could become a problem.This is where repeat testing is important.

Q: Please discuss systemic dangers for levels above 80-100ng/ml

A: I did discuss this in the lecture. Hypercalcemia, bone problems, e.g., pain, kidney problems, including kidney stones. 

Q: Why did the child with total D of 153 have all in the D3 category if you stated that they were supplementing that made it elevated, if D3 is from sun exposure? 

A: Diet/supplements can go to Cholecalciferol (D3) too. Here is a diagram:

Q: What do you think of Vitamin D injections? 

A: I have not used them.

Q: I have a client with high serotonin on neurotransmitter test, so this can be caused by gut inflammation, and can be corrected by vitamin D, is this right? 

A: It is more likely that the high serotonin is from something else such as supplements like tryptophan, 5-HTP, or even medications such as SSRI’s. There are certain foods that can generate serotonin too such as eggplant and bananas.

Q: What if you have the VDR SNP? How to manage? 

A: You need to test an individual’s Vitamin D levels, along with varying dosages of Vitamin D to maintain their level is the optimal range. In a situation like this running a test every 6 to 8 weeks for a period time can be done to get the levels consistent in the healthy range.

Q: Do you test animals? Dogs and cats? 

A: No.

Q: Not sure if addressed; which level should be checked? 25 (OH)d or 1,25 (OH) 2d? 

A: 25(OH)D since it has a longer half-life than 1,25(OH)D. The 25(OH)D is a good indicator of overall Vitamin D status. 


The material contained within this article and webinar is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.



Kurt Woeller, DO

FOUNDER OF INTEGRATIVE MEDICINE ACADEMY
Kurt N. Woeller, DO, has been an integrative medicine physician and biomedical Autism specialist for over 20+ years. He is an author of several health books including Autism – The Road To Recovery, Methyl-B12 Therapy For Autism, Methyl-B12 for Alzheimer’s Disease and Dementia, and 5 Things You MUST Do Right Now To Help With Your Rheumatoid Arthritis. He is an international speaker, educator, and practicing clinician offering specialized interventions for individuals with complex medical conditions. His health consulting practice for Autism alone is multinational with families from various countries. Dr. Woeller serves as a clinical and lab consult for Functional Medicine Clinical Rounds, as well as provides educational seminars for Great Plains Laboratory. He is co-founder of Integrative Medicine Academy (www.IntegrativeMedicineAcademy.com), which is an online training academy for health practitioners learning integrative medicine.

High Oxalate: A Major Factor in Tissue and Blood Vessel Health

High oxalates in the urine and plasma were first found in people who were susceptible to kidney stones. Many kidney stones are composed of calcium oxalate. Stones can range in size from the diameter of a grain of rice to the width of a golf ball. It is estimated that 10% of males may have kidney stones some time in their life. Because many kidney stones contain calcium, some people with kidney stones think they should avoid calcium supplements. However, the opposite is true.

When calcium is taken with foods that are high in oxalates, oxalic acid in the intestine combines with calcium to form insoluble calcium oxalate crystals that are eliminated in the stool. This form of oxalate cannot be absorbed into the body. When calcium is low in the diet, oxalic acid is soluble in the liquid portion of the contents of the intestine (called chyme) and is readily absorbed from the intestine into the bloodstream. If oxalic acid is very high in the blood being filtered by the kidney, it may combine with calcium to form crystals that may block urine flow and cause severe pain. 

In addition to kidney disease, individuals with fibromyalgia and women with vulvar pain (vulvodynia) may suffer from the effects of excess oxalates. Oxalate crystals may also form in the bones, joints, blood vessels, lungs, thyroid, and even the brain, possibly impeding their proper function. In addition, oxalates in the bone may crowd out the bone marrow cells, leading to anemia and immunosuppression.

Oxalate crystals cause pain and damage to various tissues, due to their sharp, physical structure, and may also increase inflammation. Iron oxalate crystals may cause significant oxidative damage and diminish iron stores needed for red blood cell formation. Oxalates may also function as chelating agents and may chelate many toxic metals, such as mercury and lead. Unlike other chelating agents, oxalates trap heavy metals in the tissues, leading to metal toxicity. Oxalates also interfere with the Krebs cycle’s glucose metabolism and can inhibit absorption of essential minerals necessary for optimum health. 

Foods especially high in oxalates are often foods thought to be otherwise healthy, including spinach, beets, chocolate, peanuts, wheat bran, tea, cashews, pecans, almonds, berries, and many others. People now frequently consume “green smoothies” in an effort to eat “clean” and get healthy, however, they may actually be sabotaging their health. The most common components of green smoothies are spinach, kale, Swiss chard, and arugula, all of which are loaded with oxalates. These smoothies also often contain berries or almonds, which have high amounts of oxalates as well. Oxalates are not found in meat or fish at significant concentrations. Daily adult oxalate intake is usually 80-120 mg/d. A single green smoothie with two cups of spinach contains about 1,500 mg of oxalate, a potentially lethal dose. 


Oxalate Metabolism

Oxalate (and its acid form, oxalic acid), is an organic acid that is primarily derived from three sources: the diet, fungus (such as Aspergillus and Penicillium), possibly Candida, and also human metabolism. Oxalic acid is the most acidic organic acid in body fluids and is used commercially to remove rust from car radiators. Antifreeze (ethylene glycol) is toxic primarily because it is converted to oxalate in the body. Two different types of genetic diseases are known in which oxalates are high in the urine, hyperoxalurias type I and type II, which can also be determined from the Organic Acids Test

In the genetic disease hyperoxaluria type I and in vitamin B-6 deficiency, there is a deficiency in the enzyme activity of alanine glyoxylate amino transferase (AGT), leading to the accumulation of glyoxylic acid. The high glyoxylic acid can then be converted to glycolate by the enzyme GRHPR or to oxalate by the enzyme LDH. Thus, glycolate, glyoxylate, and oxalate are the metabolites that are then elevated in the Organic Acids Test in hyperoxaluria type I and in vitamin B-6 deficiency. 

In the genetic disease hyperoxaluria type II, there is a deficiency in an enzyme (GRHPR) that has two biochemical activities: glyoxylate reductase and hydroxypyruvic reductase. This enzyme converts glyoxylate to glycolate and glycerate to hydroxypyruvate. When this enzyme is deficient, glycerate cannot be converted to hydroxypyruvate and glyoxylate cannot be converted to glycolate. In this disease, glyoxylate is increasingly converted to oxalate and glycerate is also very elevated.

External sources of oxalates include ethylene glycol, the main component of antifreeze. Antifreeze is toxic mainly because of the oxalates formed from it. In addition, some foods also contain small amounts of ethylene glycol. Vitamin C (ascorbic acid or ascorbate) can be converted to oxalates but apparently the biochemical conversion system is saturated at low levels of vitamin C so that no additional oxalate is formed until very large doses (greater than 4 grams per day) are consumed. The deposition of oxalates in critical tissues such as brain and blood vessels, the oxidative damage caused by oxalate salts, and the deposition of oxalate mercury complexes in the tissues.

How Can High Oxalates Be Treated?

Implement a low-oxalate diet. This may be especially important if the individual has had Candida for long periods of time and there is high tissue oxalate buildup. 

  • Use antifungal drugs to reduce yeast and fungi that may be causing high oxalates. Children with Autism Spectrum Disorders frequently require years of antifungal treatment. Arabinose, a marker used for years for yeast/fungal overgrowth in the Organic Acids Test is correlated with high amounts of oxalates. 

  • Supplements of calcium and magnesium citrate can reduce oxalate absorption from the intestine. Citrate is the preferred calcium form to reduce oxalate because citrate also inhibits oxalate absorption from the intestinal tract. 

  • N-Acetyl glucosamine supplements can stimulate the production of the intercellular cement, hyaluronic acid, to reduce pain caused by oxalates. 

  • Chondroitin sulfate can prevent the formation of calcium oxalate crystals. 

  • Vitamin B6 is a cofactor for one of the enzymes that degrades oxalate in the body and has been shown to reduce oxalate production. 

  • Excessive fats in the diet may cause elevated oxalates if the fatty acids are poorly absorbed because of bile salt deficiency. If taurine is low, supplementation with taurine may help stimulate bile salt production (taurocholic acid), leading to better fatty acid absorption and diminished oxalate absorption. 

  • Probiotics may be very helpful in degrading oxalates in the intestine. Individuals with low amounts of oxalate-degrading bacteria are much more susceptible to kidney stones. Both Lactobacillus acidophilus and Bifidobacterium lactis have enzymes that degrade oxalates. 

  • Increase intake of essential omega-3 fatty acids, commonly found in fish oil and cod liver oil, which reduces oxalate problems. High amounts of the omega-6 fatty acid, arachidonic acid, are associated with increased oxalate problems. Meat from grain fed animals is high in arachidonic acid. 

  • Supplements of vitamin E, selenium, and arginine have been shown to reduce oxalate damage. 

  • Increase water intake to help eliminate oxalates.


High Oxalate Food List

Fats, Nuts, Seeds

  • Nuts

  • Nut butters

  • Sesame seeds

  • Tahini

  • Soy nuts

Drinks

  • Dark or “robust” beer

  • Black tea

  • Chocolate milk

  • Cocoa

  • Instant coffee

  • Hot chocolate

  • Ovaltine

  • Soy drinks

Dairy

  • Chocolate milk

  • Soy cheese

  • Soy milk

  • Soy yogurt

Starch

  • Amaranth

  • Buckwheat

  • Cereal (bran or high fiber)

  • Crisp bread (rye or wheat)

  • Fruit cake

  • Grits

  • Pretzels

  • Taro

  • Wheat bran

  • Wheat germ

  • Whole wheat bread

  • Whole wheat flour

Misc.

  • Chocolate

Fruit

  • Blackberries

  • Blueberries

  • Carambola

  • Concord grapes

  • Currents

  • Dewberries

  • Elderberries

  • Figs

  • Fruit cocktail

  • Gooseberry

  • Kiwis

  • Lemon peel

  • Orange peel

  • Raspberries

  • Rhubarb

  • Canned strawberries

  • Tangerines

Vegetables

  • Beans (baked, green, dried, kidney)

  • Beets

  • Beet greens

  • Carrots

  • Celery

  • Chicory

  • Collards

  • Dandelion greens

  • Eggplant

  • Escarole

  • Kale

  • Leeks

  • Okra

  • Olives

  • Parsley

  • Peppers (chili and green)

  • Pokeweed

  • Potatoes (baked, boiled, fried)

  • Rutabaga

  • Spinach

  • Summer squash

  • Sweet potato

  • Swiss chard

  • Zucchini

Testing for Oxalates

The most convenient way of testing oxalates is by the Organic Acids Test (OAT) at The Great Plains Laboratory. The Organic Acids Test by The Great Plains Laboratory is the only OAT on the market that evaluates levels of oxalates in urine. The OAT checks for the presence of:

Oxalic acid (oxalates) Tests for all forms of oxalic acid and its salts or conjugate bases.

Arabinose Important Candida indicator which strongly correlates with oxalates.

Glycolic acid (glycolate) Indicator of genetic disease of oxalate metabolism called Hyperoxaluria type I due to a deficiency in the enzyme activity of alanine glyoxylate amino transferase (AGT).

Glyceric acid (glycerate) Indicator of genetic disease of oxalate metabolism called Hyperoxaluria type II due to a deficiency in an enzyme (GRHPR) that has two biochemical activities: glyoxylate reductase (GR) and hydroxypyruvic reductase (HPR). 

Ascorbic acid (ascorbate, vitamin C) Indicates nutritional intake of vitamin C and/or excessive destruction. Vitamin C can be excessively converted to oxalates when free copper is very high. Evaluate further with Copper + Zinc Profile from The Great Plains Laboratory.

Pyridoxic acid Indicator of vitamin B-6 intake. The enzyme activity alanine glyoxylate amino transferase (AGT) requires vitamin B-6 to eliminate glyoxylic acid or glyoxylate, a major source of excess oxalates.

Furandicarboxylic acid, hydroxy-methylfuroic acid Markers for fungi such as Aspergillus infection, one of the proven sources of oxalates.

Bacteria markers A high amount of bacterial markers may indicate low values of beneficial bacteria such as Lactobacilli species that have the ability to destroy oxalates.


Food as Medicine: Benefits of Omega Fats in Chronic Disease


By Jasmyne Brown, ND

In today’s developed and developing worlds, inflammation is on the rise. Inflammation is a protective mechanism employed by our bodies when being attacked or under stress. Acutely, inflammation is protective. Chronic inflammation is what contributes to long-standing chronic disease. With the ease of eating on the go and the abundance of fast food, foods that feed inflammation are on the rise in the diet of the modern individual. Also, the inflammatory nature of chronic conditions makes it imperative for healthcare professionals to know the importance of anti-inflammatories in the healing process. At The Great Plains Laboratory, we offer an easy-to-use profile, the Omega-3 Index Complete Test. This test is a dried blood spot (DBS), meaning easy collection for clients in the comfort of their home. With this ease of use, it's never been easier to get a comprehensive look at someone's fatty acid status. The test gives you the percentage of your omega 3 fats, the ratio of omega 6 fats to omega 3 fats, and a closer look at the ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA). At the end of each report, there is a nice breakdown of various fats and their percentage in your blood. Here is a link to a sample report

Those who would benefit from getting a report include anyone with a chronic disease or looking to improve their overall health profile. Common conditions the research and clinical experience have been effective in providing efficacy of omega fats are cardiovascular disease, myocardial infarction (3), autoimmune conditions like multiple sclerosis (MS) and rheumatoid arthritis (RA) (2), skin conditions (4), mental health complaints like schizophrenia (7) and depression (10), Autism Spectrum Disorders (1), ADHD (1), and Alzheimer’s and traumatic brain injury (8). Various phases of life also require omega fats. A very critical stage is during gestation, infancy, and childhood development. Also, any individual looking to support reduction of inflammatory markers like tumor necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2), phospholipase A2, etc. and anyone looking to optimize health should consider this profile. This pairs with our Organic Acids Test as inflammation is a trigger of mitochondrial dysfunction, which you can see in the mitochondrial sections of this test.  

Research has shown great benefits in omega 3 supplements as an addition to various disease states. Most common omega fats have been studied in reducing the incidence of cardiovascular events. Most of the research is focused on the reduction of total cholesterol. Omega 3 fats have been shown to reduce LDL-C and triglycerides, which are implicated in cardiovascular events (5). The addition of alpha-linolenic acid (ALA) has shown promising results in reducing the incidence of arrhythmias (3). In relation to mental health, omega fats are often seen to be reduced in the blood of those diagnosed with schizophrenia. Various mechanisms are thought to play a role in the reduction of omega 3s, especially DHA. The level of DHA in mental health is crucial to understand as 60% of the brain is constituted of phospholipids and 40% of those are DHA. This is often deficient in schizophrenic patients. In some cases, it's a genetic misincorporation of DHA as there is a fatty acid binding protein preference for more in inflammatory omega 6 fatty acids (7). This leads to an increased omega 6:3 ratio. In most cases, these patients have been noted to eat a more inflammatory diet, devoid of omega 3 rich foods (14). In depression, the addition of omega DHA and EPA has been shown to improve mood. This is also seen in perinatal and postpartum depression when given in combination with other traditional therapies. In Autism Spectrum Disorders, blood levels of fatty acids show increased omega 6 PUFA in comparison to omega 3. This equates to an elevated omega 6:3 ratio (12). More studies with larger sample sizes are needed to further the research in autism even though many clinical benefits have been seen with omega fat administration (1). 

Autoimmune conditions also have a plethora of research connecting the benefits of omega-rich fats. In RA patients taking omega 3 fats, reduction of analgesics was achieved without changes in weight when it came to joint pain. Various studies have shown improved joint pain with the addition of DHA and EPA. A positive effect on swelling and morning stiffness in the joints. Most of these benefits were seen after 12 weeks of seafood intake and/or fish oil supplementation. In SLE 2.25g of both EPA and DHA, after 12 weeks of supplementation, inflammatory markers IL-13 and L-12 were significantly decreased. The inverse was seen in high carb low PUFA diets (17). AA:EPA ratios were also higher in SLE patients with fewer symptoms and lower inflammation markers (9). This was seen in those whose diet reflected higher omega 3 intake, even without supplementation. In type 1 diabetes, CRP was lower in infants that were breastfed and supplemented with DHA than formula-fed infants (1). Daily EPA and DHA in the first year of life also significantly reduced the chance of developing T1DM. Omega 3’s also showed efficacy in blocking the pro-inflammatory PGE2 on beta-cells in the pancreas, leading to increased insulin secretion (18). In those with Type 2 diabetes levels of TNF-alpha and IL-2 were significantly decreased in omega 3 supplementation groups (11). These are just a few examples of the efficacy of omega fatty acids in autoimmunity.

In the dermatologic world, omega fats are used routinely. The skin is the outermost barrier of the body. Fatty acids play a role in the reduction of Transepidermal water loss (TEWL). This is often elevated in conditions related to dry skin. Atopic dermatitis (AD), psoriasis, and acne are all common skin conditions supported by the addition of omega fats. In AD infants fed breast milk low in omega 3 fats had a higher incidence. After 90 days of DHA/EPA supplementation, there was a detectable 30% increase in cutaneous hydration and itch-related behavior was eliminated. Gamma linolenic acid (GLA), an omega 6 fatty acid, when used for 4 weeks orally showed a lower TEWL and higher stratum corneum index. When given with omega 3 fats the production of a more inflammatory omega 6, AA, is inhibited (4). This is promising in the treatment of AD and both omega 3s and 6s should be given together. In psoriasis, low levels are seen in individuals with a diet, or ancestral diet, high in omega 3s like in the Eskimo population. In the pathogenesis of acne, C. acnes induces proinflammatory cytokine release of cytokines including IL-1β, TNF-α, IL-8, and IL-12. This is induced through the toll-like receptor 2 (TLR-2) signaling pathway (4). DHA and EPA inhibit TLR-2 and thus supplementation reduces the proinflammatory nature of acne. Insulin growth like factor-1 (IGF-1) is another signaling pathway that directly affects keratinocytes and is blocked by omega 3 fatty acids (4).  As we can see various conditions are supported by the introduction of omega fatty acids.

The Omega 3 Test also supplies information regarding important omega fat ratios. Specifically tested are the omega 6:3 and AA:EPA ratios. Ideally, both ratios should be low. As we saw above, the balance between omega 6 and 3 fats is crucial in many disease states. The Omega 6: 3 ratio in the developed world tends to be much higher than optimal health would support. This is due to the abundance of omega 6 rich foods in the diet. Concurrently, there is a substantial lack of omega 3s in the diet. Common foods like chips, snack cakes, and fast foods are readily available and cooked in oils high in omega 6. When improperly balanced with omega 3s an environment of inflammation is created. On average the ratio seen in most individuals is upwards of 15-17:1 and higher results have been documented. In asthma, a ratio of 5:1 correlates with decreased airway inflammation and improved clinical outcomes (19). In contrast, a ratio of 2-3:1 was helpful in RA. 10:1 ratio was seen as detrimental in both conditions. The differences in ratios for each condition opens the thought process that the ratio optimization will depend on the condition and also the level in which the client in question is currently trending. Testing is the best way to understand where each client's ratio stands pre-treatment.  

In cases of obesity, omega 6 rich and omega 3 devoid diets increase triglyceride levels. This pattern also leads to disruption in leptin regulation. Leptin helps to regulate the feeling of fullness. When dysregulated we have an increased consumption of calories. This phenomenon is seen as early as the perinatal period. Cord blood of infants with high omega 6:3 was seen to have increased subscapular skinfold thickness by age 3. Also, obese/overweight children were shown to have a higher level of blood AA levels. The good news is that a correction of this ratio, or lowering of it, was shown to help with the treatment of obesity. Regarding autism and ADHD, an elevated AA/EPA is consistent with affected children. In our immune cells, a Western 9diet increases the AA to about 20% while DHA and EPA reduce to 1-2%. This leads to increased production of inflammatory 2,4-series eicosanoids. But the addition of EPA/DHA supplementation will decrease AA-derived eicosanoids and increase the anti-inflammatory 3/5-series eicosanoids (6). So, by increasing the omega 3 rich foods and/or supplementation the inflammatory nature of the immune system can be greatly affected for the better.

Overall, our need for omega fats is clear. Their support in creating an anti-inflammatory environment reduces our risk of chronic disease. The addition of them during a chronic disease state can aid in the treatment of the condition. The research clearly shows the importance of balancing the omega 3s and 6s in the treatment of certain diseases. More research needs to be done to know the exact ratios for optimal overall health and other specific disease conditions. By utilizing the Omega-3 Index Complete Test, we as practitioners can guide our clients to the right omega balance for them and their conditions. This profile should be considered in any chronic disease client. If we are encouraging the intake of omega 3 rich foods, health is being well supported. 


References

  1. Agostoni, C., Nobile, M., Ciappolino, V., Delvecchio, G., Tesei, A., Turolo, S., Crippa, A., Mazzocchi, A., Altamura, C. A., & Brambilla, P. (2017, December 4). The role of omega-3 fatty acids in developmental psychopathology: A systematic review on early psychosis, autism, and ADHD. International journal of molecular sciences. Retrieved December 23, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5751211/
  2. AP;, S. (n.d.). Omega-3 fatty acids in inflammation and autoimmune diseases. Journal of the American College of Nutrition. Retrieved December 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/12480795/
  3. A., J. R. Nelson & S. Raskin, & Additional informationFundingThis article was funded by Amarin Pharma Inc. (n.d.). The eicosapentaenoic acid:arachidonic acid ratio and its clinical utility in cardiovascular disease. Taylor & Francis. Retrieved December 23, 2021, from https://www.tandfonline.com/doi/full/10.1080/00325481.2019.1607414
  4. Balić, A., Vlašić, D., Žužul, K., Marinović, B., & Bukvić Mokos, Z. (2020, January 23). Omega-3 versus omega-6 polyunsaturated fatty acids in the prevention and treatment of inflammatory skin diseases. International journal of molecular sciences. Retrieved December 23, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037798/
  5. Bradberry, J. C., & Hilleman, D. E. (2013, November). Overview of omega-3 fatty acid therapies. P & T : a peer-reviewed journal for formulary management. Retrieved December 23, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3875260/
  6. DiNicolantonio, J. J., & O'Keefe, J. (2020). The importance of maintaining a low omega-6/omega-3 ratio for reducing the risk of inflammatory cytokine storms. Missouri medicine. Retrieved December 23, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721408/
  7. Hsu, M.-C., Huang, Y.-S., & Ouyang, W.-C. (2020, July 3). Beneficial effects of omega-3 fatty acid supplementation in schizophrenia: Possible mechanisms. Lipids in health and disease. Retrieved December 23, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333328/
  8. Kumar, P. R., Essa, M. M., Al-Adawi, S., Dradekh, G., Memon, M. A., Akbar, M., & Manivasagam, T. (2014, April). Omega-3 fatty acids could alleviate the risks of traumatic brain injury - a mini review. Journal of traditional and complementary medicine. Retrieved December 23, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003707/
  9. Li X;Bi X;Wang S;Zhang Z;Li F;Zhao AZ; (n.d.). Therapeutic potential of ω-3 polyunsaturated fatty acids in human autoimmune diseases. Frontiers in immunology. Retrieved December 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/31611873/
  10. Liao Y;Xie B;Zhang H;He Q;Guo L;Subramanieapillai M;Fan B;Lu C;McIntyre RS; (n.d.). Efficacy of omega-3 pufas in depression: A meta-analysis. Translational psychiatry. Retrieved December 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/31383846/
  11. Malekshahi Moghadam A;Saedisomeolia A;Djalali M;Djazayery A;Pooya S;Sojoudi F; (n.d.). Efficacy of omega-3 fatty acid supplementation on serum levels of tumour necrosis factor-alpha, C-reactive protein and interleukin-2 in type 2 diabetes mellitus patients. Singapore medical journal. Retrieved December 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/23023905/
  12. Mocking RJT;Steijn K;Roos C;Assies J;Bergink V;Ruhé HG;Schene AH; (n.d.). Omega-3 fatty acid supplementation for perinatal depression: A meta-analysis. The Journal of clinical psychiatry. Retrieved December 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/32898343/
  13. Omega-3 fatty acids: An essential contribution. The Nutrition Source. (2019, May 22). Retrieved December 23, 2021, from https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/types-of-fat/omega-3-fats/
  14. PC;, C. (n.d.). Dietary modification of inflammation with lipids. The Proceedings of the Nutrition Society. Retrieved December 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/12296294/
  15. PC;, C. (n.d.). Omega-3 fatty acids and inflammatory processes: From molecules to man. Biochemical Society transactions. Retrieved December 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/28900017/
  16. PC;, C. (n.d.). Polyunsaturated fatty acids, inflammation, and immunity. Lipids. Retrieved December 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/11724453/
  17. Rajaei, E., Mowla, K., Ghorbani, A., Bahadoram, S., Bahadoram, M., & Dargahi-Malamir, M. (2015, November 3). The effect of omega-3 fatty acids in patients with active rheumatoid arthritis receiving dmards therapy: Double-blind randomized controlled trial. Global journal of health science. Retrieved December 23, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965662/
  18. Shaw, W. (1985). Possible role of lysolecithins and nonesterified fatty acids in the pathogenesis of Reye's syndrome, sudden infant death syndrome, acute pancreatitis, and diabetic ketoacidosis. Clinical Chemistry, 31(7), 1109–1115. https://doi.org/10.1093/clinchem/31.7.1109
  19. Simopoulos, A. P. (2002, September 11). The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomedicine & Pharmacotherapy. Retrieved December 23, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0753332202002536
    

Webinar Q+A: Mycotoxin Induced Mitochondrial Dysfunction And Cytotoxicity

On December 15, 2021, The Great Plains Laboratory hosted the Mycotoxin Induced Mitochondrial Dysfunction and Cytotoxicity webinar with Kurt Woeller, DO. Various mycotoxins can have significant adverse effects with regard to cellular function. Through DNA and RNA disruption and/or induction of oxidative stress mycotoxins can lead to various diseases, including cancer. A major target of intracellular mycotoxins are the mitochondria. This lecture by Dr. Kurt Woeller discussed some of the cytotoxic effects of mycotoxins on mitochondrial function.

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


Mycotoxin Induced Mitochondrial Dysfunction And Cytotoxicity Q+A

Q: Is it recommended for all patients who have mycotoxins to have some form of multivitamin therapy since vitamins have a huge impact on the ECT cycle?

A: I think so. I have most everyone on foundational supplements such as a multivitamin.

Q: If you have mold and candida, do you deal with them both simultaneously, or which do you treat first generally?

A: Depends on the severity of the condition, but in general mold because it can make candida worse.

Q: Maple Syrup Urine Disease is a genetic disorder in which a person is unable to break down the branched-chain amino acids. Would riboflavin make a difference in this disorder?

A: Great question and I do not know. It probably might help some.

Q: Is any other way to measure ochratoxin than the Organic Acids Test?

A: Ochratoxin is measured on the MycoTOX Profile from GPL. The OAT does not measure Ochratoxin or any other mycotoxins.

Q: Please indicate treatment strategies for aspergillus mold exposure and mycotoxins for patients with respiratory rx MAST CIRS.

A: This is a very in-depth topic and there are some webinars on the GPL site that address this, as well as seminars that are put on via the GPL Academy.

Q: I had a patient who was higher in gliotoxin than that, and we were able to completely eliminate it in less than 9 days using Ascorbic Acid and Ascorbates. We repeated this several times and got the same results using testing immediately before and immediately after the use of IV-Vitamin C. The whole process took about 9 or 10 days.

A: Awesome. I do see the value in ascorbic acid intervention too.

The material contained within this article and webinar is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the following portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.



Kurt Woeller, DO

FOUNDER OF INTEGRATIVE MEDICINE ACADEMY
Kurt N. Woeller, DO, has been an integrative medicine physician and biomedical Autism specialist for over 20+ years. He is an author of several health books including Autism – The Road To Recovery, Methyl-B12 Therapy For Autism, Methyl-B12 for Alzheimer’s Disease and Dementia, and 5 Things You MUST Do Right Now To Help With Your Rheumatoid Arthritis. He is an international speaker, educator, and practicing clinician offering specialized interventions for individuals with complex medical conditions. His health consulting practice for Autism alone is multinational with families from various countries. Dr. Woeller serves as a clinical and lab consult for Functional Medicine Clinical Rounds, as well as provides educational seminars for Great Plains Laboratory. He is co-founder of Integrative Medicine Academy (www.IntegrativeMedicineAcademy.com), which is an online training academy for health practitioners learning integrative medicine.

IgG Food Allergy and Mycotoxin Testing with William Shaw, PhD

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

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

The material contained within this article is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the following portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.


William Shaw, PhD

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

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

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

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

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

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

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

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

Q: How does fasting affect IGG?

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

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

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

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

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

Register now for our upcoming events and workshops.


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

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

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

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

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

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

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

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

A: Check out New Beginnings Nutritionals’ mold protocol.

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

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

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

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

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

A: It can bind to mycotoxins

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Q: What botanicals do you use to treat SIBo?

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

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

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

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

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

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

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

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

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

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

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

A: Not directly.

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

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

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

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

Q: Does Sauna and liposomal glutathione eliminate glyphosate?"

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

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

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

Sunlighten has a very good reputation.

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

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

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

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

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Functional Medicine Answers with Kurt Woeller, DO

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

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

The material contained within this article is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the following portions of this article is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility.


Kurt Woeller, DO

FOUNDER OF INTEGRATIVE MEDICINE ACADEMY
Kurt N. Woeller, DO has been an integrative medicine physician and biomedical autism specialist for over 20+ years. He is an author of several health books including Autism – The Road To Recovery, Methyl-B12 Therapy For Autism, Methyl-B12 for Alzheimer’s Disease and Dementia, and 5 Things You MUST Do Right Now To Help With Your Rheumatoid Arthritis. He is an international speaker, educator, and practicing clinician offering specialized interventions for individuals with complex medical conditions. His health consulting practice for autism alone is multinational with families from various countries. Dr. Woeller serves as a clinical and lab consult for Functional Medicine Clinical Rounds, as well as provides educational seminars for Great Plains Laboratory, LLC. He is co-founder of Integrative Medicine Academy, which is an online training academy for health practitioners learning integrative medicine.

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

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

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

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

Q: Why did you choose Biocidin capsules vs drops?

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

Q: Did you increase the dose slowly?

A: No.

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

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

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

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

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

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

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

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

Q: Can you augment a 165?

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

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