Editor’s Note: Dr. Neil Nathan, Dr. Jacob Teitelbaum and Dr. Ritchie Shoemaker talked about recent research findings and new treatment options with regard to mold toxicity in a recent episode of the radio program “The Cutting Edge of Health and Wellness Today.” Following is a somewhat shortened transcript. The audio version of the interview is available at this link.
Hello, this is “The Cutting Edge of Health and Wellness Today.” I’m your host, Dr. Neil Nathan. I’m joined by my co-host and good friend, Dr. Jacob Teitelbaum.
As an extra added bonus for today, we’re going to have an interview with Dr. Ritchie Shoemaker, who is the foremost expert on mold toxicity. In fact, Dr. Shoemaker actually discovered it almost singlehandedly – or at least, he really explained to us what was going on and its importance.
Let me take a moment to explain the subject of mold toxicity by explaining how Dr. Shoemaker figured this stuff out.
He was a family physician working in the little town of Pocomoke, Maryland, which is on Chesapeake Bay. Back in 1997, there was a huge die-off of fish. Literally a million fish were found dead floating in Chesapeake Bay. The various health officials said, “It’s not really a problem. There are no real issues going on. Nobody’s getting sick. Don’t worry about it.”
Dr. Shoemaker found that literally hundreds of his patients were coming in with very odd illnesses. Odd rashes, shortness of breath, anxiety, depression, couldn’t think straight.
He had no idea what he was looking at. But happily, he had one particular patient who had severe diarrhea. He provided the patient with a medication called cholestyramine. That is primarily used for treating high cholesterol, but we do also use it when people have really bad, out-of-control diarrhea. He only gave it for the diarrhea, but to his surprise, all of the patient’s other symptoms disappeared in the course of a few days.
So being the excellent scientist that he is, Dr. Shoemaker took the time to try cholestyramine with his other sick patients, and again, somewhat to his surprise, most of them began getting better.
He then went to a variety of local health experts, who figured out that what was affecting these patients was a toxin produced by an organism called Pfiesteria. It was being produced because the copper that was being used in the feed of chicken to keep fungus away was leaking into Chesapeake Bay, changing the ecosystem and allowing the Pfiesteria organism to grow, killing the fish and making people sick.
Dr. Shoemaker then took his information and applied it to outbreaks of algae in Florida. And then he put two and two together and realized that there were other things that looked just like this, including exposure to mold in water-damaged buildings.
Patients often had a weird, wild assortment of symptoms that otherwise made no sense. Fatigue, muscle aches and cramps, unusual icepick or lightning-bolt pain, sensitivity to bright light, tearing, blurred vision, cough, chest pains, shortness of breath, cognitive impairment, appetite swings, weight gain, numbness, tingling often in unusual patterns, sensitivity to static electrical shocks, thirst, weakness, headache, abdominal pain, nausea, diarrhea, joint pain, morning sickness, mood swings, night sweats, metallic taste.
Doesn’t this sound like an overview of basically everything you could imagine? For most physicians, if someone came in complaining of most of those, the thought would be, “Oh, it’s got to be in your head. It can’t really be a real thing that causes that.”
But in point of fact, mold toxicity does.
So the first thing that we want to bring to your attention is that mold toxicity is real. It occurs and it’s nasty.
There also is mold allergy and there is mold infection. This is different. This is mold toxicity, where the toxins cause these effects by causing an outpouring of inflammatory cytokines in the body. This inflames every segment of the body.
Most noticeably, this inflames various areas of the brain, causing hormonal dysregulation, particularly in the areas of adrenal, thyroid and sex hormones. And then it spreads out into other areas.
This is what Dr. Shoemaker described as the biotoxin pathway.
This is what we’re talking about when we discuss mold toxicity. There are millions of people in this country who have varying degrees of mold toxicity and don’t know it, because they have never heard of it. It is a condition that has not yet made its way into mainstream medicine.
The way that he stumbled over the truth reminds me of Churchill’s old saying, that men occasionally stumble over the truth but usually manage to brush themselves off quickly and walk away before any real harm is done.
Ritchie is one of those guys who has an incredible mind. He’s a dogged researcher.
I liked the way that you made a distinction between infections, allergies and toxins.
Why toxins? Well, you know how humans like to protect our territory. Animals protect their territory too. Well, molds do the same thing. They don’t care about us. But when you have a bunch of different molds growing in the same building, they’re going to be protecting their turf against each other.
The main way that they do that is through chemical warfare. They throw things out to try to kill the mold competition. Unfortunately, some of those toxins are not too healthy for us either.
So as these molds are attacking each other, we become the collateral damage in that.
A lot of those symptoms that you gave are symptoms of CFS and fibro. There are a lot of other symptoms too. If I see a patient with frequent bloody noses, I’m going to be thinking more about mold toxicity.
Are there other symptoms that you find especially common with mold, when you are treating CFS?
Particularly mood swings, anxiety, depression. The things that we call paraesthesias, which is numbness and tingling in weird places – for instance, when patients have numbness or tingling around their chin or around their belly button or the mid-portion of their back. If you go to a neurologist, they will say, “Oh you can’t have numbness and tingling there, because there are no nerves that go to that area.”
Actually, the autonomic nervous system can go to virtually anywhere. So when I have patients with weird symptoms of numbness and tingling, plus anxiety and depression completely out of proportion with what’s going on in their life, I think mold.
Many patients with chronic fatigue or fibromyalgia actually have mold toxicity as a component of their illness and really need to know this.
I’ll take just a moment to comment on a paper published last year by Dr. Joe Brewer. He took 113 patients with chronic fatigue and looked at mold toxicity by measuring the mold toxins in their urine. He found that 93% of those patients were loaded with mold toxin. Those patients were remarkably well treated when he began working specifically in that area.
We’re making breakthroughs in this area literally by the month.
So they used healthy controls and then compared the amount of biotoxins in people’s urine vs. CFS and fibro? Or did he use historical controls to say that these toxins shouldn’t be here at all?
We live in an environment where, I think, everyone is coming into contact with these things. But not everyone is as sensitive to them.
They did use a control population, but not specific to this group. But I don’t think that changes the results.
Keep in mind that 75% of people genetically are perfectly capable of getting rid of mold toxins from their bodies, while 25% of people can’t. So you can have a family or a work environment where 25% of the people are sick and 75% are not. This often leads them to think, “We’re fine, you’re not, so this has got to be in your head.”
It doesn’t work this way. This is a real, true illness. It’s treatable, but only if you make the diagnosis.
It’s like the old saying: you can’t diagnose something if you don’t know that it exists. And most doctors have no clue that this is even a possibility.
There are these predictable hormonal and biochemical changes that the biotoxins and particularly mold create inside the body. And they’re treatable.
One of the things that Dr. Shoemaker realized is that there is a very simple visual test that you can take, in which you look at a series of black-and-white alternating lines of different intensities and different frequencies. That test is called visual contrast sensitivity. You can take it on Dr. Shoemaker’s website, SurvivingMold.com. That will give you a clue that this is happening to you.
Also, if you’ve ever been exposed to a heavy mold infestation, you actually may become infected with mold, meaning that it colonizes in the gut and sinus areas. It may continue to produce toxins even after you have left the moldy environment. This is one of Dr. Brewer’s major newer contributions, which helps us understand how people are staying sick long after they left the mold exposure.
This is not an allergy. It’s toxicity and needs to be thought about a little bit differently.
Now we are joined by my friend and colleague, Dr. Ritchie Shoemaker. He is the guy who has put mold toxicity on the planet as something that is extremely important and very overlooked in our understanding.
I first met Dr. Shoemaker in 2005 or 2006, after one of my patients read his book Mold Warriors. She read the book, came into my office, put it on my desk and said, “Read it.”
I thought, I’ve got a whole pile of books to read. I’ll put it on the stack. But she said, “Read it now. I’ll pay you to read it during my visit.”
So I read the book and got to the point where Dr. Shoemaker is describing the biotoxin pathway. I immediately realized that Ritchie had discovered the entire mechanism by which these toxins affect our health.
I was very impressed. So I called him up and asked, “Can I come watch you work and see how you do this?” And he very nicely invited me out.
Since then, we have been friends and he’s been my mentor. I’m delighted to have him with us today on the show.
His latest paper is “Structural Brain Abnormalities in Patients with Inflammatory Illness Acquired Following Exposure to Water-Damaged Buildings: A Volumetric Study Using NeuroQuant.”
What that means is that Dr. Shoemaker has been looking at mold-toxic patients by analyzing their brains using a variation of an MRI called a NeuroQuant.
An MRI is not a photograph, though it looks like one. It’s a computer-generated image of what tissues look like when exposed to a very powerful magnetic field.
What the NeuroQuant does is to apply a specific program to look at tissues. It can quantify how large certain brain areas are. Dr. Shoemaker has used it to make some vey important scientific discoveries.
Ritchie, can you please share with our listeners what you have learned about what mold toxicity does to brain tissues?
When we think of wet buildings, there are some folks who think that mold is the problem. But there are easy ways to measure mold. There are certain molds that are associated with illnesses that we can define with inflammation markers.
But there’s way more than molds to worry about. In a wet building, there’s an entire mixture or stew that contains fragments of mold that are dead and that you’ll never find growing anywhere that cause inflammation. You will find toxins from actinomyces and compounds from bacteria that make us sick. There are other compounds that some people think might be helpful, like beta glucans, that if they have a different structure can make us ill.
Mold toxins are probably about 1 in a million of the total number of culprits here. There is an inflammatory response that the body makes to antigens – these foreign particles that the body normally would recognize as foreign and destroy with antibodies.
But these folks have genetic makeups so that they cannot make a protective antibody. So if they’re exposed to a water-damaged building, they retain these compounds. They’re not excreted in the urine and they’re not excreted in the stool. They stay with us for a long time.
Specifically what happens is that the inflammatory response over time – slowly, steadily and progressively – makes compounds that injure the blood-brain barrier.
We all know that there is a mechanism that the brain has to keep compounds in the blood out of the brain. For instance, if you have Parkinson’s disease and you want to take L-dopa, you’ve got to take a different compound and not dopamine itself. It’s got to be made up in some other way, because it won’t cross the blood-brain barrier normally.
The inflammation that we see from people in water-damaged buildings can be things like vascular endothelial growth factor (VEGF). Or matrix metallopeptidase 9 (MMP9). But the big one is transforming growth factor beta-1 (TGF-beta-1). These guys breach the blood-brain barrier and let elements in the blood into the brain where they’re not supposed to go.
Then TGF-beta-1 follows along and turns on genes in the brain that aren’t supposed to be on.
So what does all this do? We’ve known for years, since 1998 or 1999, that there are a lot of cognitive problems with these biotoxin patients. But now, with use of the NeuroQuant, we finally can show the mechanism of injury and the injury itself.
Even better, by treating inflammation, we can watch the injury in the brain heal.
So when you talk to people exposed to wet buildings and they’ve got brain fog and memory problems and confusion and can’t remember where they parked their car – they’re not making that up. Because we can show the inflammation in the brain causing brain volume changes.
I do use the word mold as a generic term. You’re absolutely correct that many many more things create that toxicity.
Our patients are often treated by family, friends and even many physicians with the thought that they’re making this up, because it seems like no one could have all those symptoms that we’re looking at.
Perhaps the worst of the symptoms are the cognitive and emotional issues. These patients have been told for a very long time that this is in their head. And now, you are proving that it is in their head – but not in the way that it has been used in a derogatory statement. We now can look at what is in their head from a brain standpoint and go, “Oh, this is very real.”
We can look at depression or anxiety or OCD tendencies – which are very high in many of our patients – and cognitive issues. For many of our patients, this is what scares them the most. They can live with a little fatigue, but not being able to think well is a very frightening place to come from.
One of the interesting findings on top of what you said is that there is also a problem of executive inhibition of response. In speaking to patients who are untreated and have these cognitive issues, even before we knew that they had volumetric problems in their brains, you can see it.
Very often an interview will start off, “Good afternoon, Mr. Jones. How are you feeling today?” And Mr. Jones will be talking about how he’s feeling, and then he sidetracks into what he had for breakfast, and then he sidetracks into he doesn’t eat oatmeal because it causes him GI problems, and he’s got parasites. This is in the first paragraph. This is not an organized, structural approach to conducting an interview.
What really is going on is the inability to inhibit incorporating those intrusive thoughts into what he’s doing. The issue is that we now know full well that the representation of some of these abnormalities is heightened in some of the dopamine-containing fibers in a part of the brain called the caudate nucleus, which sits right near the thalamus at the base of the brain.
The fascinating thing that we see in these biotoxin illnesses is that there is a unique area of brain volume loss and gray matter – but other areas are bigger than normal. This is due to fluid accumulating. Not fluid that you can see on a gross basis with an MRI, but on a microscopic basis. It’s fluid in between cells in the brain, which is called microscopic interstitial edema.
That combination is unique in what all my reading shows in brain injury. We’ve got people with funny little facial movements and jerking movements. Tics are very common and tremors are very common. Unusual seizure-like activity is not surprising.
When we get MRI’s, we’ll see a lot of scarring or unidentified bright objects, which we now call gliosis.
So we can see neurological reasons for all the cognitive and psychological manifestations that we see in this disease.
Perhaps we can take a moment to talk about the product VIP, which you were probably the first to use in this context, noting that VIP and MSH are both vastly deficient in these patients.
VIP does many things. It is a really important neuroregulator. One of the things that it does that is of supreme importance is that it regulates inflammation in the body. And it is inflammation that is the major problem in all the myriad symptoms that we see with these illnesses.
What VIP does, in a simplified way of conceiving it, is that it controls inflammation. It modulates inflammation. And when the body does not make it in adequate amounts, inflammation rages out of control.
When we can demonstrate that VIP is deficient, Dr. Shoemaker has come up with a way of figuring out which patients are the best ones to take it. He has discovered that using VIP over a period of six months – sometimes more, sometimes less – can reverse these brain changes.
One of the issues that we’ve got to look at is that of inflammation gone awry.
We think about inflammation with tests like SED rate and C-reactive protein, but inflammation is far more than just that. It’s basically a response to an injury. And if the injury is coming from a foreign invader, the inflammation will come from the innate immune system that has the duty to recognize the foreign invader through all these different receptors that contribute to recognition sites, and then to activate antibody production.
If that process is defective – and we know that there are some immune response genes associated with that – then our thoughts about inflammation must be changed. Because SED rates and C-reactive proteins invariably are normal.
The inflammation comes from cytokines and Th1 responses that are balanced by Th2 responses. Now we’ve found out the next player is Th17.
As we go back to the basic concept of inflammation gone awry, we’ve got to go back to Lewis Thomas, who wrote extensively in the New England Journal of Medicine in the 1970’s. He recognized in one of his pieces in 1973 that with the germ, what makes us sick most of the time is the host response that is not controlled that creates the illness.
The host response is not being regulated. A model for us is sepsis, which creates a storm of all these inflammatory responses. We used to think that you got the sepsis out of the blood stream and the cytokines went home, but that’s not the case. Once this illness gets started, there can be longer-lived inflammatory markers and the illness becomes chronic.
So we call it a chronic inflammatory response syndrome.
What this means is that if the body gets out of kilter, then even if you remove the biotoxins, the body somehow does not know how to right the ship. It kind of needs to get rebooted.
So what happens if you put regulation back?
Specifically, if we look at folks with this chronic inflammatory response syndrome, they all need regulation restored. Unfortunately, there is an element that we’re just now finding out about, that some of this inflammation will affect differentially gene activation or gene suppression.
So this initial event – exposure to a wet building or a tick bite or you eat some fish from Hawaii and get sick with ciguatera – that initial inflammatory event can continually lead to new illnesses.
We can think of the dominoes in a row being knocked down one after another. The final frontier is our genes. It’s genomics. So we can look at things like VIP and ask the question – this restores inflammation from so many different pathways. Not just from mycotoxins but also from bacterial toxins and beta glucans and all these other things that are not mold but are in wet buildings.
And it fixes them. It fixes them by restoring genetic regulation. That’s the key issue.
And the illness persists as long as there is ongoing lack of gene regulation.
Back when they had the human genome project, 98% of the DNA that was isolated didn’t have a known function. It was called “junk DNA.” Turns out it wasn’t junk, because in it are a whole slew of regulatory RNA’s.
So now when we talk about things like VIP, it will change surfaces of mucous membranes to let germs come in that make biofilms that will make us sick. Those guys can release substances to change our genes. VIP deficiency lets TGF-beta-1 go nuts. That’ll change our genes. Problems with autoimmunity – that’ll change our genes. Regulatory white blood cells called lymphocytes – the T-lymphocytes – can be disturbed, and that’ll change our genes.
So in this whole ever-expanding picture, you might have fatigue and cognitive problems, but you’ve got problems with neurologic function and vision, you’ve got proteomic or blood test abnormalities, and you’ve got genomic abnormalities. They all go together.
You’ve been an advocate of using the PAXgene to gather this information.
I congratulate you and your colleagues for being some of the first to use the PAXgene tubes. It’s very simple to collect one or two tubes of blood and then to keep them indefinitely in the freezer, so that you can go back to a patient that you saw in 2008 that you never understood and say, “Oh, look at this long-coding RNA going nuts. No wonder he’s got caudate atrophy!”
Sure thing. There actually are 30 papers on that website that people can get as free downloads. Not to mention really state-of-the-art comments about water-damaged buildings. Because there really is an awfully lot of nonsense out there.
Also on that website is the ability to do a visual contrast test where you can get a fairly quick read by doing a test of your vision that will help you to know both now and in the future a bit about where these toxins might be in your body.
Dr. Shoemaker and I did a few years ago a day and a half workshop about biotoxin illness. It might serve as an introduction for many of you to be able to understand this much better. That is available as a set of CD’s called “Biotoxin Illnesses: The Science Behind Accurate Diagnoses and Effective Treatment.”
I also understand that you have a new book.
Yes, the new book is called State of the Art Answers to 500 Mold Questions. It’s an ebook, available for your Kindle.
Thank you for coming on our show and sharing the most cutting-edge information about this very important field of mold toxicity. I hope you can join us on future broadcasts.
It’s always a pleasure.
I’d like to come back to understanding mold toxicity at a somewhat more practical way. How do we diagnosis this?
Dr. Shoemaker has an elaborate set of tests that he uses to make the diagnosis. These are things like VIP, MMP9, VEGF, C4a, TGF-beta-1. All things that Dr. Shoemaker mentioned.
In addition, there’s another test that Dr. Brewer has helped to clarify the value of, done by the RealTime Laboratories, in which patients submit a urine sample and we measure in it the three main mycotoxins. These are ochratoxin, aflatoxin and trichothecene. Those are things that we can measure. If there is an excessive amount of any or all of those toxins, this tells us that yes, we are dealing with mold toxicity.
One of the things that I have found particularly useful is that knowing which toxin allows me to tailor-make my treatment a bit more specifically. As Dr. Shoemaker has emphasized over the years, cholestyramine turns out to be a superb binder for many of these toxins. Particularly ochratoxin. So if patients have ochratoxins in excessive amounts, that’s the treatment we use.
However, if patients have particularly high aflatoxin or trichothecenes, we have discovered that chlorella, charcoal or bentonite clay are particularly good binders for those. Using the urine test, we can monitor and see these levels go down as time goes on.
We also can use the visual contrast test as a way of monitoring and checking to see that these toxic levels are coming down.
In my experience, it tends to take about a year to pull mold toxicity out of the body. Sooner if it’s a simple mold toxicity problem, but my practice consists largely of people who have been very sick for a very long time. Some of them have both mold and Lyme, plus a whole bunch of other infectious processes. For the sicker patients, it takes longer because their bodies are a whole lot more compromised.
We also have learned that mold is a profuse creator of what we call biofilms. Biofilms are kind of a glop that are secreted by microorganisms to protect them from the environment. They’re not only made by mold, but also many bacterial species. So we not only need to get at the mold, we also need to dissolve the biofilms so that we can get at the mold.
As Dr. Brewer has demonstrated, for many of our patients, they don’t just have mold toxin in their bodies. They are growing it because the mold has colonized their sinus and gut areas. So we need to incorporate along with these binders a treatment program that will include nasal sprays that will specifically treat mold in the sinuses. And we need oral medications that specifically will treat the mold in their gut.
Everything that I’ve said sounds fairly straightforward. We have to check our home to see if there’s mold there currently, and we need to use the correct binders, and if it’s present, we need to eradicate the mold from the gut and the sinuses.
As it turns out, it’s much much much harder to do that than you might think.
Using the binders and killing the mold – both of them have the risk of increasing the amounts of toxins in the body and making people worse. We have found it to be quite tricky and requiring a great deal of intricate tweaking to find the right doses of binders and then finding the right dose and method of administration of the treatment of the infections so that patients can very slowly get better.
What I will say is that some of my worst patients who I had not helped by a wide variety of other treatments – many of them are now getting better for the first time.
So I do think that mold toxicity is what we would call the elephant in the room. It is a huge piece of the puzzle.
For diagnoses, we talked about several things. We talked about looking at the blood test for VIP and about how if it is low, treating with it can be helpful.
We also talked about other blood tests – MMP9, C4a, VEGF. Do those really impact your decisions?
A question is how necessary those are compared to just looking clinically.
And then for treatment, what are you using to kill the mold outside of things like silver and bismuth? I know that those are my favorite biofilm disrupters. And then there is EDTA.
Are you using Pepto-Bismol to clear the biofilms in the gut, along with oral silver? Are you using anti-infectious agents?
I get a different patient population than Dr. Shoemaker. For pure mold, his tests are all very relevant, particularly for the protocol he developed.
My patients almost always have Lyme disease, bartonella and other infections. The tests that he has will largely be positive for them as well. So it does not help me to distinguish between those populations.
VIP is very useful in and of itself. The only lab that does a good job with that is a specifically ordered test from ARUP, which is a part of LabCorp. But it has to be done carefully. Routine LabCorp or Quest tests are not of much help there.
Do you send people to LabCorp to do the draw?
We do it at our clinic, because it isn’t always done properly even by them. Their techs don’t always know the right way to do it. It has to be done right. It’s tricky.
In terms of the biofilms, I use products that have EDTA and other biofilm busters for the gut. My favorite product is called InterFase Plus. I do use colloidal silver in both areas.
I use a specially compounded spray of amphotericin B or ketoconazole for the sinuses. Recently Dr. Brewer has pioneered using a new spray of Nystatin that we have available for that as well. We often use Sporanox as our primary medication for eradicating it from the gut.
We find that we need stronger medications than I usually use on candida, although these medications will have a beneficial effect on candida as well.
What dose are you using with the Sporanox?
It depends. I usually start with tiny doses like 100 mg, once every two weeks. Then I slowly ease them up until maybe I can get them to once a day. Dr. Brewer has taken it to as much as 200 mg of Sporanox twice a day. I don’t have any patients who can handle that very well.
The VIP seems to be offering a very powerful and helpful type of approach.
Are you still feeling that you have to kill the bugs in the nose before you go with the VIP? I know that Dr. Paul Cheney is moving away from that as being as critical.
Dr. Teitelbaum: “Are you still feeling that you have to kill the bugs in the nose before you go with the VIP? I know that Dr. Paul Cheney is moving away from that as being as critical.” (Note: Dr. Cheney discusses VIP starting at about 19:00 of this video.)
Dr. Shoemaker’s original finding was that the MARCoNS had to be addressed first. Some other physicians believe that it must be. Dr. Shoemaker believes that it must be but also admits that it’s very hard to completely eradicate and says that it’s less essential than we had thought.
I know that there’s way more on mold that we need to talk about. Dr. Brewer has agreed to come on to a later program, so I’m definitely looking forward to that. But for now, I hope that we have helped you to understand mold toxicity.
Dr. Ritchie Shoemaker’s website is Surviving Mold.
Dr. Neil Nathan’s website is Neil Nathan M.D.
Dr. Jacob Teitelbaum’s website is End Fatigue.
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Copyright 2014, The Cutting Edge of Health and Wellness Today.
Many thanks to Neil Nathan, Jacob Teitelbaum and Ritchie Shoemaker for allowing Paradigm Change to publish the transcript of this discussion.