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WHAT I LEARNED ON MY SPRING “VACATION”
Lessons from the recent AAEM Mold Conference
A few weeks ago, I was privileged to be part of the American Academy of Environmental Medicine’s Mold Conference, held in Dallas, Texas. Janette Hope, MD, organizer of the meeting (and excellent presenter) put together an incredible group of physicians who are especially knowledgeable about the diagnosis and treatment of mold toxicity and it was great fun to be able to meet some wonderful healers with whom I had communicated by phone and email, but never met, and share our information over three days.
So here are some of the “pearls” I took away from the meeting that will help shift what I do and what I think I know.
Before I get to the pearls, I want to share how gratifying it was that we were all on the same page. Almost every speaker shared their views that the measurement of urine mycotoxins was extremely helpful for both diagnosis and treatment and that the use of both binders and antifungal medications was central to the treatment for most patients. It is nice to be able to stop arguing about these things so we can move on to discussing the finer points of treatment.
Almost every speaker made an effort to stress that it may take 3-5 years for many patients to get well from mold toxicity, and that patience on the part of the treating physician and the patient is paramount for success.
Irene Grant, MD, pointed out that the only treatment that significantly dissolves mold when it living in its hyphae form is amphotericin B. While the use of other antifungal medications can be useful for helping to kill mold and candida in other forms, this may help me to understand why some patients have taken longer to improve. Michael Gray, MD, then suggested that the use of 0.06% amphotericin B taken both as a nasal spray, and/or orally, was very useful for this purpose and produced much less nasal congestion and side effects than stronger doses.
Keith Berndston, MD described, in some detail, the direct route which VOCs, biotoxins, and PAMPS (Pathogen-Associated Molecular Patterns) and can take to go directly through the nasal passages, through the olfactory nerves to the front of the brain through the cribiform plate. This helps to explain how, for our MCS patients, offending scents can cause a reaction within seconds of exposure to certain chemicals.
Sonia Rapaport, MD, emphasized the kinds of cyclical amplification (downward spirals) triggered by those environmental exposures that set off chronic inflammatory stimulation that the body has difficulty turning off. These spirals include a progressive increase in an inflammatory response, worsening of the psychological response, and an increase in mitochondrial dysfunction, all of which are characteristic of our chronically ill patients. We are finding it useful to replace the term CIRS with EAI (Environmentally Acquired Illness) as a better way to describe these conditions, and Dr. Rapaport provided a system to help define the initial presentation of our patients in EAI Severity Categories I, II, III a & b. This helps us to quickly get a handle on the complexity of each patient presenting to us, with categories I and II representing patients who are less ill, having stronger constitutions, and III a & b those patients who are unusually sensitive and/or toxic, who present with a more complicated illness picture. She, and several other speakers, commented on the common finding of looser ligaments as found in Ehlers-Danlos patients as something we should be looking for on physical examination as yet another piece of this puzzle.
Dr. Gray proposed another name for the complex illnesses we are seeing as “Cumulative Organic Chemical Hyper Toxicity.” He noted that zearalenone (measured on the new Great Plains mycotoxin test) is a potent estrogen dysregulator and suspects we will find it present in many cases of endometriosis. He emphasized that inhaled particles (or nanoparticles) of mycotoxins or mold fragments are far, far more readily absorbed into our bodies than body any other route of administration. This means that oral exposure to molds (i.e. in food) is much less likely to be a source of mold toxicity than air-borne particles. Most of the speakers expressed their agreement that moldy food was not the likely source of elevated urine mycotoxin levels or symptoms. He also noted that in one study, dry cleaning moldy clothes seven times did not clear the tricothecenes present in those clothes. He and other speakers emphasized that cleaning visible moldy areas with chlorinating agents (bleach) did not eradicate the mycotoxins and made those mycotoxins more lipid soluble (so they could be better absorbed through the skin) and thus, in fact, promoted longer half-lives making them even more toxic for humans.
Alan McDaniels, MD, reminded us that mold allergy may be playing an important role in our patients who have mold toxicity, and that by addressing and treating mold allergy we can make much faster and complete progress in treatment for many of those patients.
Mary Ackerley, MD, reviewed the importance of VIP (Vasoactive Intestinal Polypeptide) as enhancing phagocytosis of fibrillary beta-amyloid by microglia (the WBC of the brain), playing a role in smooth muscle relaxation and neuroprotection, decreasing neuro-inflammation and excitotoxicity, regeneration of the hippocampus, and regulating hippocampal NMDR receptors and synaptic transmission. Translation: correcting VIP by treating mold toxicity and replacing VIP at an appropriate time can assist significantly in healing. In rare cases, patients who take VIP can develop pancreatitis, so checking lipase levels may be helpful (personally I have not seen this), and an occasional patient may experience dysphoria (“bad mood”) and become irritable, dizzy, or find their OCD behaviors increase. The latter can usually be managed by decreasing the dosage of inhaled VIP.
For sleep, a significant problem for many of our patients, she noted the possible benefits of niacinamide (which breaks down glutamate), kavinace at bedtime, Remeron (especially for patients of low-to-normal weight) or Trazadone at bedtime.
Janette Hope, MD, has found that the use of nasal glutathione, 100mg/cc, administered with two sprays three times daily, (after administration lying down on one’s back with the neck extended helps with delivery) may help with healing mold toxicity. She has also noted benefits using the essential oils oregano, mint, basil and sage. When patients are having reactions to treatment, some will benefit from the use of trisalts, 1 tsp in a glass of water. The use of specific lactobacilli, namely, rhamnos, casei and plantarum, may protect against aflatoxin or ochratoxin effects.
All in all, it was a fabulous conference and I was honored to have participated. Quite a few Board members of ISEAI gave several of these lectures (see below, with photos), and the camaraderie and enthusiasm generated was palpable. We are looking at the future of education and training in the understanding and treatment of chronic environmentally acquired illnesses and I, for one, am excited.
The ISEAI Website Is Launched
(International Society for Environmentally Acquired Illness)
As of two weeks ago, the ISEAI website is now up and running.
Please check it out, at https://iseai.org. Memberships of all kinds are available, which will give access to a growing library of information, blogs, websites, YouTube videos and ultimately to the opportunity to become certified in the evaluation and treatment of these illnesses. The first conference is being planned for early May, 2019, so check this space for more details. In addition, ISEAI Board members will be speaking at the upcoming TFIM meeting in Chicago, April 5-7th, the Delmarva conference in Baltimore, April 21-22, and the AHIM (Academy of Integrative Health and Medicine) September 22-26th, in San Diego.
The ISEAI group carries the credentials, experience and enthusiasm to spearhead the teaching and certification of physicians who are interested in helping patients with chronic environmentally acquired illnesses, so be there or be square!