Toxic Chemicals

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.

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

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

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

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

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

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

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

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

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

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

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

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

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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.

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

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

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

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


Day 1 Q+A: Organic Acids

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

Introduction to the Organic Acids Test | Kurt Woeller, DO

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

Invasive Candida and Various Health Issues | Kurt Woeller, DO

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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

High Oxalate and Various Health Issues | Kurt Woeller, DO

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




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




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




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




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




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




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




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

Neurochemical Imbalances and Quinolinic Acid Toxicity | Kurt Woeller, DO

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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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


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

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

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

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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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




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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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




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



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



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



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



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



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



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



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



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



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



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



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



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



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

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

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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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

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

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



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



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



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



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



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



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




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



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



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



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



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



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



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



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



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



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



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



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

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

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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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

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

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



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



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



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


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

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

Environmental Toxins and Prenatal Care | Joseph Pizzorno, ND

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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

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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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

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


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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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




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


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

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

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  6. 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.

IgG Food Allergy and Mycotoxin Testing with William Shaw, PhD

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

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

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


William Shaw, PhD

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

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

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

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

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

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

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

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

Q: How does fasting affect IGG?

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

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

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

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

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

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

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

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

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

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

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

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

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

A: Check out New Beginnings Nutritionals’ mold protocol.

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

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

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

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

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

A: It can bind to mycotoxins

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Q: What botanicals do you use to treat SIBo?

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

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

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

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

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

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

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

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

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

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

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

A: Not directly.

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

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

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

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

Q: Does Sauna and liposomal glutathione eliminate glyphosate?"

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

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

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

Sunlighten has a very good reputation.

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

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

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

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

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Functional Medicine Answers with Kurt Woeller, DO

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

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

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


Kurt Woeller, DO

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

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

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

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

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

Q: Why did you choose Biocidin capsules vs drops?

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

Q: Did you increase the dose slowly?

A: No.

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

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

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

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

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

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

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

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

Q: Can you augment a 165?

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

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Lyme, Mold, Mycotoxins & Testing Answers with Jasmyne Brown, ND, Darin Ingels, ND & More!

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

The following Q+A is a grouping of responses from a distinguished pool of speakers who participated in the Environmental Toxin Summit with their own unique topics and lectures as labeled.

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


Jasmyne Brown, ND

Jasmyne Brown is a board-certified and licensed naturopathic doctor. She earned her Bachelor of Science in chemistry with a minor in biology from Alabama Agricultural and Mechanical University in 2013. Then she earned her Doctor of Naturopathic Medicine and Master of Human Nutrition degrees from the University of Bridgeport College of Naturopathic Medicine in 2017. Her professional training allows her to be able to interpret the GPL lab tests in a clinical manner, plus she enjoys identifying the biochemical pathways within our bodies and how nutrition and lifestyle impact them.

The Clinical Approach of a GPL Consultant
on GPL Testing

Q: Please comment about Chaetoglobosin A and appropriate treatment protocols?

A: Treatment for this toxin is like others. You would need to remove the source and detox the toxins. Binders like charcoal bind all mycotoxins at some level and can be effective for this toxin too. Consider a combo binder product.

Q: If zearalenone is very elevated (90) but the patient has low estrogen, would you believe the results?

A: Yes. Zearalenone does not necessarily increase your own estrogen but has its own estrogenic effects. Also, the LC/MS is specific to the toxins so if it’s populating there is an exposure. Also realize all toxins do not cause the same symptoms in every person.

What would be a good next step if you have a sensitive patient with mold who reacts poorly to binders such as GI Detox? Is there a binder that works better for sensitive individuals or something that needs to be done first?

A: You can use another product that doesn’t contain strong binders like charcoal and clay. Consider ToxinPul™ Multi-Function Detox by New Beginnings Nutritional’s.

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Darin Ingels, ND

Dr. Ingels is a licensed naturopathic doctor with more than 30 years of experience in the healthcare field. He is a Fellow of the American Academy of Environmental Medicine and has been published extensively. Dr. Ingels is the author of “The Lyme Solution: A 5-Part Plan to Fight the Inflammatory Autoimmune Response and Beat Lyme Disease”, a comprehensive natural approach to treating Lyme disease. Dr. Ingels specializes in Lyme disease, MS, mold/mycotoxins, and chronic immune dysfunction. He uses diet, nutrients, herbs, homeopathy, and immunotherapy to help his patients achieve better health.

Lyme, Mold and Mycotoxins: Strategies For Navigating Complex Illness

Q: What's the dosing of TRISALTS for Herx?

A: Take 1 tsp every 2-3 hours until feeling better. May cause loose stools at higher doses, so warn patients.

Q: If you are exposed to mycotoxins at the office, do you carry a risk of bringing the toxin home through your clothes and belongings?

A: It is possible that porous material can contaminate other objects, so if the exposure at work were high enough and gets in your clothes when you sit on a chair, or bed it is possible to contaminate those surfaces. However, this is not likely the way most people get exposure, and it seems this contributes to a minimal form of exposure.

Q: For treatment of molds/mycotoxins, do you treat with antifungal medication (Diflucan, Nystatin) concurrent with binders?

A: If you are treating actual mold colonization, you need itraconazole as other azoles are not effective at killing mold. They are good for yeast, but not for mold. Yes, I use concurrent with binders as they are doing different things in the body.

Q: If you use binder products from CellCore Biosciences, does that mean you do not need to use Cholestyramin or Welchol?

A: Generally speaking, yes. You do not necessarily need to have multiple binders on board. Just monitor your patient’s progress and make sure their mycotoxin levels are dropping.

Q: One of my patients decided to try this ionic foot bath instead of the IonCleanse: Regain Health & Vitality ionic foot cleanse. Are you familiar with this version and do you think it will work? She purchased it since it costs less than $200.

A: I can’t speak to other ion foot baths but know that IonCleanse has a patent on their device, so it is unlike other ion generators out there. My personal experience with IonCleanse from AMD is that most people have a good response to it. I have had other patients get different devices and they do not seem to work as well, so I’m betting you get what you pay for.

Q: Could celiac symptoms be from contamination of the wheat with mold/toxins? Instead of allergy?

A: Not likely as Celiac disease is a genetic disorder in breaking gliadin down. No doubt, mycotoxin and mold contamination can aggravate both Celiac and non-celiac gluten enteropathy.


Mark Su, MD

Mark Su is a board-certified family physician of 18 years, practicing in Newburyport, MA. He founded Personal Care Physicians as a functional medicine practice in 2014, where he and 4 other clinicians provide both primary care as well as consultation services for chronic complex illness patients. As such, he's been evaluating and treating patients for mold and other related conditions across a variety of symptom and severity stages, creating a rather diverse experience beyond treating only severely dysfunctionally ill patients. He is currently the vice president of ISEAI, and also a member of the IFM and ILADS, among other organizations.

EnvironmnetAl Illnesses
and treatment Protocols

Q: B/W salicylate, oxalate and histamine/MCAS issues, what to test for/address first?

A: I view all 3 of these matters as "back 9", or secondary, root cause problems. Commonly, there are deeper, primary root cause problems causing each of these, so I'd look for those root causes. Reflective of the very essence of my presentation, one is not likely to find a singular cause - I believe it would be very, very rare for a practitioner to cast a wide enough net and yield only one cause for any or all of these problems. But at this point in time, if I was forced to name one most likely cause, or name the one cause that is likely to be having the greatest contribution to these issues (among the many found), I'd suspect it to be mycotoxins. That's likely to be the case with histamine/MCAS, certainly, with high oxalates a close second (commonly because where there are mycotoxins, yeast is likely to be a problem as well, and oxalates are common with the latter). With high salicylate levels, if we're talking about the marker under the "toxin" biomarkers within the GPL OAT results, my suspicion would more likely lie within a gut dysbiosis root cause, but even that is commonly going to be associated with mycotoxin illness. Whereas, any other exposome/"non-self" condition (incl. tickborne illnesses, heavy metals, viruses, etc) or other "self" condition (incl. immune deficiencies, hormone imbalances, methylation dysfunctions, etc) is not nearly as likely to (singularly) cause these problems.... A decent second suspicion would be to look at gut health, which is arguably unfair in comparison since it is a more categorical answer than mycotoxins being a more focal/singular response - gut health could include bacterial dysbiosis that is driving salicylate marker abnormalities; genetic-based deficiencies in histamine metabolism (leading to excess histamine in the gut); and/or fungal dysbiosis leading to high oxalates.

Q: What are the best way to lower oxalate levels?

A: Look for root causes. Dr. Woeller/GPL staff often teach that 3 of the most common causes are yeast, oxalate rich foods, and B6 deficiency. In my experience, yeast, as reflected by high arabinose levels (marker 7 on the OAT), is a common problem, even in a more generalized health population (vs. the chronic, complex illness patients). Given such, and my clinical impression that not many patients, as a generalized population, are likely to be eating a large enough amount of oxalate foods, yeast is likely to be the most common culprit among these three. (B6 deficiency, on some level, may be pretty common, but my suspicion is that this isn't likely to be a strong enough deficiency in most people to cause high oxalates - again, across the generalized population).

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Emily Givler, DSC

Emily Givler is a Functional/Genetic Nutrition Consultant, researcher, and lecturer with a thriving clinical practice at Tree of Life Health in Lancaster County, Pennsylvania. She holds advanced degrees and certifications in Nutrition, Herbalism, and Nutrigenomics from the Holt Institute of Medicine, PanAmerican University of Natural Health, and Functional Genomic Analysis where she now serves as an adviser and supplement formulator. In her practice, Ms. Givler utilizes personalized dietary and nutritional protocols based on genetic predispositions, environmental and epigenetic influences, and functional lab testing to help her clients regain their health.

Oxalates and Mold: A Hidden Source
of Inflammation

Q: What about stone dissolving herbal therapy?

A: There are several herbal preparations that may be beneficial for high oxalate individuals. This paper, Dietary Plants for the Prevention and Management of Kidney Stones: Preclinical and Clinical Evidence and Molecular Mechanisms, summarizes their potential benefits and specific mechanisms.

Q: Do you see a pattern of lactose intolerance in genetic testing with patients with high oxalates?

A: Not necessarily, though lactose intolerance can be an exacerbating factor. Far more people will be lactose intolerant than will have a problem with oxalates.

Q: Do you have a protocol for oxalate that you can share with us?

A: The first step would be to assess which mechanisms for over absorbed oxalates are coming into play. Next, we would add Epsom salt soaks, working progressively up to 20 min 3-5x/week as tolerated. Evaluate the diet for volume of oxalates and start reducing/binding oxalates at roughly 10% per week. The next steps depend on the individual presentation and may be bile support, probiotics, antimicrobials, B1, and/or B6. The individual presentation will typically dictate the order and necessity of those pieces.

Q: Can you repeat the brand name of the sulfate/sulfite test strips you're using?

A: Quantofix

Q: Where do you get the sulfate test strips?

A: Amazon

Q: What would be considered "high" for a child when using the sulfate strips?

A: 10

Q: Can you expand on the use of sulfate test strips if/when oxalate markers aren't elevated on an Organic Acids Test? Would we expect to see low to no reported sulfate on the strip because of wasting?

A: Typically, in this scenario you will see high sulfate as the oxalate is being retained and the sulfate is being excreted.

Q: If oxalate crystals are insoluble in tissue, how can they dissolve to show up in the urine?

A: They are present in urine, not dissolved in it.

Q: Can urine be a false low?

A: Absolutely! Therefore we need to look for other clinical indications such as sulfate wasting.

Q: Can you repeat the gene that you mentioned that helps with sulfation?

A: SUOX

Q: And you suggested giving molybdenum?

A: Yes, it is the cofactor and can help when there are polymorphisms or when the transulfuration pathway is upregulated and sulfites are high.

Q: If you have high oxalates and positive for mycotoxins (i.e ochratoxin and gliotoxin) - which anti-fungal medication would you recommend starting + dosage and duration?

A: I would use an antifungal if there was evidence of colonization but am not a doctor and cannot prescribe. This also needs to be personalized for the individual. I do like Biocidin for these cases.

Q: How much baking soda are you recommending in water in between meals as prevention for oxalate dumping?

A: Very little; typically, ⅛ tsp

Q: How much Epsom salt do you typically recommend adding to a bath to help mobilize oxalates?

A: ¼c in a foot basin or 2 cups in a bath. There are sensitive individuals who do need to start more slowly.

Q: What is your favorite recommendation for dealing with fat malabsorption/digestion?

A: TUDCA and/or the combination of Quicksilver BittersX and Pure PC. Adding castor oil packs over the liver and gallbladder and using coffee enemas can be helpful if there is “sludgy” bile.

Q: Can oxalates pull calcium from bone and cause osteoporosis?

A: There are several studies exploring the associations between kidney stones and osteoporosis, but a causal link, to my knowledge, has not been clearly established. Please refer to Kidney Stones and Risk of Osteoporotic Fracture in Chronic Kidney Disease as well as Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism.

Autism, Special Needs (E.G., ADD, ADHD, Pervasive Development Disorder) And Fungal Toxins Webinar Recap


By Kurt Woeller, DO

Autism and other special needs individuals often have biochemical and nutritional imbalances that contribute to language, socialization, and behavioral problems. In some situations, these issues are exacerbated by fungal toxins linked to chronic candidiasis and mold-produced compounds. For example, chemical aldehydes from fungus are known to be highly reactive compounds that need to be converted to less toxic forms via converting enzymes and phase detoxification within the liver. These aldehydes and other compounds can have detrimental effects within the body. The use of various nutrients such as N-acetylcysteine (NAC), etc. are often essential in supporting the body against fungal toxins. This lecture designed for health professionals, as well as parents and caregivers will discuss new information related to certain fungal toxins and strategies for treatment.


GPL-Blog_2021_Graphics_Webinar_SpecialNeeds_New Blog copy.png

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

Q: What specificity of Arabinose? What are other potential sources?

A: Various foods such as apples, apple juice, grapes, pears and more need to be avoided prior to testing. Here is information from Great Plains Laboratory Organic Acids Test page – “Urine: 10 mL of first morning urine before food or drink is suggested. Patients should avoid apples, grapes (including raisins), pears, cranberries, and their juices 48 hours prior to specimen collection. Avoid arabinogalactan, echinacea, reishi mushrooms, and ribose supplements for 48 hours before collection.”

Q: Recommended tests for checking for candida? When should you retest after tx?

A: Organic Acids Test, Stool Analysis, blood IgG antibodies. The most common test is the OAT. It recommended to retest after 90 days.

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.

Mycotoxin Properties and Metabolism: Part 1


By LINDSAY GODDARD, MS, RDN, LD

It appears mycotoxins are gaining a significant amount of interest as the literature increases on their toxic effects on humans and other animals. Just with any topic, as more data surfaces, more questions arise. Mycotoxin sources, testing, impacts, and treatments have been discussed in other blogs that you can review.

What has received less attention is how these compounds behave, particularly within our bodies, and what levels are commonly observed. The latter being particularly ambiguous.  In this article, properties and the metabolism of the top four most common mycotoxins will be explained to help further understand their behaviors, along with common ranges that are typically observed in Great Plains Laboratory. It is important to keep in mind that most of this research is done within the agriculture communities and laboratories, since human evaluations can be difficult to assess, for obvious reasons. It is the intent to use as much data from human studies as possible, but it may not always be feasible. It is also important to understand that although the typical ranges are provided, this does not assess the severity of those mycotoxins to an individual. Humans and other animals deal with these mycotoxins very differently, and it appears to be highly individualized within the species and current state of health of the individual.

Ochratoxin A (OTA) is the most common mycotoxin to show up on the test. Average positive ranges are generally from 15-30 nanograms/g of creatinine for people who are suspicious of mycotoxins. Results have been shown to be much higher in more extreme cases, with levels reaching up into the hundreds and even thousands range.

Toxicology

OTA is most notably a nephrotoxin, especially as it relates to the proximal tubule, which has been observed in several phylums. It also can impact the immune system; however, the exact mechanism is variable among different species. Studies have been observed the presence of OTA and the depletion of lymphoid cells, and stimulation of cytokine production especially with IL-2 and IL-5. Other influences are linked to inhibition of various enzymes such as phenylalanine hydroxylase, phenylalanine-tRNA synthetase, renal phosphoenolpyruvate carboxykinase, and carboxypeptidase A. OTA also can enhance lipid peroxidation, which is another aspect of the cellular damage caused by this mycotoxin. It also has the potential to cause proliferation of the cell via the interference with hormonal Ca2+ signaling, and therefore impairing Ca2+ cAMP homeostasis. 

Properties

Structurally, OTA consists of a para-chlorophenolic group, which contains a dihydroisocoumarin moiety, which is linked to L-phenylalanine via an amide link. At a neutral pH, OTA is slightly soluble in water, and soluble in polar organic solvents. Once alkaline conditions occur, it becomes soluble in all the aqueous solutions. Its melting point is between 90 °C (194 °F) to 169 °C (336.2 °F) depending on the solvent, proving it’s high stability especially in food processing.

Metabolism

It is absorbed into the system, via oral, skin or inhalation routes. From the ingestion standpoint, OTA is absorbed in the GI tract through various points. Taking note that the hydroxyl group of OTA is more in the nonionized form at low pH, which improves its absorption, therefore a significant amount of OTA is absorbed in the stomach. It is also readily absorbed in the intestines via passive diffusion, which is aided by the OTA binding to serum albumin. This complex also increases the half-life with a single dose of OTA lasting about 35 days. It is thought that this binding capacity is what allows OTA to transfer from blood to milk.

The human body attempts to eliminate some OTA via the bile, however enterohepatic recycling makes that less efficient. Once in the liver, the cytochrome P-450 microsomes along with NADPH, metabolize OTA further into hydroxyochratoxin A for elimination.  OTA itself is mainly excreted through the urine, yet the organic anion transport system in the proximal and distal tubules of the kidney actively reabsorb OTA. At this point, OTA is being transported with smaller carrier proteins, which allow the compound to pass through the glomerular membrane at an increased rate. This further increases the bioaccumulation and contributes to the extended half-life, leading to the cause of the nephrotoxicity that ensues with consistent, larger exposures.

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Mycophenolic Acid (MPA) is one of the better understood mycotoxins within the medical community since it is used by the pharmaceutical industry. The average positive range tends to be between fifty and the mid hundreds. In more extreme cases, it can be in the thousands. If someone is taking the drug that contains MPA, the amount excreted tends to be between 40,000-100,000 nanograms/g of creatinine.  

Toxicology

The main mechanism of action for MPA is as an inhibitor of inosine monophosphate dehydrogenase, leading to an inhibition of the de novo pathway of guanosine nucleotide synthesis. This significantly reduces T- and B- lymphocytes since they are dependent on de novo synthesis of purines for their proliferation.

Properties

MPA is a polyketide compound, which is not soluble in water, and has a melting point around 141 °C (285 °F). Similar to OTA, it has a high affinity for albumin. When albumin is in lower amounts because of a disease or inflammatory state, the free MPA concentration may increase.  MPA is metabolized by glucuronidation via glucuronyl transferase, primarily in the liver, but also in the intestines and kidney. This ultimately forms MPA glucuronide (MPAG). This metabolite has little activity on the immune system, however the other metabolite that is formed, acyl glucuronide, will also impact the immune system, similarly to MPA. When analyzing the metabolism of MPA in stable transplant patients, 28% of the MPA taken orally was converted to MPAG, and the ratio of MPA:MPAG:acyl glucuronide was about 1:24:0.28.  

Metabolism

MPA, as observed through oral administration, is absorbed in the small intestines, and primarily eliminated in the urine by active tubular secretion and glomerular filtration, with approximately 60% or more as MPAG, and about 3% as MPA. Keep in mind here that the MPAG has less impact on the immune system versus the MPA, so measuring that would have less clinical significance as it relates to assessing toxicity. MPAG also utilizes bile in its elimination, however it can be deconjugated by certain flora in the gut back to MPA, leading it to be reabsorbed. Some of the enzymes involved in MPA glucoronidation (particularly UGT1A8 and UGT1A9), are expressed outside of the liver, thus contributing to the metabolism within the GI tract. The half-life of MPA is between 8-16 hours, therefore when extreme elevations are occurring, it is likely from a very recent exposure.

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Previously known as F-2, Zearalenone (ZEA) is another mycotoxin that has a large amount of recognition. It is a very common contaminate of grains to the point it is regulated closely by numerous countries. What sets it apart from other mycotoxins is that it has a unique application in regulating hormones in livestock due to its estrogenic effects. This pharmaceutical drug is called zeranol and is approved to be used in livestock within the US, though the FDA has banned it for human use. It should be noted here that the World Anti-Doping Agency has been tracking zeranol since 2003 in athletes (who typically consume a significant number of livestock products) and has only found 6 positive tests globally. Typical ranges found on the GPL MyCoTOX Panel tend to be below 20, and in more extreme cases, can get up in the hundreds or above.

Toxicology

ZEA’s main mechanism of action is activating estrogenic receptors, creating estrogenic responses. It is therefore classified as an endocrine disrupter. The impact of ZEA on estrogenic effects varies significantly throughout animal species. Swine tend to be the most sensitive to it, while humans require a more chronic exposure to be significantly harmful. Cascading effects have been identified in the uterine organ and mammary tissue, like estradiol elevations.  ZEA also has the capacity to act on the hypothalamus and pituitary, mimicking estrogenic effects. There is some discussion of its association with hepatotoxicity and immunotoxicity, but these are not as well understood.

Properties

The structure of ZEA is a phenolic resorcylic acid lactone and is extremely similar to the estradiol structure. There are various forms, with at least seven derivatives identified just with corn, alone. They have all been shown to impact estrogen receptors. It has a melting point of 164 °C (328 °F), and solubility in water is very limited (0.002g/100mL). However, it is soluble in various solutions, particularly in aqueous alkali. ZEA is fairly heat stable but can be partially destroyed with extrusion cooking. The heat degradation is dependent on the solution it is in, but overall, it is completely degraded at 225 °C (437 °F). It is half-life from oral dosage is approximately 86 hours in swine, and 72 hours in hens. Not much information exists on humans except for one study by Mukherjee et al. where it was estimated to be around 11.98 hours in young girls. It has been shown to bioaccumulate within adipose tissue and reproductive tissue of females, and interstitial cells within the testes. 

Metabolism

Ingestion or inhalation seems to be the most common routes of exposure, though ZEA does have the ability to permeate through human skin. Absorption of ZEA occurs within the intestinal lumen for most animals. In swine observations, somewhere between 80-85% was absorbed through a single dose. ZEA is mainly conjugated through glucaronidation in the liver and the intestinal mucosa. It then goes through enterohepatic circulation and biliary excretion, with stool being the major route of elimination. Rumen and microbiota metabolism is also a potential; however, this is dependent on absorption, enzymes, and receptor availability and/or presence in particular species.

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Citrinin (CTN) is likely the second most common mycotoxin to be reported, but unfortunately it has the least amount of recognition in the literature. It is very common to find alongside OTA, especially since they typically come from the same species (Aspergillus niger). General ranges found for positive results are below a hundred. 

Toxicology

The mechanism of action for CTN toxicity is not as well understood as the other mycotoxins. It has been found to cause oxidative stress and increased permeability of mitochondrial membranes, however, not cellular membranes themselves. In these mitochondrial preparations, CTN inhibited succinate oxidase and NADH oxidase, while also completely inhibiting cellular respiration.  The target organ appears to be the kidney in a variety of phylums. Embryocidal, fetotoxic, and genotoxic have been suspected, and proven in some organisms. Immunotoxicity and hepatotoxicity is also a potential, but data is lacking. When CTN and OTA are together within the system, they work cooperatively in reducing the activity of RNA synthesis in the renal tissue.

Properties

CTN is a polyketide mycotoxin that is insoluble in cold water, barely soluble in hot water, and soluble in polar organic solvents. It can breakdown in acidic and alkaline solutions. CIT’s melting point is around 100 °C (212 °F).  Relative to other mycotoxins, CTN is fairly heat sensitive, and unstable in temperature elevations. When heated (>175 °C, in dry conditions, >100 °C in water), it has the potential to degrade to CIT H1, which is more toxic, and CIT H2, which is less toxic, than CTN. It also has a short half-life in the human blood (~9 hours), and in urine (6-8 hours), and for this reason, it is thought it does not bioaccumulate in organisms unless there is repeated, large exposures.

Metabolism

Oral, inhalation, and skin tend to be the major routes of exposure. Unfortunately, there is very limited data as to the exact route and elimination of CIT in humans, however excretion moves through the kidney’s, which is where it has the potential to bioaccumulate.


Stay tuned for part II, where the next review will be of the less common, but potentially more toxic, group of mycotoxins measured on the MycoTox. 


References

1. Gupta, Ramesh C. Veterinary Toxicology. Basic and Clinical Principles 3rd edition. 2018. 
2. Khoury A and Atoui A. Ochratoxin A: General Overview and Actual Molecular Status. Toxins. 2010. 2(4): 461-493. PMID: 22069596
3. Plumlee KH. Mycotocins Toxicokinetics. Clinical Veterinary Toxicology. 1st Edition. 2004
4. Gruber-Dorninger C., Novak B, Nagl V, and Berthiller F. Emerging Mycotoxins: Beyond Traditionally Determined Food Contaminants. Journal of Agricultural and Food Chemistry2017 65 (33), 7052-7070. SOURCE
5. Food and Drug Association. Mycophenolic acid (Myfortic). SOURCE
6. Lamba V, Sangkuhl K, Sanghavi K, Fish A, Altman RB, and KE.PharmGKB. Mycophenolic Acid Pathway. Pharmacogenetics and genomics.2014. PMID:24220207. SOURCE
7. 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.
8. Haschek WM, Voss KA,  Beasley VR.  Selected Mycotoxins Affecting Animal and Human Health. Handbook of Toxicologic Pathology (Second Edition).2002. Pages 645-699. SOURCE
9. United States Anti-Doping Agency. Zeranol FAQ. 2021. SOURCE
10. National Center for Biotechnology Information (2021). PubChem Compound Summary for CID 5281576, Zearalenone. SOURCE
11. Ryu D, Hanna MA, Eskridge KM, and Bullerman LB. Heat Stability of Zearalenone in an Aqueous Buffered Model System. Journal of Agricultural and Food Chemistry 2003 51 (6), 1746-1748. DOI: 10.1021/jf0210021. 
12. Gil-Serna J, Vázquez C, Patiño B. Mycotoxins | Toxicology. Reference Module in Food Science. Elsevier. 2019. ISBN 9780081005965. SOURCE
13. Doughari, J. The Occurrence, Properties, and Significance of Citrinin Myctoxin.  Plant Pathol Microbiol 2015, 6:11 DOI: 10.4172/2157-7471.1000321
14. Arce-López B, Lizarraga E, Vettorazzi A, González-Peñas E. Human Biomonitoring of Mycotoxins in Blood, Plasma and Serum in Recent Years: A Review. Toxins (Basel). 2020;12(3):147. Published 2020 Feb 27. doi:10.3390/toxins12030147

GPL-TOX: Common Markers And Environmental Testing

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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.


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

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By Kurt N. Woeller, DO

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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References

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

Phases of Detox: An Overview

 

By JASMYNE BROWN, ND, MS

In today’s world various exposures to harmful substances, or toxins, is inevitable. With the invention of various chemicals used for processes like agriculture, construction, and other industrial processes, toxic exposures are a part of the average human's daily life. These toxins that are released into the atmosphere are collectively known as the chemosphere. It's an odorless, tasteless, invisible collection that has entangled itself into each breath we take. The comforting news is that the human body was designed with its own systems for detoxification. Our liver, kidneys, urinary and gastrointestinal system work together to expel  unwanted harmful toxicants the body encounters. At the Great Plains Laboratory we offer a wide variety of testing that will identify toxic exposure. We also assess detoxification capability and the metabolic effects of chronic insult to the body. To assess detoxification ability evaluate the OAT. This profile may also give you direct insight into mold overgrowth and indirect insight into further testing of other toxicants such as heavy metals and toxic chemicals. 

 During a toxic exposure and post exposure sequelae, individuals may experience a wide variety of symptoms. Depending on the toxic substance or substances, length of exposure, and level of exposure will determine the type and extremity of symptoms experienced. Common symptoms are fatigue, anxiety, brain fog, depression, chronic pain, skin rash, allergies/sensitivities, immune suppression and dysregulation, among others. When we are exposed to toxins our designed detox systems turn up the volume and work to make them less toxic and able to be cleared. In times of over exposure, like in a source of water contamination or close proximity to a large exposure source, our detox capabilities are outweighed by the toxic load. Understanding this dose dependent design of toxin exposure is key to understanding why we experience sequelae of increased toxic load. Another consequence of this increased load is increased Phase 1 activity. This can overwhelm Phase 2 leading to increased toxic metabolites that haven’t been conjugated. These unconjugated compounds, in some cases, are more toxic than the toxin itself. An overload of these overtime can lead to increased damage. This cellular damage is known as the cell danger response (CDR). Below is a description of the phases of detox that can be supported to relieve symptoms of toxic exposure.

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When it comes to detoxification, we typically start analyzing the process at Phase 1 liver detox. For overall full detoxification, Phase 0 is the true first step. Phase 0 is really your investigation stage. After reviewing the results of an Organic Acids Test, MycoTOX Profile (Mold Exposure), GPL-TOX Profile (Toxic Non-Metal Chemicals), Glyphosate, and Heavy Metals Test, the next step is finding the source or sources of exposure. This step is crucial to full resolution of symptoms. Oftentimes, I find clients and practitioners alike who want to detox without removing the source. This is a wonderful thought and would be amazing if we could do this. Unfortunately, it's almost impossible to out detoxify a current exposure. Most often we do not know the extent of an exposure source and how that is going to affect the client or how quickly the severity will increase. Once you know the toxin or toxins, finding and eliminating the sources of exposure is top priority. Without completion of Phase 0, added detox support will be just that, support. The great thing about finding out someone is toxic is that the severity of symptoms can help dictate how quickly one needs to find and eliminate the sources of exposure. The more severe the symptoms, the higher the priority.

Common sources of exposure are usually found in the home, workplace, or school environment. I often find that individuals are getting mold and mycotoxin exposure from water damaged buildings and cars, with food as a lesser exposure source. With chemicals, pesticides, and heavy metals I find water contamination to be a common exposure source. Testing home, school, and occupational water supplies can pinpoint one or potentially dual exposure. Also, where you live may influence your exposure source. Some individuals live near golf courses, parks, airports, factories, farms, etc that are using chemicals that you then breathe. New construction buildings like homes, workplaces, and even your favorite grocery store’s new renovation project could be off gassing toxic chemicals that affect you. Unfortunately, we cannot dictate what is in our every breath.  The chemosphere is so vast and varied that it’s nearly impossible to know everything you're inhaling. In some cases, moving is the best option. In other cases, waiting until the off-gassing stops is enough to reduce exposure and detoxing and employing the use of air purifiers can reduce toxic load. In any case, eradicating the offending exposure is always necessary for full resolution and detoxification.

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Once toxins have been encountered by the body, Phase 1 is the first physiologic phase of the detoxification process. This phase occurs in the liver as the toxins reach hepatic circulation for detox. The goal of this phase is biotransformation. Biotransformation is the chemical alteration of compounds, including toxins, for enhanced excretion. During Phase 1, there are certain reactions that are utilized. The transformation of the toxins prepares them for Phase 2. There are three main classes of reactions that happen in this phase: oxidation, reduction, and hydroxylation.

Oxidation reactions occur by a loss of electrons through oxygenation, dehydrogenation, and electron transfer. The following are examples of oxidation enzymes used:

  • Alcohol dehydrogenation: aldehyde dehydrogenation

  • Alkyl/acyclic hydroxylation

  • Aromatic hydroxylation

  • Deamination

  • Desulfuration

  • N-dealkylation

  • N-hydroxylation

  • N-oxidation

  • O-dealkylation

  • Sulfoxidation

The reduction enzymes work to add electrons to the compound. In some cases, reduction can actually activate the toxin making it more detrimental to the host. These reactions are:

  • Azo reduction

  • Dehalogenation

  • Disulfide reduction

  • Nitro reduction

  • N-oxide reduction

  • Sulfoxide reduction

The hydrolysis reactions work by cleaving the compound with the addition of water. This process splits the compound and adds an OH group to one part and the other is bound to hydrogen.

Phase 1 enzymes are collectively known as Cytochrome P450 (CYP450) enzymes and encoded by various genes. They are located in the mitochondria and endoplasmic reticulum of the hepatocytes. A common enzyme is the CYP1A family, which is involved in metabolizing procarcinogens, hormones, and pharmaceuticals. Various natural agents can be added to induce or attenuate the activity of these enzymes. Cruciferous vegetables, berries, resveratrol, and quercetin can upregulate this family of enzymes to support Phase 1 detox. Chrysoeriol is a compound in rooibos tea and celery that can be helpful in those with genetic upregulation. This is helpful as these individuals will have more toxic byproducts due to upregulated phase 1 detox even at an expected exposure rate. The CYP2 family metabolizes drugs, xenobiotics, hormones, ketones, and fatty acids. Polymorphisms in these enzymes can lead to poor metabolism of warfarin, metoprolol, phenytoin, or omeprazole for example. Polymorphism in the CYP2D may be associated with Parkinson’s and lung cancer. Inducers of this family are broccoli, quercetin, chicory root, rosemary, and garlic. Significantly high doses of resveratrol green and black tea, and cruciferous vegetables can inhibit these enzymes in those who have upregulation. The CYP3A4 family regulates the metabolism of caffeine, testosterone, progesterone, PAHs and aflatoxin B. This is the enzyme family that's commonly inhibited by grapefruit and also goldenseal. Supplements that induce this enzyme are St. John’s wort, valerian, and ginkgo biloba. The CYP4 enzymes have extrahepatic activity and metabolize MCTs (medium chain triglycerides), as well as the bioactivation of pneumo toxic and carcinogenic compounds. Polymorphism here is associated with bladder cancer and colitis. Not much research has been done on this class of enzymes. CYP4A1 is induced by green tea and CYP4B1 is induced by caffeic acid.

After Phase 1 biotransformation, some toxins have now been biotransformed to a hydrophilic state and can be excreted. Other toxins are then acted upon in Phase 2 for excretion. Due to the dose dependent and time dependent nature of toxin exposure, if exposure rates outweigh the body’s detox capability, some of these Phase 1 biotransformed compounds can build up if not conjugated in Phase 2 in a timely manner. Since Phase 1 can sometimes make toxic more toxic this can be detrimental to human health. This is often when individuals suffer from symptoms prior to Phase 2 supportive therapies. The support of the enzyme function will speed the conversion and eventual clearance of the toxins. 

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After toxins are biotransformed in Phase 1, Phase 2 is the conjugation of the biotransformed substances. These reactions create hydrophilic compounds. This causes the fat-soluble toxins to become water soluble for urinary excretion. Some of the primary reactions used by the liver to conjugate are the following:

  • Glucuronide conjugation

  • Sulfate conjugation

  • Acetylation

  • Amino acid conjugation

  • Methylation

Glucuronidation is the process of adding glucuronic acid to a toxic byproduct to make it water soluble. This is one of the most prevalent in drug metabolism and detox. Saccharomyces boulardii, a probiotic yeast, can reduce bacterial species that produce beta glucuronidase. This enzyme functions to break down the glucuronidation in the gut. This will release the toxic compound and allow for resorption. Utilizing S. boulardii in detox is a great addition. Another supplement choice is calcium D-glucarate. This compound works to enhance glucuronidation by supplying glucarate. Studies have shown that this compound increases blood levels of D-glucaro-1,4-lactone, which suppresses blood and tissue beta-glucuronidase activity. It works to inhibit beta glucuronidase activity in liver, kidney, and intestinal microbiome tissue. In sulfate conjugation, sulfur is used to make the toxins water soluble. Sulfur donors like n-acetyl cysteine (NAC) and sulforaphane from cruciferous sulfur-rich foods will support this process. Acetylation conjugation involves the transfer of an acetyl group from acetyl coenzyme A via N- acetyltransferases. This family of enzymes is supported with choline, vitamin D, vitamin B12, and quercetin.

The next conjugation reaction is amino acid conjugation. This reaction involves the binding of toxic carboxylic acids, bile acids, and xenobiotics to the amino group of amino acids. The most common amino acids used are aspartate and glutamate. Other amino acids used are taurine, glycine, lysine, serine, proline, ornithine, glutamine and valine. A protein rich diet will supply these amino acids. In particular, the pesticide, 2,4-Dichlorophenoxyacetic Acid (2-,4-D) that is measured on the GPL-TOX, is conjugated to aspartate for detoxification. The addition of this amino acid can be helpful in detoxing this pesticide.

Exposure of this pesticide in rats showed a significant increase in aspartate aminotransferase activity. The last two common conjugation reactions are glutathione conjugation and methylation. Glutathione is use by the body to conjugate acetaminophen toxicity and alcohol toxicity most commonly. It is used to metabolize some medications and many toxins. Glutathione production activity can be assessed on the OAT in marker 58, Pyroglutamic Acid. By adding in NAC, the precursor, or glutathione supplementation, this common Phase 2 enzymatic reaction can be readily supported to support detoxification.

Other foods and nutrients will also support the glutathione S-transferase enzymes like garlic, fish oil, black soybean, purple sweet potato, curcumin, green tea, rooibos tea, Honeybush tea, ellagic acid, rosemary, ghee, and genistein. Methylation is a common topic in the recycling of homocysteine. It is also a key in Phase 2 detox. Measuring homocysteine can be used to support dosing of methylation factors to support detoxification. A methyl group is added to toxins to make them water soluble.  The methyltransferases used a methionine group from S-adenosyl-L-methionine (SAMe). The most common methyltransferase enzyme is COMT. This enzyme is highly studied due to its effect on neurotransmitters and estrogen detoxification. Methylation is supported by cofactors and methyl donors like methionine, vitamin B12, vitamin B6, betaine, folate, and magnesium. Food high in protein will provide methionine and legumes, seeds, liver, leaf greens, avocado, asparagus, and certain grains can provide food sources of the other vitamins and nutrients.  Sucrose can inhibit methylation and slow this process. These are processed high sugar foods. The OAT can give insight to how well someone is methylating or not. By supporting all these enzymatic reactions Phase 2 detox will be able to function adequately to fully detox and make toxic compounds hydrophilic for urinary excretion. 

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Once the source of exposure has been identified and detoxification has begun to be supported, supporting the last phase of detoxification is crucial. In my opinion, it is more important to speed up this phase of detox prior to upregulating Phase 1 and 2. Once toxic substances are sent through the liver to be biotransformed and conjugated they must be eliminated. Phase 3 is the elimination stage of detox. Without proper support of elimination, toxins and potentially more toxic biotransformed products will stay in the body longer. The body has two main ways of excretion. The kidneys and urinary tract and through bowel movements are how we eliminate most toxins. By priming these routes of excretion, we can round out treatment. In times of urinary retention or constipation, upregulating the body’s detox capacity would lead to the retention of toxins and potential reabsorption. In times of dehydration or kidney damage the kidneys are unable to adequately filter and release toxins.

In the body, bile is used to help us absorb fat- and fat-soluble substances. Many toxins are fat soluble and get packed in bile and travel to the GI tract. Here 95% bile is normally reabsorbed in the ileum to be recycled and used again in the liver via enterohepatic recirculation. In time of detoxification this recirculation can impede healing as the toxin can be recirculated repeatedly before it's a part of the 5% of bile that gets excreted.  To combat this recirculation phenomenon, binding agents called binders are used. They act like static cling and attract compounds to them. The adsorbent nature of these compounds attracts bile and bind them tightly. This binding ability is great, but it is reversible. Bile can be released from the binding agent if left too long in the GI tract without excretion. In the intestines, there are also intestinal flora enzymes that can hydrolyze some glucuronide and sulfide bonds and cause resorption of toxic compounds.  Due to the binding nature of binding, they can increase the risk of constipation. In previously constipated clients, ensuring adequate bowel movements prior to adding detox factors and binders is an important top priority. By priming Phase 3 detox all the wonderful work done to support Phase 1 and 2 will be easily eliminated.


Overall priming Phases 0-3 of detox are all necessary in any state of healing. These phases work together and were designed to protect and heal our bodies. By supporting each phase individually, their synergistic activity is enhanced. Through testing with GPL you can identify offending toxic load and begin the investigation stage, or Phase 0. Then, look to New Beginnings Nutritionals for support in choosing the best quality supplements for detoxification.


References

1. Crichton, R. (2018, May 25). Zinc – Lewis Acid and Gene Regulator. Biological Inorganic Chemistry (Third Edition). SOURCE
2. Doull, J., & Rozman, K. K. (2000, April 3). Dose and time as variables of toxicity. Toxicology. SOURCE
3. Dwivedi C;Heck WJ;Downie AA;Larroya S;Webb TE; (n.d.). Effect of calcium glucarate on beta-glucuronidase activity and glucarate content of certain vegetables and fruits. Biochemical medicine and metabolic biology. SOURCE
4. Gupta, P. K. (2016, September 2). Biotransformation. Fundamentals of Toxicology. SOURCE
5. Hodges, R. E., & Minich, D. M. (2015). Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. Journal of Nutrition and Metabolism. SOURCE
6. Hundt, M. (2020, October 3). Physiology, Bile Secretion. StatPearls [Internet]. SOURCE
7. Knights, K. M., Sykes, M. J., & Miners, J. O. (2007). Amino acid conjugation: contribution to the metabolism and toxicity of xenobiotic carboxylic acids. Expert Opinion on Drug Metabolism & Toxicology, 3(2), 159–168. SOURCE
8. Macherey, A.-C., & Dansette, P. M. (2003). CHEMICAL MECHANISMS OF TOXICITY: BASIC KNOWLEDGE FOR DESIGNING SAFER DRUGS. The Practice of Medicinal Chemistry, 545–560. SOURCE
9. Mohamed, M.-E., & Frye, R. (2010). Effects of Herbal Supplements on Drug Glucuronidation. Review of Clinical, Animal, andIn VitroStudies. Planta Medica, 77(04), 311–321. SOURCE
10. National Institutes of Health. (n.d.). ToxTutor - Chemical Reactions. U.S. National Library of Medicine. SOURCE
11. Naviaux, R. K. (2019, December 23). Perspective: Cell danger response Biology-The new science that connects environmental health with mitochondria and the rising tide of chronic illness. Mitochondrion. SOURCE
12. Nilsen, O. G., Hellum , B. H., & Hu, Z. (2007, January). The induction of CYP1A2, CYP2D6 and CYP3A4 by six trade herbal products in cultured primary human hepatocytes. Basic & clinical pharmacology & toxicology. SOURCE
13. S;, S. J. L. V. N. K. L. C. C. (n.d.). 1,25-Dihydroxyvitamin D3 treatment results in increased choline acetyltransferase activity in specific brain nuclei. Endocrinology. SOURCE
14. Secretion of Bile and the Role of Bile Acids In Digestion. (n.d.). SOURCE

Common Questions on the Organic Acids Test with Kurt Woeller, DO

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The Great Plains Laboratory has been educating practitioners for over 15 years on how to help patients heal through cutting-edge testing, research and protocols. In our recent 3-Day Environmental Toxin Summit, speakers focused on the epidemics of environmental toxins and pathogen exposure after a foundation of the OAT is presented. Speakers reviewed patient cases and present testing and treatment protocols for toxin and mold-induced illnesses.

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

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


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Kurt Woeller, DO

Functional Medicine
and the Organic Acids Test

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

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

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

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

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

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

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

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

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

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

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

Q: Do antidepressants affect those OAT markers and how?

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

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

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

Q: Do you use bouvardia when treating candida?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Q: Can you take too much elemental lithium?

A: Yes

Q: Are you using regular or liposomal biocidin?

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

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

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

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

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

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

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

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

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

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

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

Q: What about cholestyramine for mold?

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

Q: Can psilocybin use contribute to fungal growth?

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

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Chronic Candidiasis: Mechanisms of Pathogenicity and Laboratory Testing Options

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By Kurt Woeller, DO

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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


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


References

1. Candidiasis. Fungal Diseases. United States: Centers for Disease Control and Prevention. 13 November 2019. 
2. Candida infections of the mouth, throat, and esophagus. Fungal Diseases. United States: Centers for Disease Control and Prevention. 13 November 2019. 
3. Symptoms of Oral Candidiasis. cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. 
4. Candidiasis. cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. 
5. Martins N, Ferreira IC, Barros L, Silva S, Henriques M. Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment. Mycopathologia. 2014. 177 (5–6): 223–40.
6. Sell D, Monnier V. Structure elucidation of a senescence cross-link from human extracellular matrix. Implication of pentoses in the aging process. J Biol Chem. 1989;264(36): 21597-21602.
7. Kiehn T, Bernard E, Gold J, Armstrong D. Candidiasis: detection by gas-liquid chromatography of D-arabinitol, a fungal metabolite, in human serum. Science. 1979; 206(4418): 577-580.
8. Shaw W, Kassen E, Chaves E. Increased excretion of analogs of Krebs cycle metabolites and arabinose in two brothers with autistic features. Clin Chem. 1995;41(8):1094-1104.
9. Sell D, Monnier V. Structure elucidation of a senescence cross-link from human extracellular matrix. Implication of pentoses in the aging process. J Biol Chem. 1989;264(36): 21597-21602.
10. Smith MA, Taneda S, Richey PL, et al. Advanced Maillard reaction end products are associated with Alzheimer disease pathology. Proc Natl. Acad. Sci U S A. 1994; 91(12): 5710-5714.  
11. Mahler H, Cordes E. Biological Chemistry. 1966; Harper and Row, NY. Pgs 322-375.
12. Ludovic Giloteaux, Julia K. Goodrich, William A. Walters, Susan M. Levine, Ruth E. Ley, Maureen R. Hanson. Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome. Microbiome, 2016.
13. Saiki, R.; Gelfand, D.; Stoffel, S.; Scharf, S.; Higuchi, R.; Horn, G.; Mullis, K.; Erlich, H. Primer-directed enzymatic amplification of DNA with a thermostable DNA polymerase. 1988; Science. 239 (4839): 487–491. 
14. Cornelius J. Clancy and M. Hong Nguyen. Finding the Missing 50%” of Invasive Candidiasis: How Nonculture Diagnostics Will Improve Understanding of Disease Spectrum and Transform Patient Care, 2013-04-04 Oxford Journals, Medicine & Health, Clinical Infectious Diseases, Volume 56, Issue 9 Pp. 1284-1292.
87–92

Webinar Recap: Clinical Considerations for Dysautonomia

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By Kurt Woeller, DO

Dysautonomia, associated with autonomic nervous system dysfunction, can manifest in various ways, including chronic fatigue, cognitive problems, cardiovascular dysfunction, e.g. low blood pressure, elevated heart rate, and mental health disorders. Lack of Thiamine (Vitamin B1), as one possibility of dysautonomia, can compromise mitochondrial function leading to imbalanced activity within the autonomic nervous system (ANS). There are other considerations too such as Dopamine Beta-Hydroxylase deficiency. This lecture focused on certain aspects of dysautonomia.

The full webinar can be viewed here:


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

Q: What got you interested in dysautonomia since few doctors are aware of it?

A: Through understanding of the organic acids test, then researching thiamine and mitochondrial issues, etc. and seeing the link to many neurological and other disorders.

Q: Do infections lead to dysautonomia because of direct nerve damage or is there a different mechanism?

A: There are likely many mechanisms involved with nerve damage from infections such as inflammation, oxidative stress, mitochondrial disruption, etc.

Q: Would POTS fall under this syndrome?

A: Yes. POTS is a type of dysautonomia.

Q: Does the OAT markers of Clostridia correlate with Clostridia in stool tests?

A: The OAT markers are more sensitive to the existence of pathogenic clostridia compared to stool testing.

Q: I am working with fraternal twins and one needed a DBH test warranted from OAT. Can those results be used on both twins?

A: According to information from the DBH activity test, reference ranges have not been established for individuals less than 13 years of age. If these twins are older than 13 years of age, they each should have their own tests done.

Q: How closely do you need to monitor patients who you prescribe Droxidopa for? How young of a patient have you personally used this for? I see a tremendous amount of POTS in my practice and I'm wondering who I'm missing this enzyme deficiency on.

A: Unfortunately, Droxidopa is hard to access because of cost. For most people it is absolutely something that needs to be covered by insurance. I have not personally used with children. Dopamine-Beta Hydroxylase (DBH) Activity Test reference ranges are not established for individuals less than 13 years of age. Monitoring a patient every one to two weeks (depending on their condition severity) in the beginning as levels are titrated works well. The range of dosing recommendations is from 100mg TID upwards to a maximum dose of 600mg TID. The need to go up is based on blood pressure and heart rate monitoring, along with clinical improvement (or lack thereof). The website at Northera has some good information HERE.

Q: I am working with a 45-year-old female Wernicke's Encephalopathy patient. How do I know what amount of Thiamine she needs ongoing now that she is out of the hospital? She is still deficient not getting B1 IV's anymore. Does she warrant a DBH test as well?

A: I would suggest performing the Organic Acids Test on her to assess for metabolic imbalances. If her dopamine (HVA) is high than DBH activity testing should be considered. With regards to Thiamine, you would need to check blood levels and correlate with her clinical response to amount being given. In somebody with this condition and comprehensive health program that includes Thiamine will be important.

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

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By JASMYNE BROWN, ND, MS

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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. 

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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.

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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.

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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.

Environmental Toxin Summit - Q+A Pt. 2

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The Great Plains Laboratory has been educating practitioners for over 15 years on how to help patients heal through cutting-edge testing, research and protocols. During our recent Environmental Toxin Summit, conducted on November 6-8, 2020, speakers reviewed patient cases, explained how to use diagnostic tests for toxins, pathogens, and metabolic imbalances in their practice, and reviewed what treatments they’ve found to be effective.

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

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


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Dale Bredesen, MD

Dr. Bredesen received his undergraduate degree from Caltech and his medical degree from Duke. He was postdoctoral fellow in the laboratory of Nobel laureate Prof. Stanley Prusiner. He was a faculty member at UCLA from 1989-1994, then was recruited by the Burnham Institute to direct the Program on Aging. In 1998 he became the Founding President and CEO of the Buck Institute for Research on Aging, and Adjunct Professor at UCSF; then in 2013 he returned to UCLA as the Director of the Easton Center for Alzheimer’s Disease Research.

Q: What do you do re: ketogenic diet in patient with cardiovascular risk, bad lipid profiles? Do you find they can still do a ketogenic diet ?

A: Absolutely—we see improved lipid profiles with the ketogenic diet (see KetoFLEX 12/3, described in the new book, The End of Alzheimer’s Program), which is plant-rich, high-fiber, low-carb, with appropriate fasting. We often see that patients are able to discontinue their statins.

Q: Do you have thoughts on progesterone dosing for proper trophic hormones?

A: You’ll want to talk to an expert in BHRT like Dr. Ann Hathaway, but typically people start with 100 mg of bioidentical progesterone at night.  Then you’d like to see an estradiol: progesterone ratio of 80:2 or so, such that the ratio is between 10:1 and 100:1, following symptoms, of course.

Q: Which test do you prefer: NeuroQuant or PET scan to look at the brain?

A: Great point as these give different information. An amyloid PET scan will tell  you whether there is amyloid present (although it may miss small amounts), and an FDG-PET will tell you whether there is reduced glucose utilization in a pattern compatible with Alzheimer’s (temporal and parietal loss, and increased specificity if there is reduction in the posterior cingulate and precuneus) as opposed to frontotemporal dementia (reduced in frontal and temporal regions) or Lewy body disease (reduced in parietal and occipital regions). The volumetric MRI (with NeuroQuant or NeuroReader) will show areas of atrophy.  If there is a question about the diagnosis, then an FDG-PET is most helpful in differentiating Alzheimer’s from FTD or Lewy body disease.


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Joseph Pizzorno, ND

Dr. Joe 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: I note your list of drugs causing or contributing to asthma included steroids. Could you comment on this? In your opinion, should steroids not be given to treat asthma?

A: Short term use is fine, long term is what causes the problems. The key mechanism appears to be causing bronchial spasm in susceptible people.

Q: Do you suggest testing both 25 OH vitamin D levels, and 1,25 OH levels?

A: Not unless there is a reason, such as:

1.       25-OHD3 does not go up in proportion to dosage

2.       The have elevated serum ionic calcium

3.       They have a granulomatous disease, which are known to cause over conversion

Q: the "3g/d" of fish oil, is that 3g of EPA/DHA or 3 g of ttl. fish oil?

A: Short term EPA/DHA. Long term fish oil.

Q: Can you water fast children safely? And for how long would you recommend

A: Yes. Must be closely monitored. Anything more than 2 days should be done at a facility specializing in fasting.

Q: Does following a blood type diet help reduce food reactions?

A: My clinical experience is “yes” but I’ve not looked for research.

Q: "100+mg/d" of DHEA? That's a lot, no?

A: Yes! I only recommend considering in SLE unresponsive to the interventions discussed.

Q: What's the best supplements to get the liver and kidneys working before doing a detox?

A: Not a simple answer. Get my book The Toxin Solution for detailed protocol. It is inexpensive.

Q: Does he like to have the Vitamin D with the Vitamin K to?

A: When using any of vitamins A, D and K, I prefer using them together.

Q: Testing for lead and arsenic via RBC best?

A: Sorry, don’t know and unclear from literature. At this time, blood lead and urinary arsenic have the most research.

Q: How often do you see aluminum toxicity and what might be the main source?

A: The aluminum toxicity is unclear to me, despite perusing the research. Probably real, but likely highly dependent on susceptibility.

Q: If I could only get one of your textbooks.  Which one would you recommend to quickly figure out solutions to problems we would face in functional medicine practice.

A: Textbook of Natural Medicine! Has been the leading textbook in the field for 35 years. 5th edition—2 volumes, full color graphics for first time—just came out in August.

Q: I have patients that feel awful with glutithione supplementation. Thoughts?

A: Most likely sulfur metabolism problem. Check their urinary sulfite/sulfate ratio. If elevated, consider molybdenum.

Q: Do you have a specific detailed detox protocol for BPA and Phthalates?

A: Easy, stop exposure. These are non-persistent and clear within days.

Q: Protocol for Lead and mercury? Many thanks! Really enjoy your talk and your books!

A: Thank you! My protocol is the same for both:

·         500 mg NAC orally once or twice a day

·         250 mg DMSA oral every 3rd night

·         5 g fiber bid

·         Patience—takes months to get these heavy metals out safely


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Ben Lynch, ND

Dr. Ben Lynch is the best-selling author of Dirty Genes and President of Seeking Health, a company that helps educate both the public and health professionals on how to overcome genetic dysfunction. He received his doctorate in naturopathic medicine from Bastyr University. He lives in Seattle, WA with his wife and three sons.

Q: Will the Genetic Testing be available for CTNC/Functional Nutrition Health Coaches?

A: We offer wholesale pricing to licensed health professionals.

Q: Are there discounts for physicians for the StrateGene test?

A: Fullscript also carries StrateGene and possibly offers it to health coaches at a discount.

Q: Will Dr. Lynch be offering a discount on his test for those attending?

A: Seeking Health offers wholesale discount tier pricing based on volumes. Our wholesale team has information about this. I’m not sure of the tiers.

Q: Can you repeat the site for the courses?

A: Online courses are available here – and much of the content is actually given as part of StrateGene – so if a health professional buys StrateGene, they are given access to much of the online courses – which pertain to understanding pathways and incorporating them into practice.


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Lyn Patrick, ND

Dr. Lyn Patrick ND graduated from Bastyr University in 1984 with a doctorate in naturopathic medicine and has been in private practice as a state licensed naturopathic physician in Arizona and Colorado for 35 years.

Q: How do you suggest we look at detoxing these chemicals?

A: Best way to “detox” is to prevent exposure. We call it “avoidance” in environmental medicine and it is the very first intervention we employ.

For toxicants that have short half-lives: BPA, perchlorate, solvents (TCE, PAH, etc.), organophosphate pesticides, atrazine, glyphosate (Round-up, etc.), phthalates, and arsenic the best intervention is to find the source (drinking water, diet, air pollution, off-gassing or source inside home) and remediate: water filtration, air filtration, and dietary changes are basic and necessary. 

For persistent toxicants (lead, mercury, cadmium, organochlorine pesticides, PCBs, other persistent organic pollutants) interventions will necessitate lowering body burden. For metals: chelation is necessary using proven chelating agents like DMSA, DMPS and EDTA. For others high fiber, binders (cholestyramine, charcoal, clay, etc.) plus glutathione/phosphatidylcholine support and sauna to liberate fat-stored toxicants is necessary. For details look at the library of lectures available for members: National Association of Environmental Medicine (envmedicine.com)

Q: A lot of my patients have memory foam pet beds for their osteoarthritis (I’m a DVM). How long to de-gas?

A: I would not suggest waiting until they off-gas, just get rid of them and replace with something non-foam, why continue to expose animals to carcinogens and potent sources of neuroinflammation?


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Mark Filidei, DO

Dr. Mark Filidei is an Internal Medicine physician who completed training in General Internal Medicine at Brown University. He is the Director of Integrative Medicine for the Amen Clinics. Dr. Filidei is an officially trained member of ILADS and treats Lyme disease and mold illness with both natural and conventional treatments. Dr. Filidei specializes in Hormone Replacement Therapy and the treatment of Mental Health disorders utilizing a functional medicine approach. He is a member of the Millennium TBI Network treating brain injury.

Q: Do you run your EBV PCR test through lab/quest?  How frequent are Antibodies positive PCR positive for EBV in your patients?

A: Yes labcorp and quest. Positive quite often.

 Q: For toxic encephalopathy, what is the most accurate test for toxic metal? Is it through hair, urine or blood?

A: All of them, provoked urine is the best.

Q: Can Biomin products be used in humans? Any studies?

A: I wish. No

Q: Before doing detox protocol do you make sure the person is methylating ok and have the right nutrients on board for detox?

A: There are many detox protocols, but glutatione and detox support always apart of it.

Q: What is the name of the organization?

A: Iseai

Q: Biomon says not available in US and Canada in the ad.

A: Correct

Q: Which method of mold testing for home or office is most reliable?

A: Ermi


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