Why Environmental Medicine is a Key Part of My Practice

BY: Jean K. Lawrence, ND, NMD, PhD, DACBN

If you’re anything like me, doing the functional medicine thing all the time and loving it, you will notice some things. You will have patients on both ends of the spectrum – either they get amazingly better with little to no intervention on your part, or they are frustratingly difficult to figure out.  We tend as practitioners to focus on our successes, but those failures are what keep us up at night. We can’t stop desperately searching for answers because most of us want to fix everyone.

I used to think that doing bloodwork would solve 99% of my patient’s issues.  Then I slowly expanded into doing heavy metal hair analysis, then hormone testing, and that made up the bulk of what I assured patients would give me the solution to their health problems. 

I quickly learned that our environment and the growing number of toxicants had to be addressed. Patients are becoming more and more complex with more and more syndromes and diagnoses that are increasingly difficult to navigate in the (1) time you have available to see them and (2) the amount of money they can spend on testing. 

In my practice, Lawrence Health and Wellness, some patients virtually check off every single symptom on my 13-page intake form.  Where to start is the question. 

My Environmental Medicine Health Protocols

I always start with a thorough health history, and discovered along the way that I needed to ask the questions that had either never been asked of the patient, or hadn’t been previously thought of.

I Ask My Patients These Questions

  1. What is your home’s source of water?

  2. Do you use or have you used in the past any pesticides or insecticides in your home or office?

  3. Do you use a lawn service or personally use weed killers?

  4. Have you ever lived in a house that has had water damage?

Patients are stunned that you would ask them these things, because no other doctor has ever done so.  They cannot make the connection between the answers to these questions and their current health status – but we can!

When I started using Great Plains Laboratory testing, now Mosaic Diagnostics, several years ago, I was excited to find a lab focused on environmental medicine.  I knew that environmental toxicants negatively impacted my patients, but I was just scratching the surface by recommending liver detoxes.  Today, I use a full menu of environmental medicine health tests to get to the root cause triggering a plethora of illnesses like Lyme Disease, autoimmune disorders like Hashimoto’s, Leaky Gut, Depression, and nutritional dysfunction.

What is the Future of Functional Medicine?

Being on the speaker’s circuit, I encounter many doctors who want to know the future of functional medicine – and my immediate reply is that it is environmental medicine.  I am the only doctor within a 90-mile radius that does testing of this sort and have seen amazing outcomes.  I like to tell patients that they are “a 1000-piece jigsaw puzzle and I only have 500 of those pieces” in their intake forms, so further testing is required. 

I also tell them that “if we don’t know where we are, we don’t know where we are going.”  Patients need answers, and they are tired of “Dr. Google” confusing and scaring them.  Watch the video below to learn the various tests I use on a regular basis to base my environmental medicine practice on a solid foundation.

I’ll share the tests I use and why these extra “tools in your toolbox” will take your practice (and your patients!) where they need to be. I believe our job as environmental health and functional medicine practitioners is to be thorough detectives.

My new patient intake form is 13 pages and I spend a minimum of 90 minutes diving deep into the patients’ history, home and work environment, lifestyle, habits, and mental wellbeing.

Watch this short video, explaining which Mosaic Diagnostics, formerly Great Plains Laboratory, test I order frequently to learn the root cause creating issues for my hard to diagnose patients.


Dr. Jean Lawrence describes the environmental medicine tests she relies on to get to the root cause of her patients’ issues.



Great Plains Lab is Now Mosaic Diagnostics

As we evolve to better serve the functional medicine industry, we are excited to announce upcoming changes with The Great Plains Laboratory.

 Over the next several months, healthcare practitioners will see innovative enhancements across our test menu, educational offerings, and customer experience. Part of this growth includes changing our company name to Mosaic Diagnostics.

As a global innovator in diagnostic testing in the functional medicine industry, we felt a name change beyond a Midwest reference was warranted. "Mosaic" exemplifies our mission of providing practitioners with the breadth of tests they need to Reveal the Complete Picture of their patient’s health.  Our new logo represents an endless knot, which signifies the interconnections of all aspects of a patients’ health.

We’re proud to build on the 25-year history and reputation of The Great Plains Laboratory. For those familiar with our history and contributions to the science of functional medicine diagnostics, we thank you for your trust and allegiance. We promise to continue and build upon our contributions. We are executing an ambitious strategic plan of offering an even more robust portfolio of tests and services that defines a new standard of quality and value.

While we are announcing our new company name today, we will be communicating with you in more detail as we roll out the exciting improvements to our offerings at each phase.

 

The Story Behind the Birth of the Mosaic Diagnostics Brand

Q.  Why are you changing the company name from Great Plains Laboratory to Mosaic Diagnostics?

A.   As a global innovator for diagnostic testing in the Functional and Integrative Medicine community, we felt a name change beyond a Midwest reference was warranted. With 2023 being a year focused on expanding our test menu and services, we feel “Mosaic” more accurately represents who the company is today.

Q.  What’s the significance of the new brand identity?

A.  Our new logo represents an endless knot, which signifies the interconnections of all aspects of a person’s health. The use of the word mosaic signifies tiles of health data coming together to reveal a complete picture of a patients’ health through scientific markers.

Q.   Why create a new brand called Mosaic Diagnostics?

A.     Mosaic Diagnostics interconnects the underlying aspects of chronic diseases to reveal a more complete picture of your patients’ health. The change is not merely cosmetic. It’s an investment in clinical excellence.

Our vision is to raise the bar in the functional medicine industry starting with the validity of our tests, the speed of our delivery, the depth of our clinical consultancy, and the breadth of our educational curriculum. We created Mosaic Diagnostics to supply the means and markers to reverse chronic disease.

3 Reasons to Eat Organic and 4 Tests to Ensure Your Diet is Clean & Healthy for You

Eren Quense, RDN, MS

SUMMARY

Over the past few years, the health necessity to eat organic food has become more popular. Moms, athletes, and the chronically ill are more aware of the health risks associated with non-organic foods. While organically grown food is no doubt more expensive than conventional foods, there are health benefits that inspire me to eat organic and I know most integrative medicine practitioners agree that eating clean outweighs the cost of purchasing organic produce that isn’t ladened with toxic chemicals.

Why Eat Organic Despite the Cost

A USDA-approved organic product is one that is grown and processed without the use of pesticides, fertilizers, genetic engineering, antibiotics, growth hormones, artificial flavors, colors, or preservatives.1 These things have been introduced into our foods over decades to help minimize food waste, increase shelf life, decrease costs, and enhance eye appeal, flavor, and palatability. By eliminating these chemicals and additives we are left with fresher, cleaner, better-for-you products, but we are also left with less control over environmental events, increasing costs for growers, and therefore you, the consumer.

Here are three reasons you might want to consider spending the extra money to eat organic for improved health.

 

Reason #1: Less Exposure to Resistant Bacteria When Eating Organic

The overuse of antibiotics in conventionally produced food has led and continues to lead to the growth of resistant bacteria.2 This bacteria can be transferred to humans from meat that hasn’t been cooked or handled properly or from crops that were sprayed with fertilizer containing manure.3 This is concerning for our health because these bacteria have become immune to treatments that are designed to kill them, leading to infections that are harder, if not impossible to treat.3 

Organic foods decrease the probability of ingesting resistant bacteria due to the non-use of antibiotics in food production. Theoretically, the money spent on eating organically could save you later on healthcare costs!

Reason #2: No Synthetic Pesticides

Pesticides are chemicals that are used to eliminate or reduce organisms that could invade and damage crops. Unfortunately, the residue of these chemicals is found on the surface of fruits and vegetables even after being washed. A study conducted by the Environmental Working Group found that people who ate mostly organic food had a 65% lower risk of having detectable levels of pesticides in their bodies.4

The effects of synthetic pesticides on the human body are many and still being extensively researched, however, one reason to avoid pesticides is that they contain endocrine-disrupting chemicals (EDC). EDCs mimic our natural hormones and affect how they are made, used, and stored in the body.5  This disruption in hormones has been linked to a whole host of negative health outcomes including poor reproductive health, altered immune and nervous system functions, learning disabilities, obesity, metabolic issues, and more.5 EDCs enter the body through other avenues but limiting the exposure by choosing organic foods could help balance your hormones.

To understand the impact of pesticides on our health, organic acid tests can be used to identify biomarkers related to exposure to these chemicals. When humans are exposed to pesticides and other toxins, certain organic acids increase in the body, providing biomarkers that highlight the effect of toxins on our cellular metabolism. In addition, the presence of glyphosate, a very commonly used herbicide, as well as heavy metals that build up over time from pesticide use, can be assessed in the body through biomarkers.

Reason #3: Higher Nutritional Value

Organic food is generally more nutritious than its conventionally grown counterpart. Certified-organic food is farmed and raised using practices that prioritize soil health and biodiversity which can result in crops that are higher in vitamins, minerals, and antioxidants.6 These higher levels of nutrients promote a better immune system and overall health.

Organic food might be more expensive than conventionally grown foods but there are many health benefits that outweigh the cost. organic food is healthier and overall safer to eat but it is important to note that eating nutritious foods is the priority.  If eating all organic is not within your budget, choose just one or two foods you can swap for organic versions. 

 

4 Tests that Ensure Your Diet is Clean & Healthy

IgG Food Map

According to Lindsay Goddard, RD, Great Plains Laboratory Clinical Consultant, food can be healing or detrimental to your health if you’re eating food tainted with toxins or that cause immune responses or food sensitivities. For this reason, Goddard recommends the Great Plains Lab IgG Food Map, which tests for food sensitivities. Goddard says the test is easier for patients than going through an elimination diet. Goddard discusses the test in detail in this recorded webinar, “Using the IgG to Help Your Patients.

Glyphosate & MycoTOX Tests

One inexpensive test to determine if you’ve been exposed to high levels of potentially harmful pesticides on your food is Great Plains Laboratory’s Glyphosate test. For less than $100, your functional medicine practitioner can have a test sent to your home to collect a urine sample to administer the test. The MycoTOX Profile can easily be added on to test for exposure to fungi and molds found in common foods like coffee and corn.

According to Shanhong Lu, MD, getting tested for glyphosate exposure is as important as your need for an annual exam.  Sadly, glyphosate is in 75% of rainfall, 75% of air, and 80% of adult American’s urine because of the amount sprayed on crops, lawns, golf courses, and grains.

Dr. Lu says the rise in the use of Roundup Herbicide (a pesticide that uses glyphosate as a main ingredient) and the rise in chronic illnesses such as digestive issues, asthma, Parkinson’s, and Alzheimer’s is not a coincidence. She has found a correlation among her patients who have chronic illness and have also lived on a farm or near a golf course.

Organic Acids Test (OAT)

Lastly, by using the Organic Acids test to identify biomarkers related to pesticides and toxins we can better understand the impact of these substances on our health and make informed decisions on what we eat.

The Organic Acids Test evaluates for 76 metabolites in the body, including oxalate levels. High oxalates can lead to kidney stones. Also, individuals with fibromyalgia and women with vulvar pain may suffer from effects of excess oxalates.

For more information about food sensitivity or testing of toxins in the body, work with your functional medicine practitioner for recommendations and protocols.

References
1.	McEvoy M. Organic 101: What the USDA Organic Label Means. Usda.gov. Published March 13, 2019. https://www.usda.gov/media/blog/2012/03/22/organic-101-what-usda-organic-label-mean
2.	Health benefits of organic food, farming outlined in new report. News. Published June 22, 2018. https://www.hsph.harvard.edu/news/features/health-benefits-organic-food-farming-report/
3.	Antibiotics in Your Food: Should You be Concerned? Healthline. Published June 17, 2017. https://www.healthline.com/nutrition/antibiotics-in-your-food#TOC_TITLE_HDR_4
4.	Environmental Working Group. EWG’s 2019 Shopper’s Guide to Pesticides in ProduceTM. Ewg.org. Published 2019. https://www.ewg.org/foodnews/summary.php
5.	Endocrine Disrupting Chemicals (EDCs). www.endocrine.org. Published January 23, 2022. https://www.endocrine.org/patient-engagement/endocrine-library/edcs
6.	Montgomery DR, Biklé A, Archuleta R, Brown P, Jordan J. Soil health and nutrient density: preliminary comparison of regenerative and conventional farming. PeerJ. 2022;10:e12848. doi:https://doi.org/10.7717/peerj.12848

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!

Lyme, Mold and Mycotoxins: Strategies for Navigating Complex Illness

Darin Ingels, ND

SUmmary:

In the full presentation Lyme, Mold, and Mycotoxins: strategies for Navigating Complex Illness, Darin Ingels, ND, discusses the origin of Lyme Disease, how Lyme is spread, different ways to test for Lyme Disease and treat those affected by Lyme Disease.

Lyme Disease (LD) is among the more difficult of chronic syndromes – difficult to define, to diagnose and to treat. Since the mysterious outbreak of juvenile rheumatoid arthritis in the 1970s in Lyme, Connecticut, was first connected to microbial Borrelia burgdorferi spread by ticks, the understanding of these conditions has increased as Lyme itself has spread through the US and Europe.

Several species of ticks are expanding their range. The spread includes Canada, although Canada drastically underreports Lyme cases. Dr. Ingels provides considerable detail on Borrelia variants with maps documenting its relentless advance during the last few decades. He mentions that US variants have a stronger T-1 pro-inflammatory response, while European variants have a strong T-17 pro-inflammatory response.

Making identification of Lyme more difficult is the slow replication of Borrelia species (days instead of hours) and the organism’s ability to change shapes. The production of antibodies by Lyme sufferers isn’t dependable either. Many patients are entirely seronegative.

Laboratories often do not test for the full extent of the antibodies that have been associated with Lyme. The well-known bull’s-eye rash resulting from a tick bite is only present in 70% of patients according to the CDC, but other sources say 40%, and many Lyme sufferers have no recollection of a tick bite.

Symptoms are vague and overlap with other infectious and autoimmune conditions, which further confounds the problem of Lyme diagnosis. In children, confounding is even higher and symptoms include PANS and OCD.  Also, diseases such as tularemia may present similarly to Lyme.

Dr. Ingels points out that the CDC criteria for Lyme Disease was designed for surveillance purposes and do not necessarily reflect active infection with Borrelia species. The official diagnosis of Lyme Disease is a clinical diagnosis (signs and symptoms). The CDC warns against diagnosis of asymptomatic individuals, although it is possible to carry the microbes without symptoms. CDC-approved testing includes ELISA and Western blot: these are 40-year-old criteria.

ILADS (the International Lyme and Associated Disease Society) has more complex criteria for diagnosis of Lyme (LD) and coinfections. Their LD assessment approach includes a symptom questionnaire and suggested labs include hormones (thyroid, adrenal), nutritional (Vitamin D, minerals, amino acids), and immune markers as well as microbial coinfections. However, different laboratory tests may report markers for different microbial strains.

Dr. Ingels then segues into the involvement of mold as a major confounder of Lyme diagnosis. Mycotoxin toxic effects (mycotoxicosis) often overlap with Lyme Disease effects, and the damage both can do to the terrain also allows them to persist in a patient and contribute to ongoing oxidative stress and cell damage.

Fixing the terrain begins with – no surprise – healing the gut. Dr. Ingels offers the standard anti-inflammatory supplements such as probiotics and glutamine, and goes on to provide detailed diet guidance, emphasizing alkaline foods. The next step is to treat active infections, preferably with herbal supplements rather than antibiotics. He recommends several lesser-known herbal products for Lyme. Steps to reduce stress, improve sleep, and remove mold from the body and the environment are also presented. Treatment protocols should be tailored to each patient: “the best binder is the one your patient will take and tolerate’. Since sensitive mitochondria suffer “collateral damage” from these chronic conditions, Dr. Ingels winds up the lecture with mitochondria support supplements and detoxification strategies.

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Concerns for Children: Can Hidden Hunger Affect Mental Health?

Jill Craig, MS, CN, CNS

SUMMARY

Mental health issues for children is now one of the top 10 reasons for children to be admitted to the hospital in the United States, according to an article in US News and World Reports.

This past September in an article in the Dayton Ohio News cited mental health concerns were the most common reasons for the admission of children to the Dayton Children’s Hospital.  

This articles explains why what we eat impacts our mental health.
 

A Happy Child by Kate Greenaway1

A September newspaper ran this story:  

Mental health now most common cause for admissions at Children’s 

The article cited that over 900 children since the start of 2022 had been admitted to a local hospital for depression or suicidal thoughts. One in seven returned within 30 days. Why? Adverse childhood experience, stress and conflict were a few reasons given.2
A 2020 National Survey of Children’s Health upholds this sad reality – many children are not happy.3 

As a consultant with Great Plains Laboratory, I routinely ask practitioners, “What can you tell me about the patient?” At times, I hear, “Well, she (or he) had a traumatic childhood.” In one case, a patient named “Nancy” was in great distress because she had just been diagnosed with bipolar disorder. Her “crazy-wild” mother received the same diagnosis when Nancy was young. While all cases are unique, two parts of Nancy’s story are common with others I hear – malnutrition coupled with mental instability. A Happy Child was written long ago when life seemed simpler, and cake was an occasional treat. As we will see, what we eat or do not eat can have influence. 

Obstacles to Good Nutrition 

A recent systematic review showed a significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents. Childhood-learned dietary habits most often segue into adulthood. Clearly, depression, anxiety, suicidal and bipolar tendencies are common in all stages of life.4 However, depression in young adults in a randomized controlled trial improved when given a
3-weeks’ intervention of a diet rich in fruit, vegetables, fish, and lean meat.5
Yet, for some families, wholesome foods may not be readily available or preferred.  

Food deserts” or “low-access communities” are areas where fresh food is hard to find and are a reality for millions of Americans. Grocery stores are not conveniently located and convenient stores at nearby gas stations mostly carry only processed food options. From my experience with community nutrition, children in food deserts often do not know names of most vegetables and fruit. Many have not even seen them.
However, it seems food swampsare of more concern to health for those of lower socioeconomic status where the prevalent presence of fast food and junk food overshadow available healthy alternatives.6, 7  

As a growing problem in European regions, as well, a recent study corroborates this.
The primary dilemma for children and adolescents when it comes to food environment is the profusion and marketing of cheap, unhealthy food, not the inaccessibility to healthy options.8, 9 And even many “healthy” foods are of concern, as well. 

He’s gluten-free and dairy-free.” I hear this often from practitioners since an elimination diet for a time may help correct GI complaints. Yet some food options are not so healthy. According to Dr. Dariush Mozaffarian of the Tufts Friedman School of Nutrition Science and Policy in Boston, “…you could create any kind of Frankenstein food that met the nutrient criteria and label it as healthy.”10   

Overall, the two primary reasons behind the food people choose to buy and eat is founded in their knowledge about nutrition and their food preferences.11  Yet, societal factors play huge roles, as well.12 This is known as “foodways”, where food and culture converge: campfires and S’mores; birthdays with cake and ice cream; Halloween and candy, candy, candy. 

Foodways, American style 

We would not want to live without traditions and the memories they bring, but 3 cups or 144 teaspoons is the average amount of sugar ONE child eats on Halloween. That is a lot of sugar. Yet, a newspaper article quotes an expert in nutrition who says three cups of sugar for a kid on a single day is “not that bad.” If they eat it and get a stomachache, well then, they will learn their lesson.13  

On top of that, Halloween is just the kick-start to the holiday season. Then come the Thanksgiving pies and sweet potato-marshmallow casseroles; Hanukkah "sufganiyot" (jelly donuts) and latkes; and Christmas cookies and candy canes. So, foodways seem to give license to increased sugar intake. Besides, the Food and Drug Administration (FDA) gives sugar a generally recognized as safe (GRAS) status with no limitations for its content in foods, other than current good manufacturing practice.14 Yet, does the stomach solely suffer? 

An ecological analysis of international differences in food supply relative to epidemiological data on the outcome of schizophrenia and the prevalence of depression showed that consumption of refined sugar worsens both.15 Yes, sugary seasonal indulgences during the holidays can be detrimental to mental health, yet, the overall increase of sugar intake in the Western diet is of greater concern, especially for children.16 Basically, sugar supplants the sense of taste for nutritious foods which can result in hidden hunger.17  

Hidden hunger, a lack of essential nutrients, is a global reality. At least half of all children under five suffer from stunted growth because of it. For several reasons, which could include displacement due to the influences of sugar, these children don’t eat enough variety of foods to support healthy growth and development.18
A pattern-analysis of the Organic Acid Test (OAT) can reflect the effects of such malnutrition upon metabolism as seen in the following case. 

Metabolic evidence of hidden hunger  

Five boys in one family with behavioral issues all appeared to be on the autistic spectrum. Toxic mold exposure was a likely part on their story, as well, yet the greatest concern was for the middle son, “Ben”, whose dietary intake was dangerously limited.
If there was something Ben liked, he’d eat. If not, he’d be content not to. In addition to showing signs of stunted growth, his symptoms included headaches, dyslexia, vision problems, symptoms associated with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), and episodes of rage.  

Ben’s OAT revealed decreased levels of many metabolites, a pattern I’ve seen commonly in children. The first analyte I noticed was lower hippuric acid (#10). This likely reflected Ben’s low intake of colorful vegetables and fruits on which bacteria feed to generate butyrate, a needed cofactor to produce hippuric acid. The beneficial bacterial analyte, DHPPA (#15), is concurrently low which implied insufficiency dysbiosis likely due to his lack of dietary fiber.19 

Secondly, the Krebs Cycle metabolites were below the mean. Because of Ben’s low caloric intake, the intermediates leave the cycle to convert to glucose, fatty acids, and non-essential amino acids. This puts a demand upon his body’s amino acid supply as the intermediates need to be refilled by amino acids at various points along the cycle to support its continued function. For example, succinate is replenished by isoleucine, valine, and methionine; fumarate with phenylalanine and tyrosine.20  So, lower Krebs Cycle metabolites suggest both suboptimal diet, an overall low amino acids status and the metabolic evidence of hidden hunger.  

Also, I observed that the end-byproducts of essential amino acids involved in neurotransmission were below the mean (#33) #34) (#38). Lower HVA and VMA are related to the decrease of fumarate and its association with phenylalanine and tyrosine. The lower HIAA may reflect low tryptophan in Ben’s diet and body stores, as well. 

Though the HVA/DOPAC ratio is only slightly lower, it may indicate slower catachol-o-methyltransferase (COMT) activity.21 Magnesium, vitamin C and S-adenosyl-methionine (SAMe) support COMT function and many other enzymatic reactions. Furthermore, SAMe is a byproduct of methionine, an essential amino acid primarily found in animal protein.22

All these were likely limited in Ben’s diet, as well, which could negatively affect COMT function. Also, several of Ben’s symptoms are common with COMT genetic defects. 

Additionally, the HIAA may be lower due to a genetically slow monoamine oxidase (MAO) enzyme and/or insufficiencies of its cofactors, vitamin B2 and iron. Iron is commonly low in infants and children.23 Genetic mutations in the MAO enzyme are also associated with mental disorders that include autism, anxiety, impulse-control disorders, and ADHD.24   

Hidden hunger in Ben’s OAT is also evident in the pattern of the following metabolites that fall below the mean.  

Lower ketones (43 - 44) and fatty acid (45 – 49) analytes common with lower dietary intake 

Lower vitamins B6, B5, and C / 50, 53 lower due to low amino acid precursors.

58 – 59 lower due to low amino acid precursorsxxv / 60 may indicate low protein intake / 76 possible low vitamin D and/or low animal protein in the diet.

A simple answer to address a complex
concern – in part
 

Current newspaper headlines relay daily the grave reality that many children suffer from mental health distress. A Happy Child. A simpler life of long ago. A piece of cake, a treat. Why are so many children not happy in our day? Surely there are many varied reasons for this as each child’s story comes with its unique, complex set of circumstances. However, malnutrition, or hidden hunger, is a common thread in Nancy’s and Ben’s stories. I would not be surprised if it also appears someplace in the narratives of the
900 admitted to Children’s. It is worth considering as what we eat or don’t eat does
have influence. 

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References
  • Nutrition for Kids: Tips on Getting Children to Eat Healthier - webinar by Dr. Tracy Tranchitella, N.D. https://vimeo.com/386074107embedded=true&source=vimeo_logo&owner=2820515 
  • Refined to Real Food: Moving Your Family Toward Healthier, Wholesome Eating ISBN: 9781880158487 
  • Feeding Baby Green: The Earth Friendly Program for Healthy, 
    Safe Nutrition During Pregnancy, Childhood, and Beyond ISBN: 9780470425244 
  • Brain Health from Birth: Nurturing Brain Development During Pregnancy and the First Year ISBN: 099967613X 
  1. Benoit, C. F. (1922) Children's Poems That Never Grow Old, for Little Folks from Six to Twelve Years Old. [Chicago, The Reilly & Lee co] [Image] Retrieved from the Library of Congress, https://www.loc.gov/item/22013224/. 
  2. Perry, Parker.(2022) Mental health now most common cause for admissions at Children’s 
    https://www.daytondailynews.com/local/
    mental-health-issues-most-common-admission-reason-now-at-daytonchildrens/DMBEHEQL7BH4BFII7UKPBUZY5U/#:~:text=More%20than%20900%20children%20have,doctor%2 0at%20the%20hospital%20said. 
  3. Mental and Behavioral Health NSCH Data Brief (2020) https://mchb.hrsa.gov/sites/default/files/mchb/data-research/
    nsch-data-brief-2019-mental-bh.pdf  
  4. O'Neil A, et. al. (2014) Relationship between diet and mental health in children and adolescents: a systematic review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167107/#bib1/  
  5. Francis, HM., et. al (2019) A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled. https://journals.plos.org/plosone/article/file id=10.1371/journal.
    pone.0222768&type=printable  
  6. Cooksey-Stowers, K. (2017) Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States. https://media.ruddcenter.uconn.edu/PDFs/ijerph-14-01366.pdf 
  7. Chen, T. (2017) Food Deserts and Food Swamps: A Primer.  https://www.ncceh.ca/sites/default/files/Food_Deserts_Food_Swamps_Primer_Oct_2017.pdf  
  8. Smets, V. (2022) The Changing Landscape of Food Deserts and Swamps over More than a Decade in Flanders, Belgium. https://www.mdpi.com/1660-4601/19/21/13854/htm  
  9. Harris, J. et. al., (2021) Fast Food Facts https://media.ruddcenter.uconn.edu/PDFs/FACTS2021.pdf  
  10. New York Times. (September 29, 2022) https://www.nytimes.com/2022/09/29/well/fda-healthy-food.html  
  11. Ver Ploeg, M. (2016) Recent Evidence on the Effects of Food Store Access on Food Choice and Diet Quality. https://www.ers.usda.gov/amber-waves/2016/may/recent-evidence-on-the-effects-of-food-store-access-on-food-choice-and-diet-quality/ 
  12. The Factors that Influence Our Food Choices. (2006) https://www.eufic.org/en/healthy-living/article/the-determinants-of-food-choice  
  13. Avril, T. (2022) Should kids eat all their Halloween candy all at once, or spread it out? Dentists and nutritionists help you with the sticky questions. https://www.spokesman.com/stories/2022/oct/27/should-kids-eat-all-their-halloween-candy-at-once-/  
  14. Code of Federal Regulations Title 21 (2022)https://
    www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=184.1854  
  15. Peet, M. (2018) International variations in the outcome of schizophrenia and the prevalence of depression in relation to national dietary practices: and ecological analysis.  https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/international-variations-in-the-outcome-of-schizophrenia-and-the-prevalence-of-depression-in-relation-to-national-dietary-practices-an-ecological-analysis/D226B13D07E36AB09016A2EED81049B6  
  16. Mills, C. (2022) The haunting facts of eating too much sugar.
    https://www.statefoodsafety.com/Resources/Resources/
    the-haunting-facts-of-eating-too-much-sugar
  17. Drewnowski, A., et. al. (2012). Sweetness and food preference. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738223/  
  18. UNICEF (2019) The state of the world’s children 2019. https://features.unicef.org/state-of-the-worlds-children-2019-nutrition/  
  19. Cronin, P., et. al (2021). Dietary Fibre Modulates the Gut Microbiota. https://doi.org/10.3390/nu13051655  
  20. Owen, O. (2002) The Key Role of Anaplerosis and Cataplerosis for Citric Acid Cycle Function. 
    https://www.jbc.org/action/showPdf?pii=S0021-9258%2820%2970110-9  
  21. Bilder, R., Volavka, J., Lachman, H. et al. (2004) The Catechol-O-Methyltransferase Polymorphism: Relations to the Tonic–Phasic Dopamine Hypothesis and Neuropsychiatric Phenotypes. https://doi.org/10.1038/sj.npp.1300542
  22. Elango, R. (2020) Methionine Nutrition and Metabolism: Insights from Animal Studies to Inform Human Nutrition. https://doi.org/10.1093/jn/nxaa155 
  23. Wang, M. (2016) Iron Deficiency and Other Types of Anemia in Infants and Children 
    https://www.aafp.org/dam/brand/aafp/pubs/afp/issues/2016/0215/
    p270.pdf  
  24. Bortolato, M. Shih JC. (2014) Behavioral outcomes of monoamine oxidase deficiency: preclinical and clinical evidence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371272/  
  25. Human Metabolomic Database (2021) https://hmdb.ca/metabolites/HMDB0000008  

The Hidden Threat of Mycotoxins

Summary:

In the presentation, The Hidden Threat of Mycotoxins, Mark Filidei, DO points out that not all molds produce mycotoxins, nor are toxins constantly produced by mycotoxin-producing molds. Mycotoxins and mold exposure can have an impact on mental health, so mycotoxin testing is a component of patient intake. Dr. Filidei reviews case studies of patients affected by mycotoxins and provides treatment insights.

Mark Filidei, DO begins with brain SPECT scans, an integral part of patient assessment at Amen Clinics. “You have to look at the brain to know if you have a brain problem,” Dr. Filidei says, but that imaging does not identify the cause. Common brain scan findings such as reduced perfusion and the presence of scalloping suggest the possibility of mold exposure, but many other potential toxins, as well as conditions such as anoxia or hypothyroidism, can damage the brain. Symptoms of mold exposure in the CNS include all the usual suspects, from headache to dementia.

Mycotoxins are metabolically expensive, and so are not produced until molds are threatened – mycotoxins are chemical warfare agents. Growing molds also emit toxic volatile organic compounds (VOCs), which can be inhaled in water-damaged buildings.

The patient’s total toxic load influences how severely an individual will react to mold exposure and how quickly mycotoxins will be eliminated. All toxins, regardless of source, are eliminated through the liver. Some of the more lipophilic toxins such as ochratoxin may be picked up by bile and deposited into the GI tract, and perhaps partially reassimilated into the bloodstream. Ultimately, toxin loads are mainly eliminated through the kidneys. If the patient has absorbed substantial levels of other toxins, they will “compete” with mycotoxins for elimination, along with normal metabolic byproducts.

Filidei commented that he has focused on mycotoxins in food, but notes that water-damaged buildings can be more dangerous. Humans may have become more adapted to mold in food, particularly ochratoxin, “which has been in our diets forever,” and is produced by the ubiquitous aspergillus genus of mold.

Much of our knowledge of the impact of mold on mammals comes from animal husbandry science and the farm/food industry.  Mycotoxins come from feeding grains. Dr. Filidei includes animal studies of how mycotoxins, including ochratoxin and trichothecenes, cause direct apoptosis of neurons, as well as damaging the intestinal lumen barrier.

Dr. Filidei also discusses Zearalenone’s effect on hormone activity and presents a study of fungus in the brain of a patient with Alzheimer’s Disease and adds a summary table of toxic and immunosuppressive effects of important mycotoxins, including deoxynivalenol (DON) and patulin, found in apples.

A case study of a woman with chronic UTIs and tail-bone infections is included with photos of the mold-contaminated home. More photos of contaminated food follow, along with a world map and extensive data showing the US is by no means a low-mycotoxin area. Dr. Filidei includes information for mycotoxin management products to prevent and treat illness in farm animals, pointing out that such products are not routinely offered for humans. 

Dr. Filidei also discusses differences in Shoemaker’s vs Brewer’s approach to fungal disease treatment, noting and emphasizing that Brewer analyzes mycotoxins in urine as well as spores in nasal swab tests, while Shoemaker relies on immune system markers. Dr. Filidei explains ERMI testing and PCR testing since removal of mold exposure is crucial. Binders for mold detox of the body is mentioned, along with glutathione, phospholipids and sauna. He winds up his presentation with a reminder that we do not live in a sterile world.

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How Candida Can Cause an Autoimmune Response and Ways to Neutralize the Fungus

Kurt Woeller, DO

SUMMARY

Candida albicans is the most commonly encountered human fungal pathogen and is frequently found on the digestive tract. Host defense against Candida is dependent upon a finely tuned implementation of innate and adaptive immune responses, enabling the host to neutralize the invading fungus. Dr. Kurt Woeller explains how the Th1 and Th17 cells play an important role in defending the body against candida.


Overview of the Immune System, Mucosal Pathogen Detection, and Inflammation Activation

The complexity of the immune system comes from its multiple cell types and overlapping functions that coordinate in their activity to recognize, combat, and initiate acute and prolonged defenses against different pathogens. The main categories of the immune system are referred to as innate and adaptive, aka acquired. The physical barriers which include the skin and mucus membranes are often described as part of innate immunity:

  • The physical barriers provide a protective defense against opportunistic and invading pathogens. If one of these barriers are breached, either from injury or inflammation, immune chemicals are produced to stop the infection. If this is not successful, then more specific innate immune cells such as monocytes are activated.

  • The innate immune system includes granulocytes like basophils, neutrophils, and eosinophils, as well as other specialized cells such as monocytes and macrophages. These innate immune cells are not intrinsically affected by prior antigen exposure and typically respond similarly with each new encounter.

  • The adaptive immune system, aka acquired immune system, is highly specialized to react to various pathogens. This includes the B-cell and T-cell lymphocytes. Adaptive immunity has an important immune memory capacity for pathogens of previous exposure.

Neutrophils and monocytes play an important role in innate immunity in the early stages of infection and injury. Macrophages, known as “big eaters,” are derived from circulating monocytes, and are critical for engulfing antigen which has first been recognized and processed by tissue infiltrating neutrophils. For simplicity, the focus here will be on the relationship between neutrophils and macrophages in a process of apoptotic neutrophil activation for macrophage engulfment.

When a bacteria or fungus invades a tissue such as the mucosal lining of the digestive system there is a flood of immune chemicals, i.e., cytokines and chemokines, released that signal circulating neutrophils to the site of activity. The end goal of this reaction is to destroy the invading pathogen. After the neutrophil has neutralized the pathogen, it transforms into an apoptotic neutrophil. This neutrophil form needs to be quickly cleared from the tissue before its breaks down and causes more tissue damage through release of its enzyme granules. The macrophage that is residing in the same tissue area is called into action to engulf (“eat”) the apoptotic neutrophil and then clear it through the locally draining lymph system. If this process does not occur in a timely fashion, the apoptotic neutrophil will degrade, release its toxic granules, and cause more tissue inflammation.


PRR and PAMP

Another important aspect of innate immunity is its ability to communicate with the adaptive arm of the immune system for a systemic and more comprehensive response. This occurs, in part, through pattern recognition receptors (PRR) and pathogen associated molecular patterns (PAMP).

The immune system is linked to various tissue receptors such as those in the gastrointestinal tract containing pattern recognition receptors. Each PRR is unique to a specific pathogen associated molecular pattern. Candida contains various PAMPs unique to its cellular structure, particularly within its complex membrane layers. For example, β-glucan, part of the candida cell membrane, is a type of PAMP that our PRRs can recognize. Candida will attempt to shield the β-glucan PAMP from the host immune surveillance system. When a fungal organism such as candida contacts the epithelial surface there are various PAMPs recognizable by host cell PRRs. Uniquely, candida interacting with the epithelial cell also triggers a series of behavioral changes within the candida organism to become invasive. The PRR-PAMP interaction is crucial with regards to immune recognition and action against a pathogen.

Dendritic Cells and Antigen Presentation

The innate immune system has additional cells called antigen presenting cells (APC). These cells relay information about a specific PAMP to the adaptive immune system. Specific APCs known as dendritic cells (DC) communicate with naïve T-cells to bring into action adaptive immune activity. This interaction between the DC and naïve T-cells induces various other T-cell types, including T-helper cells (CD4) such as Th1 and Th2, and cytotoxic T-cells (CD8). Two additional T-cell types called Th17, and T-regulatory (Treg) cells are important with regards to this discussion about candida and immune activation.  


Candida, Autoimmunity, and Autoinflammation

Autoinflammation is inflammation that occurs as a result of an autoimmune reaction. Autoimmunity is a condition that happens when the immune system attacks self-tissue. Rheumatoid arthritis and Chron’s disease are two types of autoimmune diseases where components of the immune system attack the joints and digestive system tissues, respectively, causing autoinflammation. Candida, in some cases, can be a trigger for autoimmune and subsequently autoinflammation.


T-Cell Immunity Plays Pivotal Role Fighting Candida

T-cells are part of the adaptive immune system. They play an important role in immune surveillance of both intracellular and extracellular pathogens, as well as immune tolerance. Here is a brief description of the actions of Th1, Th2, Th17, and Treg cells:

  • Th1 cells are directed towards intracellular pathogens such as viruses. For many years imbalances in Th1 cells levels or its regulation were felt to play a major role in autoimmune reactions. This was the case until Th17 cells were discovered.

  • Th2 cells are directed towards extracellular parasites and can be involved in allergy, asthma, and similar conditions.

  • Th17 cells are directed towards extracellular bacteria and fungus. They are now recognized to play a significant role in autoimmunity. Th17 cells are important for mucosal reactivity against fungus, e.g., Candida albicans.

  • Treg (T-regulatory) cells are regulators of overall immune responses, immune tolerance (to aid against immune attack against self-tissue), and homeostasis.

 

The Dance of T-Cells

The relationship between these T-cells is a complicated dance coordinated by various cytokines such as TGF-β, INF-α, and IL-6, as well as cell membrane receptors, second messenger reactions, and induction of genetic influencing transcription factors which influence protein production. As a general overview as it relates to candida and autoimmunity, the following is key information:

  • Increased Th17 cells producing IL-17 against candida can have a suppressive effect on Treg.

  • Decreased Treg can lead to reduced immune tolerance

  • Reduced immune tolerance increases the potential for autoimmune reactions

  • Reduced Treg decreases its influence on Th1 and Th2 which may also lead to increased activity of these T-cells in response to other existing pathogens.

  • Non-regulated immune activity of Th1, Th2, and Th17 in various tissues can lead to increased inflammation causing tissue destruction and cellular degradation.

  • Increased cellular degradation can lead to cellular structure exposure which can increase self-antigen immune recognition and drive autoimmunity.

Although there is always more to learn about the immune system and means of intervention. The next short section are some basic strategies which can be implemented for improved health, digestive function, and reduced potential for candidiasis triggering of autoimmunity.


Basic Strategies for Reducing Gastrointestinal Candida and Potential Mucosal Immune Activation

The following is a short list and descriptions of things that can be helpful in improving digestive system health, microbiome diversity, and eliminating/reducing opportunistic candida:

  • Microbiome diversity can be greatly enhanced through a high plant-based diet, fiber, and the use multi-strain probiotics. The improved microbiome diversity aids in pathogen reduction, mucosal barrier integrity, and reduced capacity for fungal overgrowth.  

  • The mucosal immune function helps to maintain optimal signaling between the mucosal immune mechanisms and innate and adaptive immune reactivity. Multi-strain probiotics, i.e., lactobacillus and bifidobacteria species, secretory IgA (SIgA) stimulators such as colostrum, Saccharomyces boulardii (which helps combat opportunistic candida and promotes SIgA production), can all be helpful.

  • Elimination or reduction of opportunistic pathogens through antimicrobial support, including individual or combination botanicals.

  • Elimination of gut mold colonization and mycotoxins

  • Elimination or reduction of environmental chemicals known to alter immune and gut function.

  • Incorporating omega-3 fatty acids (DHA & EPA), resveratrol, and curcumin to aide in inflammation control and oxidative stress.  

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References
  1. Candidiasis. Fungal Diseases. United States: Centers for Disease Control and Prevention. 13 November 2019. 
  2. Candidiasis. cdc.gov. February 13, 2014. Archived from the original on 29 December 2014. 
  3. Cottier F, Hall R. Face/Off: The Interchangeable Side of Candida albicans. 2000. Frontiers in Cellular and Infection Microbiology. 
  4. Roe K. How major fungal infections can initiate severe autoimmune diseases. 2021. Microbial Pathogenesis. Science Direct. 
  5. Nydiaris, H.S., et.al. Th17 Cells in Immunity to Candida albicans. 2012. Cell Host & Microbe Review. 
  6. Peter J. Delves, Seamus J. Martin, Dennis R. Burton, Ivan M. Roitt. Roitt’s Essential Immunology 13th. 2017. Wiley-Blackwell Publishing. 

Identifying and Treating Mold Toxin Induced Illness with MycoTOX Profile

SUMMARY:

In this presentation, James Neuenschwander, M.D., reviews some tell-tale signs of mold illness. He discusses the mechanisms by which mold toxins make patients ill and how a MycoTOX Profile helps identify these factors. Dr. Neuenschwander also provides practical protocols to remove patient barriers to healing of those suffering from mold or chronic illnesses.  

Before outlining a practical approach to treating mold illness patients, James Neuenschwander, M.D. provides a step-by-step description of the cellular response to toxins. The health information we consume frequently refers to “toxins” and “toxicity” without explaining how cellular processes are altered by toxic compounds. These cellular responses to toxins can manifest as the myriad and often baffling symptoms that chronic patients report.

He begins with the cell danger response (CDR), which triggers a cascade of cellular responses that may result in recycling of organelles or end in apoptosis of the cell itself. Apoptosis or “programmed cell death” is a normal process of growth and development, as well as a defense against pathogens. In a healthy state, cells are replaced, differentiated, and reconnected with neighboring cells.

Disease develops when the cellular healing process gets stuck; this can occur when mold and mycotoxin exposure is ongoing. Dr. Neuenschwander points out that if the host is sick, the host microbiome will also be out of balance and show signs of dysbiosis.

The full presentation includes the role of mitochondria, thought of primarily as energy producers, but which are very involved in the cellular response to stress. The presence of ATP outside the cell is part of cellular danger signaling, along with the appearance of various caspase enzymes at several points in the apoptosis process. The cell resorts to aerobic glycolysis, oxidative stress and glutamate level increase, and glutathione is diverted, vitamin D production drops, and methylation reactions are impaired.  Eventually, thyroid function is thrown off, and histamine increases. Patients with a chronic toxic load may develop MCAS and other indications of immune upregulation.

Dr. Neuenschwander mentions the myriad patient symptoms that can result from toxic processes instigated by mycotoxin exposure: psychiatric and cognitive symptoms, any chronic syndrome, respiratory symptoms, as well as POTS and other vagal symptoms. He uses Organic Acid Test (OAT) results as well as MycoTOX Profile results to illustrate possible responses to mycotoxins such as trichothecenes, aflatoxins, zearalenone, and ochratoxins. He also discusses the utility of specific immune and neurological testing.

An individual patient workup is included in this presentation and emphasis is placed on removal of mycotoxin exposure as determined by environmental testing. Food can also be a source of mycotoxins, particularly ochratoxin for which digestive binders are useful. Dr. Neuenschwander points out that unsprayed, organic food can often have higher mold content. He notes that the sickest patients have both mold colonization and an upregulated immune response to mycotoxin exposure and notes when antifungal treatment is called for.

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Before & After Organic Acids Tests Reveal Patient Progress Recovering from Grief & Mold

Summary

Functional medicine tests help practitioners learn what's affecting their patients at a cellular level. Amy Petrarca, RN, shares the before and after Organic Acids Test reports, six months apart, that were pivotal in her treatment of a patient suffering from grief, Polycythemia Vera, mold exposure, and joint pain.


Sometimes hidden ailments not uncovered by traditional physicians can only be revealed by tried and true tests such as the Organic Acids Test (OAT) and a comprehensive stool analysis.

After years of caregiving for her father, Lori’s emotional, physical, and spiritual life had all but flatlined. When her father passed away, Lori decided to seek help for a new and threatening diagnosis of Polycythemia Vera, which she found terrifying. Her current clinical symptoms at that time included anxiety, depression, poor concentration, fatigue, joint pain, and decreased appetite.

One of Lori’s best friends referred her to work with a functional medicine provider, Amy Petrarca, MS, RN, L Ac, Dipl. OM, IFMCP, owner of BiaoHealth in San Francisco, California.

Lori was hopeful that Petrarca’s 25 years of experience in emergency nursing and more than 10 years of experience treating patients with functional medicine would be the right blend of experience to assist her with moving forward.

During their initial consult, Petrarca learned that Lori was grief stricken, depressed, and struggling with numerous imbalances including profuse itching and ocular migraines.  She also had a history of kidney stones.

Lori shared her CBC bloodwork with Petrarca, which revealed elevated RBC and elevated Platelets – consistent with the diagnosis of Polycythemia Vera (PV), which is typically treated with Hydroxyurea, an oral chemotherapy agent – a medication that at the age of 65 terrified Lori.

A Battery of Diagnostics Reveal Needed Answers

Initial test report, click to view

To gather more data, Petrarca ordered a Comprehensive Stool Analysis, Organic Acid Test, and Advanced Lipid Panel. The below sample reports shows what the OAT revealed to Petrarca initially and during a six-month follow-up.

Lori’s intake OAT revealed yeast, fungal, bacterial issues, specifically marker 54 showed evidence that yeast and mold were thriving inside her body. The OAT also showed indications of microbial and cellular stress to the mitochondria and high oxalates.

Lori worried that the higher level of oxalates on page three of her OAT may lead to future kidney stones and was concerned about the implications.


Treatment Protocol

Petrarca focused on the core modifiable lifestyle variables at the bottom of the IFM MATRIX, which include stress, sleep/restoration, nutrition, relationships, and exercise/movement.

Petrarca then advised Lori to begin focusing on quality rest and relationships to assist her mind, body and spirit during the grieving process. Fortunately, Lori was also starting work with a mental health therapist to assist with these goals. Petrarca helped Lori support her health through leveraging the MATRIX – which included supplements to repair her gut, and support mitochondria to help her regain energy because Lori’s current diet was insufficient in nutrients as demonstrated in the OAT findings.

To help Lori mend emotionally, Petrarca also encouraged her to spend as much time as possible with supportive relationships in her life, including friends, her dog, and riding her horses and encouraged Lori to continue building a new wellness treatment team.

At the turn of the year, Lori was able to leave her primary health care doctor at Kaiser, and initiate care with a provider who she could choose that accepts Medicare patients.

Petrarca booked a scheduled clinical consultation with Jasmyne Brown, ND of GPL to collaborate on the initial and follow-up OAT findings.

During consultation with the patient where the initial OAT findings were revealed, Petrarca learned that Lori’s house was built over a creek and had cabinets that could be damp or moldy.

Here were Petrarca’s initial recommendations:

  • Please continue with all previously recommended supplementation to date.

  • OrthoSpore by Ortho Molecular – 1 capsule once per day.

  • Acetyl-L-Carnitine – Lori mentioned that she can receive this as an injectable. If you cannot receive injectable – and/or you decide to go with the oral route, please alert me – and I can help you with a recommendation.

  • Please discontinue Buffered Vitamin C for now.

  • Please consider reading into and investigating mold as a major contributor to your situation. You could hire a mold inspector. Brown mentioned this resource: https://www.namri.org/index.php

  • It is also possible to consider the MycoTOX Profile by Great Plains to do a “deeper-dive” into the mold picture, if you wish. Please fill out an MSQ now and then periodically, so we can monitor your progress.

 

6 Months Later, Lower Oxalates

6-month follow up, click to view

After six months of therapy and functional medicine protocol adherence, Lori felt substantially better. She had stopped eating packaged food and started preparing meals with fresh vegetables. She had started remodeling her kitchen and finally was therapeutic on the Hydroxyurea pharmaceutical, after her fears and anxiety had dissipated – with the support of her new medical team.

Lori’s second OAT test revealed that her Oxalates had fallen from 105 to 86 (Marker 21). Her mitochondria markers had returned to normal range and her hydroxmethyl-2 furoic (Marker 2) had dropped from 46 to 3.5, suggesting that the yeast and fungal colonization was likely no longer an issue.

Thanks to the dedication of a new treatment team and willingness of a patient to trust, test and heal through lifestyle changes and compliance, Lori is whole again.

 

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Mold and Alzheimer’s: An Unacknowledged Pandemic

Quick Glance:

  • Mycotoxins participate in cellular damage during the emergence of complex chronic diseases such as Alzheimer's Disease.

  • Alzheimer’s Disease begins in the patient decades before it can be observed in behavior or in the standard tests.

  • Dale Bredesen, M.D. lists 36 contributors to Alzheimer’s Disease including pathogens such as MARCoNs, from staph bacteria, and mycotoxins, as well as insulin resistance and high homocysteine

In the presentation Mold and Alzheimer’s: An Unacknowledged Pandemic, Dale Bredesen, M.D., explains how mycotoxins participate in cellular damage during the emergence of complex chronic diseases such as Alzheimer's. Symptoms that seem specific to mycotoxin-associated Alzheimer’s include a negative Apo-E(4), low GSH, Zn, and triglycerides as well as chronic headache and/or sinusitis.  

Dr. Bredesen dives deep into the cellular processes underlying the development of Alzheimer’s, emphasizing that the disease process begins in the patient decades before it can be observed in behavior or in the standard tests. He also points out that the various drug monotherapies for Alzheimer’s have only marginally slowed the degenerative process and lists 36 contributors to Alzheimer’s development and six subtypes of the disease.  

In Mold and Alzheimer’s: An Unacknowledged Pandemic. The lecture includes information from his Journal of Alzheimer's Disease publication Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project.

These contributors include pathogens such as MARCoNs, from staph bacteria, and mycotoxins, as well as insulin resistance and high homocysteine. Such wide variability of disease triggers requires personalized treatment plans. 

This lecture provides a blow-by-blow description of cellular defense, cellular damage, and the final apoptosis of damaged cells. The role of mycotoxins in damaging cells and their interaction with the immune system and in causing oxidative damage are discussed. The cellular disease progression begins with the amyloid precursor proteins and includes variables such as sufficiency of blood flow, presence of sleep apnea, and hippocampal and gray matter volume. 

Dr. Bredesen describes the struggle getting IRB (Institutional Review Board) approval for studies targeting more than one variable in the development of Alzheimer’s. The first study was focused on identifying the contributors to development of Alzheimer’s in various patients.  

When Dr. Bredesen first introduced the studies in 2012, he included brief case reports, including Patient Zero, who made a substantial recovery over a decade. Evaluation of improvement includes CNS-VS (vital signs), the MoCA (Montreal Cognitive Assessment), AQ-20/21 cognitive questionnaires for patient partners, and MRIs.  

Alzheimer’s Treatment and Proof of Concept 

The recently completed Precision Medicine Trial (proof-of-concept on multi-pronged treatments) showed substantial reduction in cognitive decline in most patients, as well as improvements in brain volume measurements. The research group has now moved on to conducting a larger trial.  

Treatment protocols include maximizing energetics (ketones, glucose), increasing insulin sensitivity, providing nutrient/hormonal (trophic) support, lowering inflammation, reducing pathogens and toxins, and, finally, reducing amyloid-beta itself. Energetics (supporting mitochondrial function with adequate fuels) and reduction of inflammatory mediators are as critical as reducing toxins for reversal of decline related to Alzheimer’s.  

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Workshop Q+A Part 2 - Mitochondria and Toxins

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

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


Joseph Pizzorno, N.D.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Elena Villanueva, D.C.

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

 

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

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

Q: What is your glyphosate protocol? 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A: Yes, those plus the environmental toxins and Glyphosate

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

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

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

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


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

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

Registration includes:

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

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

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

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

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

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

Workshop Q+A Part 1 - Mitochondria and Toxins

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

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


Kurt Woeller, D.O.

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

Q: How much more is covered in your Advanced OAT Mastery Course?

A: We go over every marker on the Organic Acids Test from Great Plains, as well as certain other markers commonly seen on other OATs.

Q: Do you ever delay addressing the bacterial/fungal dysbiosis to gently detox the patient first so that the removal of the biofilm is more effective and is only done once?

A: Yes, this can be done for some people.

Q: I have a patient who gets recurrent vaginal yeast infections monthly. She is told by her gynecologist that it’s hormonal. Could it be from a yeast/mold issue within the gut and environment? Should I run an Organic Acids Test on her?

A: Absolutely run an OAT.

Q: Do you typically avoid fungus plants in mold/mycotoxin patients? Do you use saccharomyces boulardii?

A: I use this from time to time. It can be helpful overall, but some people are sensitive to it.

Q: If the test shows candida or mold does that mean it is currently active?

A: On the OAT its active.  

Q: Or could it be showing that you did at one time have candida and there are antibodies or organic acids still present?

A: The IgG Food MAP can indicate past problems, but the OAT is current and active.

Q: Once you see the clostridia markers high on the OAT, do you run a stool test to confirm Clostridia presence before treating?

A: No, only unless they have significant bowel problems and want to rule out C. difficile with toxins and A and B.

Q: Polyethylene glycol is used widely in nursing homes for older people with constipation. It is also a component in some drugs and foods, how much of a health risk is this?

A: It’s a risk and certainly not ideal to use. There are many other options for constipation in the natural medicine world worth looking into.

Q: I understand, from other information I've viewed, that the OAT test can be hit-or-miss for oxalates because of cyclical excretion. Are you familiar with this phenomenon or its implications?

A: Yes. It’s called dumping. However, most of the time it is picked up on the OAT.

Q: For patients taking high doses of quercetin ascorbate (i.e. 2-8g/day) for mast cell hyperactivity, do you think there is a high probability of oxalate issues from such high doses of Vitamin C? Would a downward taper be a good idea, to avoid possible dumping when coming off it again?

A: Yes. Oxalates can manifest through this. For people who are very sensitive this would be a good idea. Not necessary for many people though.

Q: I've heard of good results with AURO topical glutathione. Your thoughts? Have you used it? vs Tri Fortify?

A: I have not used it.

Q: Would ADD medication affect the HVA value on the OAT?

A: Anything that drives up dopamine can affect the HVA value.

Q: What D-lactic free probiotics do you use/how do you know if the probiotic is D-lactic free?

A: It has to do with the type of bacteria in the probiotic. You will need to do some research on which bacteria produce D-lactic.

Q: Which marker on the OAT could indicate a coinfection of virus interfering with mitochondria function or getting damaged inducing the cell danger response?

A: There is no specific marker for viruses and no markers per se specific to the CDR.

Q: Do you have any thoughts or preferences on the form of CoQ10 to use, ie. Ubiquinol or Ubiquinone?

A: Ubiquinol.

Q: Do you have any thoughts on supplementing with Calcium Citrate for Oxalates and K2 amounts to address uptake? Does it matter if the Calcium is getting bound with the oxalates?

A: Vitamin K helps with bone mineralization so less availability for oxalate binding. It is a good idea to use too.

Q: Do molds that are known to be toxic that show up on the OAT not always produce toxins that would show up on the MycoTOX Profile?

A: Correct. There may not always be mycotoxins present, but they often are.

Q: Is Gliotoxin just produced by fungus or also candida?

A: There seems to be controversy around it, but it appears more likely that Candida can produce it too.

Q: Do you avoid using saccharomyces boulardii as an antifungal in those with fungal or mold related illness due to it being in that family of organisms, or do you find it still beneficial?

A: I do not use SB a lot. It can be helpful for some people, but watch out for reactions in people with inflammatory bowel disease.

Q: Can colonized molds create mycotoxins?

A: Yes

Q: Does the nephrotoxicity associated with ochratoxin, etc, tend to reverse once the detoxification has been done? 

A: It should if the problem has been more of a recent onset.

Q: Any experience using modified citrus pectin?

A: Some. It is another type of binder.

Q: At what level of a positive MycoTOX Profile do you treat mycotoxins? 

A: Any level outside the green. If its in the green than I mostly leave it alone unless the patient has known exposure and there is a high suspicion of mold/mycotoxin exposure.


James Greenblatt, M.D.

A pioneer in the field of integrative medicine, James M. Greenblatt, M.D., has treated patients since 1988. After receiving his medical degree and completing his psychiatry residency at George Washington University, Dr. Greenblatt completed a fellowship in child and adolescent psychiatry at Johns Hopkins Medical School. He currently serves as the Chief Medical Officer at Walden Behavioral Care in Waltham, MA and serves as an Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College Geisel School of Medicine. Dr. Greenblatt has lectured internationally on the scientific evidence for nutritional interventions in psychiatry and mental illness.  He is the author of seven books, including Finally Focused: The Breakthrough Natural Treatment Plan for ADHD. He is the founder of Psychiatry Redefined, an educational platform dedicated to the transformation of psychiatry, which offers online CME-approved courses, webinars, and fellowships for professionals about functional and integrative medicine for mental illness. jgresources@gmail.com www.PsychiatryRedefined.org www.JamesGreenblattMD.com

Q: Do you think that the safety profile differs much between lithium carbonate, lithium citrate, and lithium orotate or are they all primarily dose-dependent?

A: I believe that the side effect profile is most often due to the amount of elemental lithium not the carrier model (i.e., Carbonate, citrate, or orotate). It is important to remember 150 mg of lithium carbonate only has 28 mg of elemental lithium.

Q: For patients with brain fog associated with long COVID, have you found Lithium helpful? Any protocols specific for long COVID?

A: Other than “the basics,” the most effective supportive supplements for long-haul COVID involve the use of lithium and OPC’s. Lithium (Lithium (Orotate) 1mg | Pure | Doctors and Patients Access (pureencapsulationspro.com) and Lithium (Orotate) 5mg | Pure | Doctors and Patients Access (pureencapsulationspro.com)) is recommended for patients with starting dose at 1-2 mg and titrate up if tolerated or needed to 5-10 mg. The OPC product is usually 2-3 times per day and we use the Curcumasorbmind (Cognitive Support Supplement* | Pure | Doctors and Patients Access (pureencapsulationspro.com)

Q: What kind of doses of lithium (or lithium levels) show the greatest effect on inflammation?

A: Using nutritional lithium for irritability, prevention of dementia, and neuroinflammation, we often use dosages that do not result in blood levels. There is very little research correlating blood levels with efficacy on any disorder except for bipolar disorder.

Q: It looks like some studies were done in the 90s showing “no effect” in OCD, but theoretically lowering neuro-inflammation would improve OCD. Have you seen any benefit of low dose lithium on PANS/PANDAS/OCD? How long would you trial it for in a pediatric patient before concluding it has no effect on them?

A: I have seen tremendous benefit in patients with PANS/PANDAS/OCD. I think the problem in our field is that we oversimplify our treatment response and simply assume every PANS/PANDAS/OCD patient with respond. As you know, there are multiple genetic and environmental factors that contribute to these illnesses and the exacerbation of symptoms. Lithium often plays a critical stabilizing role but without adequate testing and targeted treatments for the infection and other drivers of inflammation, lithium by itself is usually not enough.

Q: Is low lithium excretion on the urinary essential elements test equivalent to low lithium on hair mineral analysis?

A: I am not familiar with urine tests and am not convinced of utility of urine tests for assessment of lithium status. I know a few labs have developed these very quickly. I have not yet found them useful in clinical practice.

Q: Who offers lower than 5 mg dose in supplement form for Lithium?

A: Pure Encapsulations offers a 1 mg lithium orotate.

Q: What is the appropriate dosage for a suicidal person in an emergency and how soon will it calm the patient?

A: Any patient that is suicidal should be in an emergency room and low dose lithium is not an agent that is used for acute suicidal behavior.

Q: With the 1-2mg dosing in irritable children, is that 1-2mg of Lithium Orotate, or elemental?

A: Both. They should be the same. It should be elemental lithium, most commonly found as lithium orotate. For younger children under 6 years of age, I would recommend to start with 500 micrograms.

Q: How does lithium impact the Orotic marker on the OAT?

A: Lithium orotate simply will raise Orotic acid.

Q: Would there be any value in administering Lithium via IV?

A: I have not investigated IV lithium and, since lithium is so easily absorbed, it likely won’t be significantly advantageous.

Q: Can stress from living in a low social economic environment deplete lithium and require higher need?

A: Stress is unlikely to deplete lithium directly but all the related inflammatory markers and disruption in neurotransmitter utilization will likely require higher lithium.

Q: What are the parameters for dosing carbonate, as well as orotate in adults and then for children?

A: I can only share 150 mg lithium carbonate and 28 mg of lithium orotate. These should be dosed according to a physician’s clinical experience based on symptoms and underling diagnoses.

Q: What is the dosage range of lithium for generalized anxiety disorder?

A: I would recommend sticking to lower doses 1-5 mg.

Q: Which SNPs are related to higher lithium needs?

A: There are SNPs associated with lithium but not well understood. The only SNP that I consistently look at is BDNF.

Q: Would low dose lithium be acceptable for patient with Hashimoto’s and elevated levels of TSH when patient has Lithium deficiency?

A: I have utilized low doses of 2-5 mg with patients with thyroid disorder with good success, but this should be done carefully by monitoring thyroid function.

Q: Do you suggest Lithium carbonate or Lithium orotate with patient who is deficient?

A: Based on the dose, I usually use 1-20 mg lithium orotate. If I am looking for 30 mg or higher, I use lithium carbonate.

Q: What is dosage for adult female 115 lbs.?

A: Lithium is not dosed per body weight. We always start with 1-2 mg and titrate as we monitor symptoms and possible side effects.

Q: Would a thyme supplement be an alternative for lithium micro dosing?

A: I have not found that for any patients with clinical symptoms that herbal supplementation is sufficient.


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

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

Registration includes:

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

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

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

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

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

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

Diagnosing Molds, Mycotoxins, and Things that Go Bump in the Night

SUMMARY

Mold is found in the environment and grows in water-damaged buildings. When exposed to mold and mycotoxins, patients will have no reaction, an allergic reaction, or a toxic reaction. Common toxic effects from mycotoxins include their ability to be neurotoxic, hepatotoxic, nephrotoxic, GI irritants, immune suppressant and modulating, skin irritants, hematologic toxins, carcinogenic, cardiovascular toxins, endocrine toxins, etc. This post discusses mold and mycotoxin exposure and recommends how a combination of diagnostic tools like the the Organic Acids Test, MycoTOX Profile, and the Mold IgE Allergy Test can guide your treatment.

By: Jasmyne Brown, N.D.

Functional medicine practitioners are not only healers but investigators of the root cause of runny eyes and noses. It’s our job to determine if a person’s allergic symptoms stem from seasonal triggers like grass and pollen or environmental triggers such as pet dander, mold, or mycotoxins. 

Mold and its mycotoxins seem to be ever present in the lives and sometimes the bodies of our clients. For some practitioners, mold and mycotoxins exposure and treatment may not have been taught during their training. So, what is mold exactly? Is it a yeast, a fungus or something completely different?  


Fungis, Molds, Yeasts, and Microorganisms that Cause Dysfunction 

In the animal kingdom, mold falls under the classification of fungi. These are eukaryotic microorganisms(3). Mold exists here along with yeasts and mushrooms (3). So indeed, it is a fungus making it closely related to yeasts like Candida. Unlike yeast, mold does not reproduce by budding. It reproduces by formation of multicellular hyphae via apical extension(4,6).  

Mold is found ubiquitously in the environment and found to grow in water-damaged buildings. Mold can contaminate foods that must be dried and stored, and mold is used in foods like in the production of cheese.  

Source: World Health Organization and Mycotoxins. Clinical microbiology reviews. Bennett, J. W., & Klich, M 

We’re constantly exposed to mold when we’re outdoors even though we can’t see it. Our forecasters tell us it’s there and how much of it is in the air during the evening weather forecasts. 

On days when the count is moderate to severe, we can see a rise in allergy-type symptoms in individuals with allergies.  

Another common source of mold exposure is from our diet. Certain foods are more prone to mold growth due to the way they are stored and/or grown. There are checks and balances that limit the number of mold/mycotoxins that are allowable before it is sent to market. This limits our exposure from food unless we overindulge in these foods. Common foods include coffee, grains, corn, dairy, wine, etc. Learn more about mold and mycotoxins in food here.  

Mold decomposes dead organic matter so it can grow on wood, the paper facing on gypsum board (drywall) and other materials made from wood. To grow, mold requires oxygen, heat and moisture. Due to this, mold commonly contaminates water damaged buildings. Materials often found to be contaminated include wallpaper, gypsum board, adhesives, pastes, and paints(1,5).  

Although it doesn't grow on non-organic matter like concrete and glass and metal, the dirt on these materials when in the right environment will allow for the growth of mold (1). This is where people get overly exposed to mold and its mycotoxins. The most common are Penicillium chrysogenum, Aspergillus versicolor, and Chaetomium globosum (1).  

When we get exposed to mold, we’ll either have no reaction, an allergic reaction, or a toxic reaction. In certain cases, we’ll experience both allergies and toxicity. So, what's the difference between an allergy and toxicity?   

How the Body Fights Back From Mold Exposure 

When an allergy is present, exposure to the offending substance or antigen triggers a response. This response is made by the immune system. In a true allergic situation, immunoglobulin E (IgE) antibodies are produced by the body. These IgE antibodies attack the antigen, in this case mold, and bind to cells like mast cells and basophils(7). This then triggers the release of chemical mediators like histamine. These chemicals are what induce the symptoms associated with allergies.   

Allergic reactions can also happen to common household molds rather than just molds that produce mycotoxins in water damaged spaces. Commonly people experience itchy watery eyes, sneezing, coughing, urticaria, sinusitis, asthma and wheezing, etc.(7) In sensitive individuals, whenever exposed to the antigen these symptoms will arise.  

During peak mold months in the summer and fall, you may be one of the millions of consumers combing your local drugstore for over-the-counter allergy medications and nasal sprays to find any relief from common allergens like pollen, and mold. You might also watch the weather forecast to prepare for the air quality and level of mold spore spikes in the air.  If you’re unfortunate enough to live in a water-damaged building, you can expect to see a chronic persistence of these allergic type symptoms.  

When Mold Exposure Elevates to a Chronic Illness 

Mold toxicity is different from mold allergy. In a toxicity, there is an over exposure to toxic metabolites that are produced by mold organisms. Toxicity states do not require immune mediated responses to be harmful or to cause what is experienced by the affected party.  

Mold toxins are considered mycotoxins. These compounds have activities that are harmful to humans, animals, and even other microorganisms. Their toxic nature includes neurotoxicity, nephrotoxicity, hepatotoxicity, immune dysregulation and suppressive properties, GI toxicity, cardio toxicity, carcinogenic, hematologic toxins, endocrine toxins, and more (2, 8).  

Myotoxicity has been referred to as the great masquerader in some scientific circles as it can present in many ways for different individuals. Exposure and symptomatology associated with mycotoxins is known as mycotoxicosis(2). It can be acute with a rapid onset that is clearly a large toxicity, or chronic which is a longer-term low-level exposure that usually results in cancers and more irreversible symptoms(2). 

Myotoxicity differs from mold allergy due to the lack of an immune mediated response. The symptoms you may experience from toxins are due to the toxic nature that they already have. An allergy, on the other hand, is the body’s immunologic response mounted to protect us from a foreign substance. Symptoms arise due to the degranulation of mast cells and basophils and the release of chemicals like histamines(7).  

This release is what causes allergic-like symptoms. In a pure toxicity state, you would not experience allergy symptoms. Also, someone without allergies could still feel the effect of mycotoxin overload, but wouldn’t suffer from congestion, itchy watery eyes etc. during allergy season. At least not from mold.  

When people are going through a toxicity state they are often dealing with an active exposure. This exposure is less likely due to the outside air alone, but maybe experienced in high outdoor air exposure rates. During high mold spore count months (summer and fall) those who compost, garden, forage, or do other activities in the soil, toxicity can be seen from these activities and situations(5).  

Though this is not what I commonly see. Water-damaged buildings and cars are the most common culprits for mold overexposure, in my experience. As said earlier, mold decomposes organic materials. Woods, wallpaper, and gypsum board are their fuel, due to the cellulose content, and happen to be extremely common building materials (1,5). When the mold is in ideal conditions it will grow in prominent levels and emit its toxic byproducts.  

Mold Affects Each Person Differently 

During large exposure levels toxicoses can occur. Various toxins can lead to different experiences, and individuality of people can lead to different manifestations. What does this mean? For example, you may have a stay-at-home mother and young child complaining of fatigue, anxiety, skin rash, ASD, GI issues etc., along with a partner and older child with no symptoms or mild fatigue or headache symptoms. Why is this?  

Usually, in these cases the mother and child spend an exponentially greater time in the moldy home than the older child and partner. As they may be going out of the home for work/school. There are also four different, yet similar, genetic make ups that allow for or do not allow for adequate detoxification and may make them more susceptible to the toxin’s effects.  

Situations also arise where the mold is concentrated in one person’s main living space that other family members do not frequent. Thus, increasing their exposure comparatively. All these factors are considered in mycotoxicosis. By understanding these differences and environmental spaces you can better pinpoint where the exposure is coming from.  

Common toxic effects from mycotoxins include their ability to be neurotoxic, hepatotoxic, nephrotoxic, GI irritants, immune suppressant and modulating, skin irritants, hematologic toxins, carcinogenic, cardiovascular toxins, endocrine toxins, etc. due to the wide range of effects and the endless toxic profile someone could present with, the manifestations that can occur are also endless and look different in each person (2). Because of this, looking into mold toxicity would be a good place to start or to rule out for someone with a chronic disease or a new onset of symptoms. 

Mold Exposure Diagnosis and Treatment 

Now that we understand the diverse ways mold can affect our bodies, are they interconnected in disease states? Of course, they are. It is common to see an allergic patient who also presents with a chronic disease or a new onset of symptoms. You may be dealing with a mold exposed client.  

On the other hand, these two manifestations of mold exposure can happen independent of each other. An allergic person not living or working in water damage can just have allergy symptoms. They wouldn't also present with toxic symptoms. This would also be limited to certain seasons when outdoor mold is higher. These individuals would also have significant relief in their home since mold is not growing there.  

In someone without an immune reaction, they would present with strictly toxic symptoms like fatigue, anxiety, pain, dizziness, headaches, etc. These would not be relieved while in the home/workplace/car and they may see relief when away from the exposure for a time.  

When you have someone come to you and you are thinking that they may be dealing with a mold issue, a combination of diagnostic tests can guide your treatment. When I suspect mold exposure, I like running the Organic Acids Test, MycoTOX Profile, and the Mold IgE Allergy Test. These three test will clarify what type of exposure you are dealing with. Is it toxicosis, allergies, or both. A full comprehensive mold workup includes all three of these reports.  

With this information, you will have better insight on what tools are needed to help heal your client from their mold exposure. Overall, an overexposure to mold can lead to two different experiences: allergic response and/or toxicity. When we understand how our clients respond to mold, we can better support them in their healing. 

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


JASMYNE BROWN, N.D.

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


References  

  1. Andersen, B., Frisvad, J. C., Søndergaard, I., Rasmussen, I. S., & Larsen, L. S. (2011, June). Associations between fungal species and water-damaged building materials. Applied and environmental microbiology. Retrieved August 3, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131638/ 
  2. Bennett, J. W., & Klich, M. (2003, July). Mycotoxins. Clinical microbiology reviews. Retrieved August 3, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164220/ 
  3. Classification of animals: The complete guide. AZ Animals. (2022, February 19). Retrieved August 3, 2022, from https://a-z-animals.com/reference/animal-classification/ 
  4. Lakna. (2017, November 16). Difference between yeast and mold: Definition, structure, function, similarities. Pediaa.Com. Retrieved August 3, 2022, from https://pediaa.com/difference-between-yeast-and-mold/#:~:text=The%20main%20difference%20between%20yeast,of%20sexual%20or%20asexual%20spores. 
  5. Lstiburek, J., Brenna, T., & Yost, N. (2002, January 15). RR-0208: What you need to know about mold. Building Science Corporation. Retrieved August 3, 2022, from https://www.buildingscience.com/documents/reports/rr-0208-what-you-need-to-know-about-mold/view 
  6. McGinnis, M. R., & Tyring, S. K. (1996). Introduction to mycology - medical microbiology - NCBI bookshelf. National Library of Medicine. Retrieved August 3, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK8125/ 
  7. Sánchez, P., Vélez-del-Burgo, A., Suñén, E., Martínez, J., & Postigo, I. (2022, March 9). Fungal allergen and mold allergy diagnosis: Role and relevance of Alternaria alternata alt a 1 protein family. MDPI. Retrieved August 3, 2022, from https://www.mdpi.com/2309-608X/8/3/277/html 
  8. World Health Organization. (n.d.). Mycotoxins. World Health Organization. Retrieved August 3, 2022, from https://www.who.int/news-room/fact-sheets/detail/mycotoxins#:~:text=Mycotoxins%20are%20naturally%20occurring%20toxins,under%20warm%20and%20humid%20conditions.  

Kidney: The Often-Forgotten Part of Detoxification

Quick glance

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

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

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

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

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

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


How the Kidney Works

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

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

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

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

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


Eliminating Toxicants

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

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

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

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

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

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

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

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

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



Eliminating Chemical Toxicants

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

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

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

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

How to Support the Kidneys

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

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



Additional Recommendations

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

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

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

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

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

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

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

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

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

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Open an Account

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


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

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


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

When to Run an Organic Acids Test (OAT): An Essential Metabolic Profile

By Jasmyne Brown, ND

Since the creation of the Organic Acid Test, by William Shaw, PhD, many people have found answers to lingering health questions that could not otherwise be explained. To many seasoned and new practitioners, the wonders of the OAT have been known, but oftentimes practitioners still pose the question: When should I run an OAT?

This is a valid question as this profile can seem intimidating the first time you see it. With GPL-provided training and supportive consults, the OAT is a useful tool for any client. In some cases, you'll see a client with chronic disease that isn't well supported with traditional therapies. Or maybe you will come across a client who you feel stumped on, or you feel uncertain or where to start your investigation of the root cause of disease. In other cases, you may have someone just looking to prevent disease that runs in their family. In any case, the OAT will shed light on the health situation at hand. 

To begin, let's understand why we should run the OAT. Let's unpack its purpose and what information you will learn. At its core, the OAT is a metabolic profile that informs us about a wide range of body functions. Gastrointestinal fungal and bacterial overgrowth are assessed with specific Clostridia and mold biomarkers in the first section. Next oxalate formation and mitochondrial function are assessed. Then you get an understanding of neurotransmitter status. On page 4 of the OAT report, there is a comprehensive nutritional profile. Additionally, the indicators of detoxification section clue us into how well someone can handle their toxic burden.

With all this information from one urine sample, how could you not consider assessing this profile for most of your clients. For more information on these sections review 10 Reasons To Do an Organic Acids Test by Kurt Woeller, DO.

Again and again, we’re asked: What conditions are best supported by the OAT? The fortunate news is OAT is beneficial to help diagnose numerous conditions. Because this is a metabolic profile, the results will show you how the person’s body is responding on a metabolic level to any condition they are suffering from. Whether it be a grouping of mysterious symptoms, a confirmed diagnosis of some sort, or a normal life phase like menopause, the OAT guides you in diagnosing and treating a wide range of conditions. To narrow things down there are a few conditions we often see well supported by using this report:

  • Autism Spectrum Disorders

  • ADHD

  • Depression

  • Anxiety

  • Parkinson’s

  • Alzheimer’s

  • Cognitive decline

Generalized malaise and fatigue along with chronic pain are conditions for which people often seek support. 

In neurologic conditions like Parkinson’s disease, the Organic Acid Test has shown itself to be helpful repeatedly. When viewing the neurotransmitter section, keep your eye on number 35, the HVA/VMA ratio. This marker assesses the function of the Dopamine Beta Hydroxylase enzyme (DBH). This enzyme converts dopamine to norepinephrine/epinephrine.

Under hypo functioning states many neurologic conditions arise including Parkinson's disease (5). Genetic polymorphisms in this enzyme's functionality have been shown to contribute to the development of this diagnosis. DBH deficiency is also linked to Alzheimer’s, PTSD, ADHD, POTS, Depression, Autism (6), and schizophrenia (1). The presence of clostridia toxins in markers 15, 16, and 17 can also block DBH (6). Cases like this cause the same type of symptoms as the genetic disease. In relation to chronic pain, oxalates are highly implicated. Research has linked oxalates to vulvar pain syndrome as an irritant (4). Oxalate crystals also deposit in the joints and other tissues causing irritation and pain (3).

Autoimmune & Dermatological Conditions & the OAT

Other conditions that you can glean information from the Organic Acid Test include autoimmune conditions and dermatological complaints. I have seen various cases of eczema be healed as a result of information revealed in this profile. Often it was due to mold, candida, or other GI bacterial dysbiosis and overgrowth with poor detox abilities and nutritional deficiencies (2). One case showed elevated detox markers with no signs of mold or GI involvement. In this case the child was bathing in contaminated water by a toxin found on the GPL-TOX Profile. Marker 24 was elevated, and this led us to look at that report. Herpes virus recurrence was once a consequence of mold colonization found on the OAT. Hashimoto's thyroiditis and a case of autoimmune alopecia in a child were well supported with the use of the OAT. 

I have also seen a handful of multiple sclerosis and ALS cases. In these cases, various causes and contributing factors have been alluded to and concluded using the OAT. Sometimes mold was the culprit, other times clostridia was involved. In some cases, chemicals and metals were the cause along with mitochondrial impairment. The more we do the OAT in complex diagnoses like these, the more we can make new connections that may not have been available before.

The more you complete the OAT profile the more doors will be opened in the treatment and support of various conditions.

 

So, as you can see the Organic Acid Test isn't a test for only a handful of diagnoses and symptom pictures. It is a metabolic profile that helps us understand what is affecting the body and how we can metabolically respond. This helps us as practitioners to best support each client in their healing journey. 

Because the OAT is a metabolic profile, you don't have to limit its use to only those that are not feeling well. Oftentimes, people find themselves curious about how healthy they are. They ask themselves: is a healthy diet, exercise, supplements, and meditation helping my body to work better? Am I really doing all I can to prevent disease? On the other hand, you have individuals who don't necessarily incorporate healthy living habits and want to know where they stand. In some cases, you will have the client with an aged parent with a chronic disease and they want to understand what they can do to potentially prevent themselves from developing it. 

When circumstances like these presents themselves, it is a great idea to add an OAT. Even if this is the only test you run, the information is invaluable. In some cases, I have seen results from people with no health complaints that showed increased mold growth or mitochondrial distress. Cases like these have helped with the prevention of disease. People were feeling well enough to test and remediate their home, then to undergo the detox protocol without a whole gambit of unfavorable symptoms. These are the cases where preventative medicine thrives. We should all be aiming to encourage clients to be proactive in their health and to get these wellness checks regularly so we don't have to be reactive when disease arises. 

Other circumstances can sometimes, let's be honest, leave us feeling stuck as practitioners. After gathering all pertinent current and past medical history we find ourselves sometimes stumped. The person in front of us has a long history of many symptoms that can seem a mile, or two, long. This can be overwhelming, especially when they bring in completed traditional lab work that all reads normal or is well controlled on supplements or medication. Sometimes we ask ourselves, “Where do I start from here?” Often in these situations I find the OAT a great place to start. The way I describe the OAT is like a road map. This report will open new areas for you to stop and dig deeper. It will guide you in a direction you may have never thought to consider. Support also comes when it closes some doors that you've been considering or treating long term with little to no success. Profiling clients with the OAT gives you confirmation of your suspicions, new directions to consider, and an overall metabolic picture so you can support that person the way their body is asking to be supported. 

At the end of the day, or end of history taking, the Organic Acid Test should be on the forefront of your mind as a practitioner. Really any client should be offered to take this worthwhile test. From your chronic disease patient to your “I just want to stay healthy” patient everyone will benefit. If you still find yourself asking “When do I run the OAT?” Keep in mind neurologic disease, autoimmune disease, chronic fatigue, pain, and autistic communities.  In any case adding the OAT will be a benefit to anyone you offer it to. 

Order a Test or
Open an Account

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

 

JASMYNE BROWN, ND

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

 
References:
  1. Gonzalez-Lopez, E., & Vrana, K. E. (2019, October 15). Dopamine beta-hydroxylase and its genetic variants in human health and disease. Wiley Online Library. Retrieved June 24, 2022, from https://onlinelibrary.wiley.com/doi/full/10.1111/jnc.14893
  2. Hope, J. (2013, April 18). A review of the mechanism of injury and treatment approaches for illness resulting from exposure to water-damaged buildings, Mold, and Mycotoxins. The Scientific World Journal. Retrieved June 24, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654247/
  3. Lorenz, E. C., Michet, C. J., Milliner, D. S., & Lieske, J. C. (2013, July). Update on oxalate Crystal Disease. Current rheumatology reports. Retrieved June 24, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710657/
  4. R; B. M. S. S. E. H. J. (n.d.). Urinary oxalate excretion and its role in vulvar pain syndrome. American journal of obstetrics and gynecology. Retrieved June 24, 2022, from https://pubmed.ncbi.nlm.nih.gov/9322615/
  5. Shao, P., Yu, Y.-X., & Bao, J.-X. (2016, May 13). Association of dopamine beta-hydroxylase (DBH) polymorphisms with susceptibility to Parkinson’s disease. Medical science monitor: international medical journal of experimental and clinical research. Retrieved June 24, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915320/
  6. W; S. (n.d.). Elevated urinary glyphosate and clostridia metabolites with altered dopamine metabolism in triplets with autistic spectrum disorder or suspected seizure disorder: A case study. Integrative medicine (Encinitas, Calif.). Retrieved June 24, 2022, from https://pubmed.ncbi.nlm.nih.gov/28223908/#:~:text=Excessive%20dopamine%2C%20caused%20by%20inhibition,elements%20such%20as%20the%20neurofibrils.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Day 1 Q+A: Organic Acids

Kurt Woeller, DO

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

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

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


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

A: Very common


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

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


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

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



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

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


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

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


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

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

 

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

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


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

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


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

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


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

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


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

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


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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

Q: What are the problems with PCR stool testing?

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



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

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

Registration includes:

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

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

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

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

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

Common Parasites, Detection Methods, and Intervention Considerations

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

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

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

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

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

Blastocystis hominis

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

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

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

Cryptosporidium parvum

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

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

Dientamoeba fragilis

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

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

Entamoeba histolytica

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

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

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

Giardia lamblia

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

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


Detection Methods

Parasitic and Comprehensive Digestive Stool Analysis (CDSA)

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

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

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

Antigen Detection

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

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

Polymerase Chain Reaction (PCR)

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

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

Other Parasite Testing Methods

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

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

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

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


Intervention Options with Examples

Metronidazole (Flagyl)

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

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

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

Nitazoxanide (Alinia)

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

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

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

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

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

  • Alina oral suspension comes in 100mg/5ml

Botanicals

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

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

Black Walnut

Black Walnut

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

Bilberry

Bilberry

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

Goldenseal

Goldenseal

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

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

Oregano

Oregano

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

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

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

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

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


Kurt Woeller DO

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

References
  1. About parasites, Centers for Disease Control - https://www.cdc.gov/parasites/about.html
  2. About protozoa, Centers for Disease Control - https://www.cdc.gov/parasites/about.html
  3. Ectoparasites, malaria, Centers for Disease Control - https://www.cdc.gov/parasites/about.html
  4. Noël C, Dufernez F, Gerbod D, et al. Molecular Phylogenies of Blastocystis Isolates from Different Hosts: Implications for Genetic Diversity, Identification of Species, and Zoonosis. Journal of Clinical Microbiology, 2005. 43 (1): 348–55.
  5. Rostami, A.; Riahi, SM.; Haghighi, A.; Saber, V.; Armon, B.; Seyyedtabaei, SJ. The role of Blastocystis sp. and Dientamoeba fragilis in irritable bowel syndrome: a systematic review and meta-analysis. Parasitol Res, 2017. 116 (9): 2361–2371.
  6. United States Centers for Disease Control and Prevention. What are the symptoms of infection with Blastocystis? 2014.
  7. Centers for Disease Control and Prevention. Surveillance for Waterborne-Disease Outbreaks-United States, 1993-1994. 
  8. Windsor JJ, Macfarlane L.  Irritable bowel syndrome: the need to exclude Dientamoeba fragilis. Am. J. Trop. Med. Hyg, 1995. 72 (5): 501.
  9. Dientamoeba fragilis: A harmless commensal or a mild pathogen? Paediatr Child Health, 1998. 3 (2): 81–2.
  10. Rawat A, Singh P, Jyoti A, Kaushik S, Srivastava VK. Averting transmission: A pivotal target to manage amoebiasis. Chemical Biology & Drug Design, 2020. 96 (2): 731–744.
  11. Shirley DT, Farr L, Watanabe K, Moonah S. A Review of the Global Burden, New Diagnostics, and Current Therapeutics for Amebiasis. Open Forum Infectious Diseases, 2018.
  12. American Water Works Association. Waterborne Pathogens. American Water Works Association, 2006. ISBN 978-1-58321-403-9. 
  13. Meyer E.A.; Radulescu S. Giardia and Giardiasis. Advances in Parasitology, 1979. 17: 1–47.
  14. Parasites.org - https://www.parasites.org/stool-test-for-parasites/
  15. MedlinePlus. “Immune system and disorders" US National Institute of Medicine. 28 September 2020.
  16. Restif, Olivier; Reece, Sarah E.; Webster, Joanne P.; Brown, Sam P. (2013). "Life in cells, hosts, and vectors: Parasite evolution across scales". Infection, Genetics and Evolution. 13: 344–347.
  17. Tachibana, H., Kobayashi, S., Cheng, XJ. et al. “Differentiation of Entamoeba histolytica from E. dispar facilitated by monoclonal antibodies against a 150-kDa surface antigen.” Parasitol Res 83, 435–439 (1997).
  18. Saiki, R.; Gelfand, D.; Stoffel, S.; Scharf, S.; Higuchi, R.; Horn, G.; Mullis, K.; Erlich, H. “Primer-directed enzymatic amplification of DNA with a thermostable DNA polymerase.” 1988; Science. 239 (4839): 487–491. 
  19. K. Abbas, Abul; Lichtman, Andrew; Pillai, Shiv (2018). “Cellular and molecular immunology” (Ninth ed.). Philadelphia: Elsevier. p. 97.
  20. Krafts K, Hempelmann E, Oleksyn B (2011). "The color purple: from royalty to laboratory, with apologies to Malachowski". Biotech Histochem. 86 (1): 7–35.
  21. Metronidazole". The American Society of Health-System Pharmacists. Archived from the original on 6 September 2015. 
  22. McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. (March 2018). "Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)". Clinical Infectious Diseases. 66 (7): e1–e48.
  23. White CA (2004). "Nitazoxanide: a new broad spectrum antiparasitic agent". Expert Rev Anti Infect Ther. 2 (1): 43–9. doi:10.1586/14787210.2.1.43. PMID 15482170.
  24. Rossignol JF (October 2014). "Nitazoxanide: a first-in-class broad-spectrum antiviral agent". Antiviral Res. 110: 94–103.
  25. First Generic Drug Approvals". U.S. Food and Drug Administration (FDA). Retrieved 13 February 2021.
  26. Dama L.B.; Jadhav B.V. (1997). "Anthelmintic effect of Juglone on mature and Immature Hymenolepis nana in mice". Riv. Di Parassitol. 2: 301–302.
  27. Bilberry: Science and Safety | NCCIH". Nccih.nih.gov. Retrieved 2018-03-19.
  28. Puupponen-Pimiä R, Nohynek L, Alakomi H.-L, Oksman-Caldentey K.-M. Bioactive berry compounds-novel tools against human pathogens. Appl Microbiol Biotechnol. 2005a; 67:8–19.
  29. Anthony JP, Fyfe L, Stewart D, McDougall GJ, Smith HV. The effect of blueberry extracts onGiardia duodenalis viability and spontaneous excystation of Cryptosporidium parvum oocysts, in vitro. Methods 2007; 42(4):339-348.
  30. Ettefagh K.A., Burns J.T., Junio H.A., Kaatz G.W., Cech N.B., "Goldenseal (Hydrastis canadensis L.) Extracts Synergistically Enhance the Antibacterial Activity of Berberine via Efflux Pump Inhibition", Planta Medica 2010.
  31. Sun, Y., Xun, K., Wang, Y., & Chen, X. (2009). “A systematic review of the anticancer properties of berberine, a natural product from Chinese herbs.” Anti-cancer drugs, 20(9), 757–769).
  32. L Pradebon Brondani, et. al. “Evaluation of anti-enzyme properties of Origanum vulgare essential oil against oral Candida albicans.” J Mycol Med. 2018 Mar;28(1):94-100.
  33. Yin, D., Du, E., Yuan, J. et al. “Supplemental thymol and carvacrol increases ileum Lactobacillus population and reduces effect of necrotic enteritis caused by Clostridium perfringes in chickens.” Sci Rep 7, 7334 (2017).
  34. Force M, Sparks WS, Ronzio RA. “Inhibition of enteric parasites by emulsified oil of oregano in vivo.” Phytother Res. 2000 May;14(3):213-4.

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

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

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

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


Day 2 Q+A: Advanced Organic Acids


Kurt Woeller, DO

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

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

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


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

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


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

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

 

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

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

 

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

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


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

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


Q: What is the significance of low aconitic?

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


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

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

 

Q: Do PPIs for GERD affect the mitochondria?

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


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

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


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

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


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

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


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

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


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

A: Yes. I feel they should be.


Q: What is the dose for PTERIDIN-4?

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


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

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



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

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


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

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


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

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


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

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


Joseph Pizzorno, ND

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

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

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


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

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


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

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


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

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


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

A. I am not aware of any convincing research.

 

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

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


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

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


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

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

 

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

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


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

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


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

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


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

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


Bob Miller, CTN

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

 

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

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

 

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

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

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

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



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

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

Registration includes:

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

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

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

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

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