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Lyme, Mold and Mycotoxins: When and Why You

Should Be Concerned

NationalAutismAssociationConferenceMay2019

LindseyE.Wells,ND

www.lindseywellsND.com

OUTLINE

• MoldandMycotoxins• LymeDisease• EvaluationandTesting• Treatment

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MOLD

SOURCES OF MOLD •  Bathrooms, Laundry rooms, Basements •  Leaking pipes, poorly fitting drains, roof leaks •  Walls

•  Air conditioning systems •  Underneath sinks

•  Closets •  Window Sills

•  Refrigerator •  Mold can be present in areas of home with

condensation, poor ventilation, window/air drafts, roofing issues, plumbing leaks, etc.

•  Lower risk for mold if humidity < 60% in summer and 45% in winter

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SOURCES OF MOLD

• Mattress• Pillows• Cups• Bathtoys•  Teethingtoys• Rottenfoods

MOLD TOXICITY

•  Thisisnotanewconceptalthoughlimitedresearch•  DescribedintheOldTestament(Leviticus14)

•  Warnsthatifaman’shouseiscontaminatedwithplagues,mold,andleprosythat“heshallhavetheinsideofthehousescrapedallaroundandtheplasterthattheyscrapeofftheyshallpouroutinanuncleanplaceoutsidethecity”

•  During1970-1980sUSDefenseDepartmenthadconcernsregardingtheuseofmycotoxinsforbiologicalwarfare

•  MayoClinicin1990madestatementthatchronicsinusinfectionsmaybeduetofungalinfectioninsteadofbacteria

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MOLD TOXICITY

•  In1997,Dr.RitchieShoemakerinMarylandobservedunusualsymptomsinhispatientsinatthesametimetherewasdeathofthousandsoffishinlocalenvironmentofChesapeakeBay

•  DiscoveredthattheillnesswasduetothepresenceoftoxinscreatedbydinoflagellatePfiesteria

•  Hefoundthatthesetoxinscouldbeboundbycertainbinders,suchasCholestyramine

•  Moldtoxicitycanalsooccurfrommoldsporefragments,volatileorganiccompounds(VOCs),andothermicroorganisms.

MYCOTOXINS

•  Moldsproducemycotoxinsasawaytokeepothermoldoutoftheirecologicalniche

•  Mycotoxinssporescanbeinhaledintoourlungs,absorbedthroughourskinbytouch,orconsumedthroughfoodintotheGItract

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BIOTOXICITY

•  Microbes(i.eyeast,bacteria,spirochetes,parasites,etc)cancauseillnessduetoinfection.

• Whentreatmentisimplementedtokilloffthesemicrobes,themicrobescanreleasetoxinsinresponsetobeingkilledàbiotoxins

•  Biotoxinsaredifficulttodetoxifyandcanaccumulateinthesystem

• WillaccumulateintheliverforexcretionandbeboundtobileastheymovethroughtheGItracttobeexcreted.However,theenterohepaticcirculationwillconservethebile,thereforerecyclingthebiotoxinsaswell.

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BIOTOXIN PATHWAY

•  Mold Toxins are ionophores •  One end lipophilic (dissolves in lipids) •  Other end Hydrophilic (dissolves in water)

•  After inhalation, ingestion, contact the Ionophores insidiously move throughout the body

•  End result is inflammatory immune response

MYCOTOXIN INFLAMMATORY RESPONSE

Mycotoxins •  Enter Fat Cell

Binding releases 2nd Messenger •  Activates NF Kappa B

Moves into Nucleus •  Turns on gene

transcription •  Cytokine production

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MYCOTOXIN INFLAMMATORY RESPONSE

Cytokines•  Block Leptin Receptors

Fat cells produce more Leptins •  To override creating Leptin

resistance

Hypothalamus no longer makes MSH, VIP •  Critical regulators of neurologic,

immunologic, endocrine function

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SYMPTOMS OF MOLD TOXICITY

•  Electricshocksensations•  Icepickorlightingboltpains•  Vibratingorpulsingsensations(especiallydownspine)

•  Muscleweakness•  Numbnessandtingling•  Disequilibrium•  Dizziness•  Anxiety•  MusclePain•  GIsymptoms•  Chesttightness

SYMPTOMS OF MOLD TOXICITY

•  ChronicSinusCongestion/RecurrentSinusInfections

•  BrainFog•  OCD•  Sleepdisturbances•  Headaches•  Rashes

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HISTORY

Takeacarefulhealthhistoryincludingenvironmentalhistory

Whatyearwasthehousebuilt?

Istherevisiblemoldinhis/herenvironment?

Isthereamustyodorinhis/herenvironment?

Anywaterleaksorfloodinginhis/herenvironment?

Anyventilationissuesinhis/herenvironment?

Dobehaviors/symptomsdecreaseorincreaseincertainenvironments?

Anyoneinthefamilywithsimilarsymptoms?

PHYSICAL EXAM

FINDINGS

•  Tenderness of sinuses on palpation •  Nasal Congestion •  Inflammation of turbinates •  Resting tremor, (often subtle, can be

Parkinsons-like) •  Cool and/or discolored hands and feet,

pallor •  Unilateral weakness, especially in shoulder

muscles •  Note: evaluating the ability to maintain the arms

outstretched with downward pressure on the hands and then rechecking this will usually reveal weakness

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TESTING

MycotoxinUrineTest•  Bestdoneaftertwoweekcourseoforalglutathione,IVglutathione,and/orSauna• Watchforworseningofsymptomsduringchallenge• Morespecificandlessinvasivetesting• Mayworsenatstartoftreatment•  Nof1(testingasguide)

VisualContrastSensitivityTest•  Biotoxinexposurecanimpairopticnerves•  Abilitytoseepatternsimpaired•  98%whofailVCSandhave8symptomsormore,haveabiotoxinillness

• Monitorchangesovertreatmentcourse•  Canbetestedonline

MYCOTOXIN TEST •  Mycotoxinurinetestwillscreenforelevendifferentmycotoxins,from40speciesofmold

•  Firstmorningurine(10mlrequired)

•  Fastingfor12hoursmayincreasetheexcretionofmycotoxinsfromtheadiposetissue

Metabolite Results(ng/g creatinine) Common Range of Positive Results

Aspergillus

Aflatoxin-M1 0.00 3.5 - 20

Ochratoxin A 62.12 4 - 20

Gliotoxin 1366.35 200 - 2000

Penicillum

Sterigmatocystin 2.43 0.2 - 1.75

Mycophenolic Acid 91.04 5 - 50

Stachybotrys

Roridin E 0.00 1 - 6

Requisition # Physician Name

Patient Name Date of Collection 12/18/2018

Patient BirthDate Time of Collection 7:00 AM

Sex Print Date 12/31/2018

MycoTox Profile

11813 West 77th Street Lenexa, KS 66214 | (913) 341-8949 | Fax: (913) 341-6207 | www.GPL4U.com

Testing performed by The Great Plains Laboratory, Inc., Lenexa, Kansas. The Great Plains Laboratory has developed and determined the performance characteristics of this test. The test has not been evaluated by the U.S. Food and Drug Administration. The FDA does not currently regulate such testing.

Patient Name: Jennifer Nelson Requisition #: 640040

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VISUAL CONTRAST SENSITIVITY •  Nothing visible in Row E •  Barely able in Row D •  Test failed = biotoxicity

•  Interpretation – note hand drawn checks & ovals

•  Check = black and white component seen clearly

•  Oval means component not seen

TOXIC by Neil Nathan, MD

TESTING •  C3a–elevated•  C4a–elevated•  TGFbeta-1–elevated•  MMP9-elevated

•  VEGF–low•  VIP–low•  Leptin-low•  MARCONsNasalSwab-

Multiple Antibiotic Resistant Coagulase Negative Staph

•  Identified by nasal culture; Barrier to immune defenses; colonization (not infection)

LABMARKER NORMALRANGES

VIP 23-63(ARUPlabsonly)

MSH 35-81

MMP-9 85-332

c4a <2380

TGF-beta-1 <2380

Leptin Male:0.5-13.8;Female:1.1-27.5

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TESTING

ERMItests• EnvironmentalRelativeMoldinessTest• vacuumeddustofspace(home,office,school,other)examinedfor36moldtoxins

• Thehigherthenumber,thegreatertherelativemoldburden

HERTSMI–2• HealthEffectsRosterofTypeSpecificFormsofMycotoxinsandInflammagens

• Looksfor5SpeciesofMold(alsoincludedinERMI)• Scoringsystem(www.survivingmold.com/diagnosis/hertsmi-2)• <10–SAFE• 11-15–Borderline;cleanandretest• >15–DangerousforthosewithCIRS

EvaluationbyMoldSpecialist

TREATMENT

Shoemaker and House, 2006 Neil Nathan, TOXIC

•  Avoid exposure to toxic molds! •  Leave environment, remediate environment, prevent re-

exposure get out •  Increase Essential Fatty Acids

•  3-4 grams/day •  Use Binders

•  Cholestyramine •  Activated Charcoal •  Bentonite Clay •  Chlorella •  S. Boulardii •  Okra

•  Add Oral or Nasal Antifungals •  Oral Antifungals:

•  Prescription •  Herbals: berberine, oil of oregano, grapefruitseed

extract, gymnema, uva ursi, pau d’arco, caprylic acid, garlic, plant tannins

•  Nasal Sprays: •  Xyltiol •  Argentyn 23

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TREATMENT

Breakupbiofilms

•  Biofilmenzymes•  NAC

AvoidConstipation

• Magnesium,aloe,vitaminC

Supportliveranddetoxfunction

•  Glutathione,NAC,MilkThistle,Dandelion,Phosphatidylcholine,antioxidants,oilpulling,ioncleanse

Mitochondrialsupport

•  CoQ10,MCToil,PQQ,antioxidants

Removeglutenifpositive;anti-inflammatory,amylose-freediet

TREATMENT

•  Makesuretotest/treatforLymeorLymecoinfectionsasthiscancomplicatehealingfrommoldtoxicity

•  ThereisageneticpredispositioninsusceptibleindividualstobiotoxinsincludingMoldandLyme

•  ConsiderHLA-DRtesting•  HLADR8andDQ•  4/3/53•  11•  12/3/52G•  14/5/52B

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LYME

CDC estimates 300,000 new cases of Lyme Disease are discovered each year in the

United States.

20% of population will have tick-borne diseases and up to 35% in

some areas (like CT)

LYME DISEASE

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LYME HOSTS

•  > 22 species of borrelia (burgdorferi, afzelli, garinii, miyamotoi…) •  Ixodes transmitted tick borne diseases

•  Borrelia burgdorferi, miyamotoi, mayonii •  Babesia, Ehrlichia, Barotonella, Anaplasma species

•  Ixodes ticks bite a variety of hosts •  Mice, rats, squirrels, shrew •  Incidental hosts – humans, domesticated animals, lizards •  Gestational

•  Tick dispersion over wider distances •  Many species of songbirds •  Deer

LYME TRANSMISSION

•  Tick saliva injected into dermis – it is not just about the infection (anesthetic, anticoagulant, immune modulating properties)

•  Borellia Myomata - Can be transmitted without a full tick (that has NOT eaten)

•  Gestational and Perinatal Transmission

7

20

40

60

80

100

24 48 72 96

Attachment time

Trans-mission

Rate

No Guaranteed Minimum

7% transmission in under 24h

At 60h, transmission rate = 50%

Peisman J. J Clin Microbio 1987

Risk very small if < 24h attachment but not fictitious

Slide courtesy of Elizabeth L. Maloney, MD

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LYME RASH

•  “Typical” rash – EM (Erythema Migrans)

•  Central clearing, raised expanding border

•  Oval, erythematous, spreading •  Painless, warm, may be itchy,

raised

•  < 32% have “classic” bulls-eye rash •  Any shape possible •  Faint pink – deep scarlet; can be

solid coloring •  Vesicular (especially on legs) •  Check skin folds, hairy areas

LYME SYMPTOMS

BORRELIA•  Flu-likesymptoms•  Bulls-eyerash(erythemamigrans)•  Nervepain•  Peripheralneuropathy•  Vertigo•  Headaches(wholeheadhurts)•  Neckpain•  Jointpain•  Cardiacsymptoms

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BARTONELLA SYMPTOMS

•  Sensitivitytonoise/light/chemicals/smells•  Paininsolesoffeet•  Sensationofvibration/trembling•  Numbness/tingling•  Joint/musclepain•  Emotionalinstability•  Anxiety,panicattacks•  Headaches(locatedinbackofhead)•  GIsymptoms•  Pelvic/bladdersymptoms

BABESIA SYMPTOMS

•  Nightsweats•  Shortnessofbreath(”airhunger”)•  Headaches(frontal)•  Cognitivedysfunction•  Hallucinations•  Cognitiveimpairment

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EHRLICHIA SYMPTOMS

•  Headache •  Myalgias •  Malaise •  Vomiting •  Cough, pneumonitis •  Repetitive stress injuries

•  Signs:

•  Initial leukopenia, thrombocytopenia •  Then leukocytosis, elevated liver

enzymes

PHYSICAL EXAM

•  ErythemaMigrans–BORRELIA•  Striaethatblanches–BARTONELLA

•  SwollenLymphNodes•  Heartrhythmirregularities•  Facialpalsyandneuropathy•  Swellingofjoints

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TESTING

•  Testing (not positive for several weeks after tick bite) •  Extended western blot (18, 23-25, 31, 34, 37, 39, 83, 93) •  Coinfections (babesia, bartonella, ehrlichia) •  CD57 (decreased levels, inaccurate, not sensitive) •  PCR (poor sensitivity < 30%) •  Inflammatory and immune markers (ANA, ESR, hsCRP) •  Metabolic markers (homocysteine, B12 (MMA), plasma

zinc, RBC magnesium, T3, T4, thyroid antibodies) •  Mitochondrial markers (carnitine, ammonia, lactate, CK,

amino acids, urine organic acids) •  Other germs (mycoplasma, viruses, strep and yeast) •  Intracellular infection – VEGF, TGF beta, C3a, C4a)

TREATMENT

InitialtreatmentforLyme(4-6weeksoforalagent)• Doxycycline(preferredantibiotic)• Amoxicillin• Cefuroxime• Azithromycin

BabesiaTreatment• AtovaquoneandAzithromycinORClindamycinandQuinine(CDC2015TreatmentGuidelines)

• Bioavailabilityofatovaquoneislowandvariableandishighlydependentonformulationanddiet

• Atovaquoneshouldbetakenwithfattyfood• Withfood,bioavailabilityisapproximately47%• Withoutfood,bioavailabilityis23%

EhrlichiaTreatment• DoxycyclineandRifampin(Dumler2009)

BartonellaTreatment• Treatment-nosingletreatmentiseffective;(Spach2015)• RifampinandBactrim;RifampinandAzithromycin;BactrimandAzithromycin

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LYME TREATMENT

•  JapaneseKnotweed•  Cat’sClaw•  Teasel•  Andrographis•  Biocidin•  Samento•  Banderol•  Cumanda•  IFYOUFINDATICK–CONSIDERLEDUM30C(HomeopathicRemedy)

LYME CO-INFECTION TREATMENT

Babesia• Cryptolepis• ChineseSkullcap• Bidenspilosa• Artemisinin• RedSage•  SidaAcuta

Bartonella•  JapaneseKnotweed•  EGCGwithquercetin•  L-arginine• Cordyceps•  SidaAcuta• RedRoot• Argentyn23• A-Bart

Ehrlichia• Cordyceps• Redsage• Houttuynia• ChineseSkullcap• Astragalus•  Kudzu• Quercetin

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HERXHEIMER REACTION

Evaluating Undesirable Outcomes

Correct Diagnosis?

Right Rx for Lyme?

Jarisch-Herxheimer?

Other possibilities …

Other tick-borne disease?

Yes No

Yes No

Lyme + Co-infection?

Unexpected Course

50Slide courtesy of Elizabeth Maloney, MD

Select Appropriate

Antibiotic

•  Herxheimer” reaction ~20% of patients

•  First described with PCN treatment of syphilis

•  Intensification of baseline symptoms

•  Variable duration, onset often within hours

•  HerxSupport:•  Epsomsaltbaths•  Activatedcharcoal•  Burburpinella•  Alkalization•  Otherbinders

Pound MW. J Clin Pharm Thera. 2005

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NUTRITION

•  Remove sugars, processed food, GFCF

•  Stevia – antimicrobial benefits

•  Pomegranate Juice – antimicrobial benefits

•  Increase antimicrobial spices and herbs in diet

•  Oregano, cinnamon, clove, garlic, ginger, rosemary, etc.

•  Add bone broth, fermented foods

•  Increase foods high in antioxidants (berries, nuts, green leafy vegetables, etc.)

PREVENTION •  KnowEndemicareas•  ClothingProtection

•  Tuckinpants•  Hats•  Longsleeves

•  UseNaturalTickSpray•  Recipe:

•  25dropsGeraniumessentialoil•  10dropsCitronellaessentialoil•  5dropsLemonessentialOil•  2ozofWitchHazel•  2ozWater

•  Makesuretodotickchecks!

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IMPORTANCE OF PROPER

TREATMENT CIRSLymeandLymeCo-Infections

MoldToxicity

Mycoplasma

Viruses

Strep

CHRONIC INFLAMMATORY RESPONSE SYNDROME

Toxinsand/ormicrobes

StimulatedImmuneResponse

INFLAMMATION

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CHRONIC INFLAMMATORY

RESPONSE SYNDROME

•  Symptomsin6clusters

• Commonlyupto10

TREATMENT

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CLOSING REMARKS

ThereisarelationshipbetweenLymeandMoldToxicity

Multisystemtreatmentisneeded

Treatthewholechildandthewholeillness(yourNof1)

IdentifyunderlyingproblemsbylookingatINDIVIDUALhistory,physicalexamcluesandlaboratorydata

Thinkenvironmentalexposures(i.emoldandLyme)whennotmakingprogresswithtreatmentasexpected

Besttoincludeherbalsandsupplementsintreatmentplanforsuccessfullongtermoutcomes!

THANK YOU!

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