GPL-TOX

The Most Common Chemical Toxicants Measured at GPL

The Most Common Chemical Toxicants Measured by the GPL-TOX Profile

In this blog, Dr. Joseph Pizzorno, ND, summarizes the GPL-TOX Profile’s compounds that are found most frequently at high levels. The GPL-TOX Profile quantifies the most widespread human-made toxic compounds, including acrolein, acrylamide, bromopropane, MTBE, and perchlorate, followed by phthalates, styrene, and xylene.

Dr. Pizzorno is an expert in Environmental Medicine where he assesses the effect of toxic compounds on human health and metabolism. He is well versed in identifying mitochondrial damage, glutathione depletion, CV disease, respiratory toxicity, diabetes, dyslipidemia, and cognitive impairment tied to specific toxins.

Because the GPL-TOX Profile is mainly carried out on individuals who are ill, and these common toxicants are found everywhere, there is no control group to compare disease statistics. The percentages reported are based on NHANES population data from the CDC (except for MTBE/ETBE) collected on the general US population, as opposed to individuals with measurable workplace exposure.

Outlined below are each toxin and its prevalence in daily life. The mechanisms of cellular damage and routes of elimination from the body, as well as disease conditions that can be at least tangentially connected to a particular toxin, is outlined below as well.

Benzene is the only GPL-TOX Profile compound included near the top of ATSDR’s 2019 Substance Priority List. ATSDR (Agency for Toxic Substances and Disease Registry) is the branch of the CDC responsible for assessing toxic threats to the US population. However, several of the ATSDR priority compounds are toxic metals such as lead, which are quantified by a different chemical method. Also, the ATSDR priority compounds are more likely to be found in toxic dumps, which have not yet been remediated.

Acrolein is an EPA high priority compound. As a combustion byproduct, it can be found in beverages like coffee and alcohol, and foods cooked at high temperature, particularly unsaturated oils. Acrolein produces protein and DNA adducts as well as damaging mitochondria (which most toxins seem to do). Acrolein exhibits multiorgan toxicity, including cardiovascular, diabetes, respiratory damage, and abnormal lipids.

Acrylamide is not as persistent as acrolein, but it is also a product of cooking technique. The amino acid asparagine combines with starches during cooking to produce acrylamide: potatoes (e.g. French fries, chips) are a major source in our diet. The browning of foods makes them tastier and always provides some acrylamide with the meal.  It has been estimated that one third of our foods contain acrylamide. Rodent studies link fetal damage and smaller head circumference to exposure. Adequate Vitamin D appears to reduce DNA damage and adducts. A brief discussion on AGEs (Advanced Glycation Endproducts) follows.

Bromopropane on the GPL-TOX Profile was introduced as a less toxic, less ozone-depleting substitute for trichloroethylene (TCE), which is high on the ATSDR list. 1-BP has now been added to the Toxic Release Inventory (TRI) and large-scale usage must be reported. This widely used halogenated solvent is used to clean electronics and synthesize asphalt, but there is “surprisingly limited human data.”

Hairdressers who use chemical straighteners or relaxers are exposed; so are employees of dry cleaners. Clinical signs reported included muscle weakness, paresthesia, numbness, urinary incontinence, and memory disturbances.

Phthalates make plastic more flexible, but they are released easily from both food (fast food and food-handling gloves) and non-food sources (health and beauty aids). They bind to insulin receptors; Pizzorno estimates that 25% of diabetes is the result of phthalates. Phthalates also contribute to growing infertility issues (particularly reduced testosterone) in both sexes, lower IQ, and an increase in ADHD in children. Flavonoids in diet mitigate the effects and fasting helps clear phthalates from the body.

Perchlorates are not persistent but there is some speculation that chlorination of drinking water may increase exposure. Although rocket fuel and fireworks are the well-publicized sources, perchlorate is also allowed to control static in plastic food packaging, which is now the major source. Perchlorate binds to iodine and so reduces hyperthyroid activity in Grave’s disease.

Does perchlorate exposure contribute to hypothyroid conditions? Probably, but the impact of perchlorate on thyroid function has been difficult to demonstrate since widespread iodine insufficiency is the crucial factor.

MTBE was once used as an antiknock additive for gasoline, replacing lead.  MTBE has a half-life of only eight minutes, and supposedly is no longer added to gasoline in the US; however, it is still present in water supplies in many cities (perhaps from leaking gas tanks).  MTBE is an industrial solvent and still produced in large amounts for export and is present in “virtually” the whole population of the US. The health effects of MTBE are difficult to determine apart from other gasoline constituents.

Styrene is important in many chemical manufacturing processes, and exposure to the public can come from disposable plastic coffee cups, memory foam mattresses, vehicular exhaust, and smoking. Exposure to styrene elevates malondialdehyde (a marker for oxidative stress), depletes glutathione, and creates DNA adducts (8OHdG test). Styrene may add to ASD risk, hearing and vision loss, genotoxicity and perhaps cancer. Health effects are difficult to pinpoint because there is no unexposed cohort.

Xylene health effects are hard to distinguish from other solvents; it is not persistent in the environment. Half of industrial xylene goes to producing PET bottles and polyester clothing.

Dr. Pizzorno notes that the entire population is exposed to most of these potential toxicants, so that teasing out specific effects is very difficult and disease associations can be quite vague. He cites the CDC’s National Report on Human Exposure to Environmental Chemicals as a resource for what exposure and health effect data is available.

However, individuals have unique biochemistry. There can be over 100-fold difference in Phase 1 and 2 detoxification ability. A small percentage of the population is very slow to detox. Reactions to individual toxins are dependent upon total body toxin load, so the best strategy is to minimize exposure and consume nutrients that facilitate detoxification. Properly prepared organic food (not burned to generate acrylamide) is the best diet approach. He points out that detoxification requires patience. Expected and hoped-for results come very slowly, even slower than the health gains from nutritional therapy.

As Dr. Pizzorno repeated throughout his presentation (video access above):  The best intervention is always avoidance. More guidance is revealed in his book for consumers: The Toxin Solution.

Note: The 19th marker on the panel is tiglylglycine, a compound related to mitochondrial function. Tiglylglycine could not be measured using OAT methodology, but the peak could be seen on the GPL-TOX Profile’s LCMS, so it was added at the end of the report.

About Joseph Pizzorno

Joseph Pizzorno, ND, is a thought leader in functional medicine. As founding president of Bastyr University in 1978, he coined the term “science-based natural medicine” which set the foundation for Bastyr to become the first accredited institution in this field anywhere in the world.

Learn more with our live webinars!

Workshop Q+A Part 2 - Mitochondria and Toxins

On August 5-7, 2022, GPL Academy hosted the Mitochondria and Toxins: Advanced Strategies & Protocols in Chicago and live-streamed online. The following Q+A is a grouping of responses from the workshop presentations.

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


Joseph Pizzorno, N.D.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Elena Villanueva, D.C.

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

 

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

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

Q: What is your glyphosate protocol? 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A: Yes, those plus the environmental toxins and Glyphosate

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

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

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

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


LEARN NEW WAYS TO HELP PATIENTS WITH DIFFICULT-TO-DIAGNOSE AND CHRONIC HEALTH ISSUES.

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

Registration includes:

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

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

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

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

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

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

Kidney: The Often-Forgotten Part of Detoxification

Quick glance

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

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

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

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

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

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


How the Kidney Works

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

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

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

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

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


Eliminating Toxicants

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

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

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

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

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

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

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

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

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



Eliminating Chemical Toxicants

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

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

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

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

How to Support the Kidneys

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

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



Additional Recommendations

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

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

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

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

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

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

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

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

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

Order a Test or
Open an Account

GPL improves health treatment outcomes for chronic illnesses by providing the most accurate, reliable, and comprehensive biomedical analyses available.


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

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


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

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

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

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

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


Day 2 Q+A: Advanced Organic Acids


Kurt Woeller, DO

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

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

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


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

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


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

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

 

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

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

 

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

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


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

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


Q: What is the significance of low aconitic?

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


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

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

 

Q: Do PPIs for GERD affect the mitochondria?

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


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

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


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

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


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

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


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

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


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

A: Yes. I feel they should be.


Q: What is the dose for PTERIDIN-4?

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


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

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



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

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


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

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


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

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


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

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


Joseph Pizzorno, ND

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

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

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


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

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


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

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


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

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


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

A. I am not aware of any convincing research.

 

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

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


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

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


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

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

 

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

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


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

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


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

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


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

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


Bob Miller, CTN

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

 

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

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

 

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

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

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

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



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

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

Registration includes:

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

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

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

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

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

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.

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.

GPL-TOX: Common Markers And Environmental Testing

GPL_Blog_Q+AandVideo_MarkersandEnvTesting_Graphics_Thumbnail Bump copy.png
GPL_Blog_Q+AandVideo_MarkersandEnvTesting_Graphics_Photo.png

Jasmyne Brown, ND

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Q: Please talk about marker 17.

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

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

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

Q: What about testing for glyphosate?

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

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

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

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

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

Q: What is contact info for my tap score?

A: HERE

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

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

Q: Which air filter do you recommend?

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

Q: Glyphosate 2.15 how bad is this?

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


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

GPL-Blog_Graphics_2021_MasterPractitioner_Mar2021_Q+A-04.png

The Great Plains Laboratory has been educating practitioners for over 15 years on how to help patients heal through cutting-edge testing, research and protocols. In our recent 3-Day Master Practitioner Workshop, speakers shared detailed information on how the MycoTOX Profile, IgG Food MAP and Glyphosate Test can work for you. As well as gave additional information about markers in the OAT and GPL-TOX.

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

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


GPL-Blog_Graphics_2021_MasterPractitioner_Mar2021_Q+A_Rostenberg.png

Andrew Rostenberg,
DC, DIBAK

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

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

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

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

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

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

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

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

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

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

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

A: Most likely yes.

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

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

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

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

Q: How does mold affect dopamine?

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

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

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

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

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

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

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

Register now for our upcoming events and workshops.


GPL-Blog_Graphics_2021_MasterPractitioner_Mar2021_Q+A_Neu.png

James Neuenschwander, MD

Identifying and Treating Complex Patients with Mold Toxin Induced Illness

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

Q: Prefer IV Voriconazole or oral, and what doses?

A: Oral: 200mg twice daily.

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

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

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

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

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

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

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

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

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

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

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

A: That is a two hour lecture.

Q: Do you consider EMFs in your patients?

A: Yes, but extremely difficult to treat.

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

A: I use voriconazole.

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

A: I typically use DNRS. LINK

Q: What is the electron transport chain test called?

A: MitoSwab

Q: Any specific lab for AVH alpha MSH?

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

Q: Any recs for alternative to tenting for termites?

A: Not an exterminator.

Q: Vocabulary check POP (persistent organic pollutants)?

A: Yes.

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

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

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

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

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

A: Yes.

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

A: Too quick of a detox will create symptoms.

Q: Can mycotoxins be responsible for persistent fever?

A: Any immune activation can cause a persistent fever.

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

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

Register now for our upcoming events and workshops.


GPL-Blog_Graphics_2021_MasterPractitioner_Mar2021_Q+A_Givler.png

Emily Givler, DSC

Oxalates & Mold: A Hidden Source of Inflammation

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

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

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

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

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

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

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

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

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

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

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

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

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

Q: Where do you get the sulfate test strips?

A: Amazon.

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

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

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

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

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

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

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

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

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

A: Yes, that would be my own preference.

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

A: Potentially.


Organic Acids, Mycotoxins & Heavy Metals - Common Questions

GPL-Blog_Graphics_2021_MasterPractitioner_Mar2021_Q+A-04.png

The Great Plains Laboratory has been educating practitioners for over 15 years on how to help patients heal through cutting-edge testing, research and protocols. In our recent 3-Day Master Practitioner Workshop, speakers shared detailed information on how the MycoTOX Profile, IgG Food MAP and Glyphosate Test can work for you. As well as gave additional information about markers in the OAT and GPL-TOX.

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

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


GPL-Blog_Graphics_2021_MasterPractitioner_Mar2021_Q+A_Woeller.png

Kurt Woeller, DO

Functional Medicine
and the Organic Acids Test

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

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

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

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

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

Q: Which stool test do you recommend?

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

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

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

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

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

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

A: Yes, all the time.

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

A: Not that I know of.

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

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

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

A: Only the potential for die-off.

Q: Will these also bind helpful nutrients?

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

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

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

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

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

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

A: I have, but conservatively like one capsule.

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

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

Q: Can saccharomyces boulardi impact the arabinose marker?

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

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

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

Register now for our upcoming events and workshops.

Q: What’s the significance of 5 hydroxybenzoic?

A: Could come from Paraben exposure.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Q: Any headaches associated with oxalate?

A: Yes. They could be.

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

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

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

A: Fat maldigestion will cause increase oxalate absorption.

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

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

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

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

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

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

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

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

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

A: No.

Register now for our upcoming events and workshops.

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

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

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

A: No.

Q: What does HVA/VMA ratio means?

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

Q: And HVA/DOPAC indicate?

A: Ratio between HVA and DOPAC.

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

A: Problem in fatty acid metabolism with the cell.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A: Improved.

Register now for our upcoming events and workshops.

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

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

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

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

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

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

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

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

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

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

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

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

Register now for our upcoming events and workshops.


Indicators of Detoxification: The Assessment of Pyroglutamic Acid

Dr-Brown-Headshot.png


By JASMYNE BROWN, ND, MS

In assessment of the Organic Acid Test (OAT), a beneficial section is the “Indicators of Detoxification,” The first marker found in this section, marker 58, gives insight into detoxification and glutathione synthesis. As this marker increases, it can guide practitioners to the possibility of toxic exposure being a piece to the client’s clinical picture. In understanding the biochemistry of this marker, further dysfunction may potentially be prevented.

GPL-Blog_Graphics_2020_UnderstandingOATIndicators_Header Block 1.png

Marker 58 In this section is a urinary metabolite known as pyroglutamic acid. This is a functional marker of glutathione status.  Though it does not directly look at glutathione status, it measures the activity of the rate limiting enzymatic process in the production of glutathione. Thus, it is assessing the process of antioxidant production, and when upregulated informs us of increased stress on the system. Glutathione, itself, is the major antioxidant produced in abundance in the liver. It is composed of three amino acids: cysteine, glycine, and glutamate. In periods of nutritional deficiency, stress, increased reactive oxygen species (ROS), toxicity, mitochondrial dysfunction, cellular proliferation, Phase 2 detoxification, etc. glutathione stores are depleted, and the production status is upregulated. Prolonged glutathione depletion leads to mitochondrial dysfunction, that can be assessed on the OAT, and is directly supported with glutathione administration.

GPL-Blog_Graphics_2020_UnderstandingOATIndicators_Header Block 2.png
GPL_Social_Blog_UnderstandingOATIndicators_GPL_Instagram.png

In general, the production of glutathione involves a series of enzymatic reactions that combine the three necessary amino acids for its production. On a regular basis the following process is completed to produce daily needed amounts of glutathione:

The process of glutathione production is known as the gamma-glutamyl cycle. In this cycle pyroglutamate, also known as 5-oxoproline, is degraded by the ATP dependent enzyme 5-oxoprolinase into glutamate. Glutamate is then combined with cysteine via the enzyme gamma-glutamyl cysteine synthetase. The next step is the incorporation of glycine via GSH synthetase to make glutathione itself. Glutathione is then transported out of the cytosol for use throughout the body. For the cycle to continue, reduced glutathione is transported back into the cytosol. In order to be transported back into the cell, it must be enzymatically cleaved by gamma glutamyl transpeptidase (GGT- another significant blood biomarker for glutathione status) to break it down into a cysteine-glycine complex and free glutamate. The cysteine-glycine complex is then cleaved further into the respective amino acids then transported into the cell. The glutamate is then transported into the cell as gamma-glu-aa and is transformed into 5-oxoproline via gamma glutamyl cyclotransferase. From here it can then be cleaved into glutamate via 5-oxoprolinase, continuing the cycle. This process is always happening at some extent regularly in the human body.

GPL-Blog_Graphics_2020_UnderstandingOATIndicators_Header Block 2 copy.png

During this process, as glutathione is produced, there is a negative feedback loop. When in abundant supply, glutathione inhibits the gamma-glutamyl cysteine synthetase enzyme. This blocks the combining of cysteine and glutamate before being joined with glycine to form more glutathione. This is the body's way of regulating the amount of glutathione in the system. In times of oxidative stress, toxic exposure, inflammation, etc the glutathione production cycle is upregulated due to an increased need for glutathione to protect the body. When glutathione is deficient, the negative feedback loop is dysregulated allowing for more cysteine to be joined in the production of more glutathione. Since the regulation is no longer happening the entire cycle of production is upregulated. Thus, there is also an upregulation of 5-oxoproline being converted into glutamate. Because the enzyme, 5-oxoprolinase, is ATP dependent and the rate limiting enzyme of the whole cycle there becomes a buildup in pyroglutamic acid. This is because the need for glutathione production, in times of stress and toxicity, outweighs the rate in which 5-oxoprolinase can transform 5-oxoproline into glutamate. So, 5-oxoproline builds up leading to elevated urinary values of pyroglutamic acid.  Also, due to the ATP dependent nature of the enzyme, energy depletion is seen and stimulates the expression of energy depletion symptoms.


When evaluating marker 58 on the OAT, elevations give insight to how upregulated the glutathione cycle is at the moment of testing. In instances of true elevations, out of the reference range, there is clear glutathione deficiency. It can be said that the person’s body is struggling to make adequate glutathione. In situations like this all aspects of the client’s health presentation and medications/supplements should be evaluated. Certain pharmaceuticals, like large amounts or regular small doses of acetaminophen, which is known for its hepatotoxicity, stimulate the need for more glutathione. This is especially significant when people are taking multiple pharmaceuticals that may be liver toxic and have a cumulative effect. Other things that deplete glutathione include alcohol, recreational drug use, a fructose rich diet, the natural aging process, prolonged fasting (24 hours or longer), and anything that causes increases in oxidative stress. If this has been ruled out as the cause of elevations in pyroglutamic acid, then toxic exposures can be assessed. As stated, glutathione production is upregulated during a toxic exposure. Since the body upregulates glutathione for various reasons, it's hard to pinpoint which toxin test to perform. It could be heavy metals, non-metal toxins, mold toxins, or a combination. Consider running GPL offered profiles: MycoTOX, GPL-TOX, Heavy Metal Testing.

Assessing for depleting causes is helpful in the healing process as it can open up people to environmental testing and detoxification. Pyroglutamic acid is a useful marker and upregulation can give insight to glutathione needs. 


References
1.    CG. Alfafara, A., CG. Alfafara, K., Anderson, M., A. Anschau, L., M. Ask, V., A. Ayer, C., . . . X. Zhang, H. (1992, January 01). Microbial production of glutathione. Retrieved December 11, 2020, from HERE
2.    Francini F;Castro MC;Schinella G;García ME;Maiztegui B;Raschia MA;Gagliardino JJ;Massa ML;. (n.d.). Changes induced by a fructose-rich diet on hepatic metabolism and the antioxidant system. Retrieved December 11, 2020, from HERE
3.    M;, E. (n.d.). Acetaminophen toxicity and 5-oxoproline (pyroglutamic acid): A tale of two cycles, one an ATP-depleting futile cycle and the other a useful cycle. Retrieved December 11, 2020, from HERE
4.    M;, E. (n.d.). Acetaminophen toxicity and 5-oxoproline (pyroglutamic acid): A tale of two cycles, one an ATP-depleting futile cycle and the other a useful cycle. Retrieved December 11, 2020, from HERE
5.    Martensson, J., & Meister, A. (1989). Mitochondrial damage in muscle occurs after marked depletion of glutathione and is prevented by giving glutathione monoester. Proceedings of the National Academy of Sciences, 86(2), 471-475. doi:10.1073/pnas.86.2.471
6.    Pizzorno, J. (2014, February). Glutathione! Retrieved December 11, 2020, from HERE
7.    Richman, P., & Meister, A. (1975, February 25). Regulation of gamma-glutamyl-cysteine synthetase by nonallosteric feedback inhibition by glutathione. Retrieved December 11, 2020, from HERE
8.    An Under Recognised Cause of Metabolic Acidosis. (2018, September 13). Retrieved December 11, 2020, from HERE
Vogt, B., & Richie, J. (2002, November 05). Fasting-induced depletion of glutathione in the aging mouse. Retrieved December 11, 2020, from HERE

GPL TOX: Health Concerns and Exposure of Common Markers Part 2: Testing Air and Water Quality

Dr-Brown-Headshot.png


By JASMYNE BROWN, ND, MS

GPL-GPL-TOX_full-color.png

Our recent post discussed some of the more commonly elevated GPL-TOX markers. It looked at where these toxins are commonly found. A lot of these are being released in the air, contaminating our water supplies, and/or are in our commonly used daily products. This post aims to describe various resources for testing the air and water for these chemicals and to find products free from these toxins.

In the presence of multiple toxins and certain toxins, water contamination is the most plausible source of exposure. Assessing the water for contamination is the first step in realizing if the water is their source of exposure. There are various ways and organizations that we can turn to during these situations. Initially, a first step for assessing water is by contacting your local municipality. This is a simple way to get information from the supplier of your tap water. As a consumer, you can inquire about the chemical testing that is done on your water supply. This is a good first and affordable step to start your investigation.

Other resources you can use include the Safe Drinking Water Hotline powered by the EPA. Here, you can contact the EPA and ask questions about your drinking water. Simply fill out their online form and add your city and state information and your questions. They will contact you with answers. Other online resources for third party testing can be utilized as well. These services are provided for a price. Two water testing companies are National Testing Laboratories Ltd and SimpleLab Tap Score. These companies are independent water testing labs that offer testing for both city and well water sources. Each company has a widespread range of contaminants tested. You can choose from either company based on the contaminants you want tested specifically.

For chemicals that are not commonly found in water, or come back negative on water testing, may be in the air. In new buildings or newly renovated or clean buildings, there can be off-gassing of many chemicals used in the construction and cleaning industries. Due to the odorless and colorless nature of a lot of these chemicals, it is difficult to know which, when and how much of a chemical is being released into the air. Air testing is an option for those who populate many elevations on the GPL-TOX. This can help pinpoint where you are being exposed and how much of an exposure is being had. There are various air monitors and tests that can be used to determine your air quality. 

GPL-Blog_Graphics_GPLTOX_Pt2-02.png

The first resource for home air testing is a company called Home Air Check. This company allows consumers and business owners to test their air for various chemical contaminants. Tests kits can be rented based on your air testing needs. Another company that looks at similar chemicals allows for the purchase of testing kits. This company is called Design Well Studios. They test for 500 airborne chemicals. These companies also, in addition to testing the sample, offer consultations with clients to help you understand your results and resources for cleaning up the environment.

GPL-Blog_Graphics_GPLTOX_Pt2-03.png

Another resource for home monitoring is in-home monitors. One you can consider is Awair.  This company offers in-home air quality sensors. These sensors can be monitored directly or via the online dashboard. Temperature, humidity, CO2, chemicals, fine dust, ambient noise and light are all monitored. In this way, you can monitor your home in real-time for elevations in these categories. Also these can be used in businesses to monitor large spaces. This will alert you to high-level exposures in your environment that can then be pinpointed and addressed to remove a toxic exposure. After removal, this can still be an asset to alert you to a possible new exposure in the future.

GPL-Blog_Graphics_GPLTOX_Pt2-04.png

Other resources consumers can use to reduce their chemical exposure involve the use of resources that categorize products based on their toxin level. Sometimes, after water and air testing, our personal care products should be tested for potential exposures. Oftentimes, cosmetics and dyes can have toxic chemicals that we apply to our skin on a regular basis. A great resource is the Environmental Working Group (EWG). There is a sector called Skin Deep and it is a database of many body care products and their environmental ratings.  This database categorizes products based on toxins in the ingredient list, ingredient transparency, and the use of good manufacturing practices. If the product meets these standards, it will be granted the EWG verified mark of approval. This means it meets all of EWG’s standards for avoidance of toxic chemicals. With this database, you can also search for a rating for your favorite products you already use. While in stores looking at new products, you can also consider using an app. The Think Dirty app is a good in-store way to scan products you're considering using to verify the ingredients being used. This app and its online site categorizes products based on toxic chemical ingredients. There is a wide range of “clean” products that are recommended. This resource can help you avoid purchasing products that use ingredients that may potentially be harmful to human health.


Overall, we live in a world with toxins. They are nearly impossible to completely avoid all the time. The best we can do as consumers is educate ourselves and assess our environments. Hopefully, this can serve as a resource to open doors for more monitoring of our environments and thus a reduction of toxin exposure.

GPL-TOX: Health Concerns and Exposure of Common Markers

Dr-Brown-Headshot.png


By JASMYNE BROWN, ND, MS

GPL-GPL-TOX_full-color.png

The Great Plains Laboratory, for a while now, has offered a non-metal toxin profile, the GPL-TOX. This profile has garnered much attention for its extensive range of environmental toxins assessed. As a consultant for GPL it is my goal to shed some light on the most common toxins I get questions about.

In the assessment of this profile, we must realize that we, unfortunately, live in a toxic world. Whether we know it or not the world we live in is composed of various toxins that we are exposed to daily. The routes of exposure include inhalation, ingestion, and direct dermal contact. Because these toxins can be in the air, there are a myriad of unforeseen issues that cannot always be accounted for when assessing one’s exposures.

GPL-Blog_HeaderBlocks_GPLTOX-01.png

The first marker on this profile is the metabolite 2-Hydroxyisobutyric Acid (2HIB). This is the urinary metabolite of methyl tertiary butyl ether/ ethyl tertiary butyl ether (MTBE/ETBE) after it is processed in the human body. These chemicals are important to human health as acute and chronic exposure can lead to a range of health concerns. Acute exposure symptoms include nausea, headaches, dizziness, ocular irritation, and feelings of confusion. Chronic symptoms can include central and peripheral neurologic changes, liver and kidney damage, leaks from the gallbladder into other areas of the body, sleepiness, low white blood cell count, and has been shown to be carcinogenic in animals.

In the production of gasoline lead was the additive of choice to improve octane levels. When lead was discovered to be harmful to human health, the common gasoline additive was changed to MTBE/ETBE. After its incorporation into the gasoline used across the United States, these chemicals were found to cause harm to human health as well. Due to this fact MTBE/ETBE have been phased out as gasoline additives. The rest of the MTBE/ETBE gasoline had been phased out of use in the U.S. by the late 2000’s but it is still in the soil. This leads to common exposure in water supplies. The groundwater that is contaminated could be feeding wells and potentially city water supplies that could be exposing someone through ingestion and dermal contact.

GPL-Blog_HeaderBlocks_GPLTOX-02.png

Styrene is the next marker on the profile I commonly get questions about. On the profile it is measured by its urinary metabolite, Phenyl glyoxylic acid (PGO). This is a manmade chemical most used to manufacture plastics, rubbers, and resins. Styrene goes by other names like vinylbenzene, ethynylbenzene, cinnamene, or phenylethylene. Commonly those who work with styrene are going to have the highest risk of exposure. Occupations that involve the manufacturing of boats, tubs, and showers have rather high risks of exposure. Other exposure sources include the use of plastics as food containers or vessels for beverages. Also consider how much Styrofoam is used. Styrofoam cups and food containers have had an uptick in use due to increased carryout during the new normal the pandemic has brought us. Also heating these containers whether by leaving them in a sun exposed area or heating in a microwave can cause a migration of styrene into the food or beverage consumed out of said container. Factors that are not so easy to pinpoint from other sources due to their presence in the air include car exhaust fumes and cigarette smoke. We are additionally exposed from some photocopier toners that are made with styrene and potential groundwater contamination.

Acute symptoms of a large styrene exposure are feeling of intoxication, mucous membrane irritation, gastrointestinal effects, and respiratory effects. Chronic ongoing exposure can lead to neurologic symptoms like fatigue, weakness, depression, CNS dysfunction (reaction time, memory, visuomotor speed and accuracy, intellectual function), and hearing loss, peripheral neuropathy, minor effects on some kidney enzyme functions and on the blood. All sources of exposure should be considered when this marker populates as elevated.

GPL-Blog_HeaderBlocks_GPLTOX-03.png
GPL_Social_Nov-2020_GPLTOX-CommMarkers_GPL_Blog.png

Also commonly elevated is the marker for perchlorate. Perchlorate is a chemical that, when the body is exposed, is passed unchanged and is excreted as perchlorate itself. It can be taken up in large amounts in a few organs such as the thyroid, breast tissue, and salivary glands. Acute large dose exposure can lead to hypoactivity. Long term or consistent exposure typically is associated with impaired thyroid function. Due to its effect on the thyroid’s uptake of iodine prolonged exposure can lead to hypo-functioning of the thyroid gland. Symptoms of hypothyroidism can manifest because of contamination.

Sources of perchlorate are commonly occupational. It is used in the production of solid rocket propellants, munitions, fireworks, airbag initiators of vehicles, matches, and signal flares. For those that do not work with the chemical as a part of their job or hobby of choice, perchlorate can be a contaminant of groundwater. Bleach is also a common source of exposure of perchlorate that tends to be overlooked. We can also be exposed through food sources. If the water irrigation for crops, like leafy greens, is contaminated with perchlorate we can become exposed from eating these foods. Cows that are fed grass that has been contaminated can produce milk that is contaminated with perchlorate. Finding the source is necessary especially in childbearing aged women as perchlorate can pass the placenta and breast milk. This contamination in the fetus or breast-feeding child can lead to decreased iodine uptake in the child and development of cretinism.

GPL-Blog_HeaderBlocks_KetonesandFattyAcids-02.png

The next common toxin is the metabolite diphenyl phosphate (DPP). This is the urinary metabolite for Triphenyl phosphate (TPHP). TPHP is an organophosphate flame retardant. It is used in manufacturing industries and can commonly contaminate water supplies.  It is also a common ingredient in nail polish. Many times, I have encountered women and girls with hormonal changes associated with elevated DPP. It turned out it was their routine nail polishes that they were being continually exposed. Children are often elevated for this marker as well. Flame retardants may be used in children's products like toys, nap mats, and pajamas for their safety. In recent years, in some states, the use of TPHP has been banned in children’s products. Common health effects of TPHP contamination include neurologic changes like pins and needles, hepatic and renal complications, reproductive challenges due to the estrogenic properties, and it is potentially carcinogenic.

GPL-Blog_HeaderBlocks_GPLTOX-05.png

N-acetyl(propyl)cysteine (NAPR) marker is the urinary metabolite for 1-bromopropane exposure. This chemical exposure is one of the most difficult to pinpoint, especially if the person exposed does not work with this chemical. Most common symptoms of 1 bromopropane include neurologic changes like  headaches, dysarthria, dizziness, loss of consciousness, confusion, difficulty walking, ataxia, loss of feeling in arms and legs, arthralgia (non-arthritis joint pain),  and also infertility. The most common sources of exposure include solvents used for the cleaning of metal, plastics, and electronics. Additionally, the dry-cleaning process uses this chemical and it is used in the application of asphalt. 1-bromopropane is used in the furniture making process. The solvent is used as a foam glue in the cushions of furniture and as an adhesive spray. Another source of exposure is carpet and carpet cleaning. The adhesives used to keep carpeting secure and cleaners used to rid carpets of stains can have this chemical in the list of ingredients. These sources should be assessed when this marker is elevated.

GPL-Blog_HeaderBlocks_GPLTOX-06.png

Propylene oxide is another common elevation. The urinary metabolite is N-acetyl(2-hydroxypropyl) cysteine (NAHP). This chemical is often found in those who use it in their occupational duties. Propylene oxide is used in the production of polyether’s which are used for polyurethane foam production and propylene glycol. Propylene glycol is a common ingredient in cosmetic products. Other uses for this chemical include herbicides, solvents for preparation of lubricants, surfactants, and oil demulsifiers and the fumigation of medical instruments and foodstuffs. A common food propylene oxide is used to fumigate are almonds. Often the ingestion of almonds and almond based products soars when we take on gluten free, dairy free, or peanut free diets.  Many people who embark on these diet changes may not be eating the organic variety of these almond based products. Oftentimes switching patients to organic almond products will reduce their exposure to this toxin. Common symptoms of toxicity are in the central nervous system. Propylene oxide is a mild CNS depressant and can lead to symptoms including fatigue, lack of concentration, drowsiness, etc.

GPL-Blog_HeaderBlocks_GPLTOX-07.png

The last marker that gets a lot of attention is acrylamide. Acrylamide is an organic compound that can be created from high heat cooking of high carb and high protein foods. The process of roasting, deep frying, and baking causes the production of acrylamide. Acrylamide is also a solvent used in the creation of polyacrylamide used in water treatment plants, making water contamination a common source of exposure source. Tobacco smoke and cosmetic products like lotions and makeup can be sources of acrylamide toxicity.

Symptoms of acrylamide toxicity include nervous system dysfunction, it is carcinogenic, and infertility. Oftentimes I find that individuals are eating a good amount of processed foods. This should be ruled out. Also due to its water-soluble nature, acrylamide is easily processed in the body and quickly excreted. If someone admits to a dietary change even temporarily prior to sample collection, this could be the cause of the elevation seen on the report.


All-in-all, the world we live in is not non-toxic. No matter what we do or where we go the opportunity for toxin exposure is upon us. In times of disease and dysfunction, ruling out elevated toxin exposure could be the cause of the symptomology presented. Assessing every aspect of life is crucial to pinpointing where these exposures could be stimming from.

GPL-TOX: Managing our Toxic Environment

Welcome back to the GPL blog.  I am really excited to be entering our second month of providing what we hope is useful information to the community.  Last month I discussed some of the uses of the GPL-SNP1000 test.  This month we will be discussing environmental toxicants.  Some of the topics covered will be the most prevalent toxicants in our environment, the best way to test for them, and relevant case studies. In the last blog this month I’ll cover some ways to detoxify the body and what tests can determine how well a patient is able to detoxify.

The Great Plains Laboratory introduced GPL-TOX (our toxic organic chemical profile) last July that measures 168 different toxic chemicals.  Our goal was to provide a test that measured as many chemicals as possible for a reasonable price.   These compounds fall into the categories of phthalates, benzene, pyrethrin insecticides, xylenes, styrene, fuel additives, 2,4-Dicholrophenoxyacetic (2,4-D), and organophosphate pesticides. Once a person has been exposed, the chemicals undergo several metabolic changes in the process of elimination and detoxification.  We measure the end products in the urine to determine how much chemical exposure has taken place.  Last October we introduced a test for the toxic compound glyphosate which is the world’s most widely produced herbicide. You have probably heard of it already, as it is the active ingredient in the broad-spectrum herbicide Roundup TM.  

Here at GPL, our scientists are continually working to improve our tests.  Later this month we are introducing eight new analytes to our GPL-TOX test for no additional cost. The new analytes are acrylamide, acrylonitrile, diphenyl phosphate (fire retardant metabolite), perchlorate, butadiene metabolite (carcinogenic component of rubber), dimethyl thiophosphate (pesticide metabolite),  propylene oxideacid and bromopropane.  Even before our recent update, GPL-TOX was one of the most comprehensive toxic chemical tests available.  Next week, I will discuss how all of these new analytes can affect a patient’s health.   This week I am going to provide more details about the analysis and review  a few of our current toxic analytes. I am also going to provide a few examples of case studies.   

To better understand the relevance of GPL-TOX, I’d like to explain the percentiles on our report.  The CDC issues a report of the exposure of many different chemicals to the US population.  Our percentiles are pulled from these reports.  If you are in the 95th percentile, then that means that only 5 percent of the population would have a higher value than yourself.  Since we do not know what the safe amounts are for many of these compounds we recommend reducing levels as much as possible. 

Every year over 1,000 million tons of organophosphates are used in the agricultural industry and in our home gardens.  This is a problem that is affecting us all, because even if we eat exclusively organic food, there is evidence that many of these organophosphates have contaminated the water supply.  The evidence of this has been centered on the increasing prevalence of depression, ADHD, pervasive developmental disorder, and birth defects, linking these toxins to these disorders. GPL-TOX looks at two metabolites related to organophosphates, Dimethylphosphate (DMP) and diethylphoshate (DEP).  Together these two metabolites allow us to track over 151 different organophosphates through urine, including nine of the ten most commonly used organophosphates. 

Another marker that makes GPL-TOX useful is monoethylphlate (MEP), which is a metabolite of phthalate exposure.  Many of us know about the pervasiveness of these compounds, which seem to be found in so many common products.  These products include lubricants, paints, perfumes, children’s toys, gels, and pesticides.  We are seeing many of our sickest patients possessing high values of phthalates.  Some of the symptoms we are seeing are fatigue, depression, ADHD, and arthritis.   

I want to share a couple of case studies to help illustrate what we are seeing.  The first is a painter with arthritis, fatigue, and depression.  The MEP on this patient’s GPL-TOX report came back at 19,110 (see Figure 1), which was ten-fold higher than our 95th percentile.  We recommended a detoxification program to this patient, which many of our patients are using with great success.  I will discuss different means of detoxification in my blog on May 30th, so check back for that.

Figure 1

Figure 1

Here is one more interesting case study.  We have all heard about fracking (the process of injecting liquid chemicals at high pressure far underground, in order extract natural gas or oil) and some of the resulting damage it does to the environment and our water supplies. The results below are from an extremely autistic patient with PANDAS who lives near fracking wells in the summer (see figures 2-4).  This sample was taken months after he was exposed.

Figure 2

Figure 2

Figure 3

Figure 3

Figure 4

Figure 4

These results are pretty alarming.  Obviously not everyone has high values like this, but even if we don’t live near fracking sites, we are exposed to toxic chemicals in our environment more and more every day.  If you do come up high for one or more of these chemicals, there is hope.  On May 30th I will discuss potential treatment options to detoxify the body and recommendations to avoid future exposures.  After treatment and avoidance, I recommend running the test again to make sure that you have sufficiently decreased the toxicants. 

Next week I will talk about the new analytes for the GPL-TOX test and why measuring these particular analytes is important.  In the meantime, stay vigilant about the many chemicals you and your family may be exposed to on a regular basis in every area of your home, from the food you eat and the water you drink, to all your household products.

Email gplblog@gpl4u.com if you have any questions about this blog post.