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Mold and Mycotoxins: Often Overlooked Factors in Chronic Lyme Disease

Disclaimer: Treatment is always individual to the patient. The following information is not to be taken as a recommendation for any specific patient. Always speak to your practitioner before making any changes in your treatment. Mold testing is an evolving science, and new tests and treatments may be used that are not mentioned in this article.

Excepts from the article by Scott Forsgren with Neil Nathan, MD, and Wayne Anderson, ND
Originally published in the July 2014 issue of the Townsend Letter

‘Lyme’ Is More than Lyme Alone

Dr. Wayne Anderson has found that exposure to Lyme disease can make one more susceptible to mold illness, and vice versa; exposure to mold can make one more susceptible to Lyme disease. Both have the potential to affect the immune system and make the other more difficult to treat. […]

Symptoms Mold and Mycotoxin Illness

The symptoms may depend on the types of molds and mycotoxins, the duration of the exposure, and the overall health of the exposed person. Mycotoxins damage the immune system and may make one more sensitive to bacterial endotoxins found on the outer membrane of bacterial cell walls. With an increased sensitivity, the body’s response to Borrelia burgdorferi, the causative agent of Lyme disease, and coinfections may be heightened and lead to a further exacerbation of overall symptoms.

Mycotoxins can cause coughing, wheezing, asthma, shortness of breath, sneezing, burning in the throat and lungs, and sinusitis. Memory loss, confusion, brain fog, and cognitive impairment may present. Vision problems, eye irritation,  headaches, swollen lymph nodes, ringing in the ears, dizziness, hearing loss, fatigue, muscle weakness, multiple chemical sensitivities, joint pain, muscle pain, irregular heartbeat, seizures, depression, anxiety, irritability, psoriasis, skin irritation, fever, chills, sleep disorders, coagulation abnormalities, and numerous other symptoms have all been associated with mycotoxin exposures. […]

Genetic Predisposition to Mold and Mycotoxin Illness

Practitioners such as Nathan and Anderson integrate the best of the (Ritchie) Shoemaker Protocol with the recent findings by (Joseph) Brewer and their own clinical experience into a “best of all worlds” integrative approach. Anderson has said many times that if he could only run one test, the HLA DR panel would be the one that he would choose because it provides him the most useful information from any single test. […]

In patients with an HLA DR type associated with mold biotoxin illness, Anderson has found an association with their compromised ability to excrete mycotoxins via the urine. More specifically, some patients need to have their urine tested after a sauna session, which can mobilize mold toxins, or a challenge test with glutathione to demonstrate that they do indeed have a high level of mycotoxins in their system. These patients require a treatment protocol that supports the excretion of mycotoxins in order to optimize the test results.

Everyone has two HLA alleles, one from the father and one from the mother. Four combinations are known to be the primary mold susceptible types (7-2/3-53, 13-6-52 A/B/C, 17-2-52A, 18-4-52A). Anderson has found that when only one of the alleles has a primary mold susceptible pattern, there may be a milder illness presentation associated with the mold and mycotoxin issues. This does not mean that the person won’t have issues with ongoing mold exposure, but the treatment itself is often easier and the immune system often responds more appropriately when the body is dealing with this layer of the illness.

In contrast, a person with two mold-susceptible alleles will generally present with a more significant illness. They will be more likely to have a higher burden of intracellular mycotoxins. Until the detoxification systems are supported and working more effectively, these toxins may remain stuck inside the cells and thus may not be present when one is attempting to identify mycotoxins in the urine. Anderson has found that the more one’s genetic predisposition is toward mold-associated biotoxin illness, the more additional detoxification support will be needed; further, more aggressive antifungal therapies may be needed to treat any molds that may be colonizing the body. He has observed that the likelihood of colonization and how deeply inngrained in the system the mold issue may be can also depend on how susceptible the person is to mold-related illness based on genetic predisposition.

In those with a single allele defect, the colonizing molds will attempt to grab and expand their territory in the body, but the immune system can still control this expansion somewhat and the surface area affected will be mild to moderate. In those with a double allele defect, meaning that both HLA DR patterns are mold susceptible, there is often much more significant colonization. These same people often had more frequent ear infections as children, developed asthma as teenagers, experience irritable bowel syndrome with bloating and gas, and have sinus infections. Females may have more common vaginal yeast infections and a higher propensity toward interstitial cystitis. There is far less ability for the body to respond to colonizing molds and to detoxify from their mycotoxins when a double allele defect is present. Anderson’s observation has been that those with a single mold associated allele are often more easily treated for colonization. The treatment is more difficult than in a person with no mold-associated defects, but far easier than in a person with a double mold allele defect. In those with a double defect, a significant focus on detoxification is critical.

Beyond mold-susceptible or borrelia-susceptible HLA DR types, there are the multi-susceptible HLA DR types (4-3-53, 11/12-3-52B, 14-5-53B). With respect to the mold component of the illness, Anderson has found that the multi-susceptible HLA types are generally easier to treat than those with primary mold-susceptible patterns. His observation has been that those with the multi-susceptible types are more affected by formaldehyde, petroleum-based chemicals, solvents, pesticides, and insecticides. These then become the focus of detoxification. In Anderson’s world, detoxification is often the most important aspect of treatment.

Anderson has found that if one was born with a predisposition to mold biotoxins activated early on in life and later was infected with Lyme and associated coinfections, Lyme disease may be layered on top of the underlying fungal issue, and the fungal issue may not be what the person needs to address at that time. If the Lyme-related infections are what is drawing the attention of the immune system at that moment, it may only be after this layer is addressed that the fungal symptoms appear. In other words, some patients can have a significant mold load, but the practitioner may not be able to address that issue until the body is no longer being provoked by the Lyme layer.

Anderson has also observed that there can be seasonal influences that affect the primary layer that the body is dealing with. The immune system may have prioritized Lyme or a particular coinfection and may be ignoring underlying fungal issues; this can then flip in the winter when the rain hits. The increased exposure to molds in the winter may lead to the re-prioritization of the fungal layer by the immune system. At that point, Anderson may need to shift from treating the Lyme-related issues to treating the mold issue. If mold allergy is present, this may also be seasonally influenced. The protocols are dynamic and must constantly be adjusted based on several factors such as the environment, new exposures, and what the immune system deems the dominant issue or pathogen.

While HLA DR testing is often very helpful, it is important to note that this is a genetic potential but does not represent whether or not the specific genes have been expressed. There may be additional gene correlations that are equally important but simply detoxification pathways and facilitate the body’s ability to release the stored toxins. […]

RealTime Laboratories Mycotoxin Testing

Prior to performing the urinary mycotoxin panel, the practitioner must ensure that the patient can detoxify in order to optimize the results. Some not yet known. So, while this is often a very useful guide, a less than optimal HLA DR result is far from the end of the story in terms of one’s potential for recovery. […]

Some practitioners such as Nagy have found the use of far infrared (FIR) sauna (only when tolerated and not in patients with POTS or untreated adrenal insufficiency) prior to the urine collection to be very helpful. Both Nathan and Anderson have observed some patients who tested negative after a FIR sauna challenge but later tested highly positive when supporting detoxification with liposomal glutathione. These patients had far more issues clinically than what the test showed, and using liposomal glutathione for a week or more prior to the test collection can assist in opening up the cell membranes and facilitating excretion of stored mycotoxins. […]

Anderson has found the RealTime mycotoxin testing to be very reliable and values the quantitative nature of the results. He often performs the test on patients when mold-related illness is suspected or when their HLA DR pattern leans toward mold-associated biotoxin illness. It gives him insight into how close to the surface the mold and mycotoxin components of the broader illness may be. In a chronically ill patient, the mold and mycotoxin component of the illness is often one of many layers. An attempt to look for mycotoxins in the urine is often the most productive when this layer comes to the surface. […]

Mold and Mycotoxin Illness Treatment

Both Nathan and Anderson have worked with patients with mold- and mycotoxin-associated illness for several years. They are intimately familiar with the Shoemaker Protocol and have used it with patients with positive results. While the Shoemaker Protocol is not the focus of this article and is not covered in the approach outlined here, a combination of approaches may be used. With the recent publications from Brewer on the potential for colonization of fungal mycotoxin-producing organisms, they have incorporated a treatment approach based on these newer findings.

There are three main steps:
• removing the exposure
• binding internal mycotoxins
• treating colonizing molds in the body […]

Anderson often selects a binder in relation to how frequently the patient has a bowel movement. Constipation is the enemy of any detoxification protocol. If the patient tends to be more constipated, he will generally avoid the use of cholestyramine or charcoal and instead consider chlorella or modified citrus pectin. Modified citrus pectin adds fiber, which often enhances bowel movements. If one tends to have diarrhea, cholestyramine or charcoal may be perfect options. […]

Anderson follows a very specific order in approaching detoxification. First, the gastrointestinal system must be considered, as patients cannot adequately detoxify if they are constipated. Next, the liver, gallbladder, kidneys, and lymphatic system must be supported. Finally, toxins in the cells must be removed. However, you cannot start by attempting to dump intracellular toxins if the routes of elimination are not open, or you will make the patient more ill. “You simply add more traffic to the traffic jam,” says Anderson. […]

There are a number of herbal antifungal agents that may be considered, such as Byron White Formulas A-FNG and Beyond Balance MYCOREGEN. Anderson has used A-FNG as a multipurpose tool in that it both helps to support the body with removal of stored intracellular mycotoxins and serves to reduce fungal organisms in the body. He may use oregano oil or undecylenic acid. […]

In my discussions with Anderson, he has observed a connection between people living in the presence of mold from a water-damaged building and candida overgrowth. Treating candida is often far more difficult if the patient is still being exposed on an ongoing basis to other molds in the living environment. In a number of cases, Anderson has worked with patients who reported vaginal discharge associated with candida infection shortly after moving into a moldy home. Living in an environment with ongoing mold exposure leads to immune dysregulation that allows candida to overgrow in the body. Anderson has noted that abnormally high candida antibodies are commonly found in his patients. While candida is technically a yeast and not a mold, it does produce mycotoxins that negatively affect health and thus needs to be considered in a treatment protocol. Fortunately, it responds to many of the same antifungal therapies used for the treatment of colonizing molds. […]

Mold Allergy

Nathan and Anderson have each noted that one can have both mold toxicity and mold allergy. Each of these may need to be treated separately in order to fully address the broader mold illness. Immune therapies such as low dose allergen (LDA) or Low Dose Immunotherapy (LDI) injections can be helpful in those presenting with an allergic response, or an overreaction of the immune system, to the molds. Desensitization may be approached using sublingual drops that are personalized to the specific patient. […]

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