Lisa: Yeah, absolutely. Well, look mould toxicity, or I guess really mould illness, but it’s also CIRS, which is chronic inflammatory response syndrome…you can get mould illness from a number of…a number of things can happen to you when you’re exposed to mould. But I guess when we’re talking about chronic inflammatory response syndrome, what we’re talking about is a multi-system cluster of symptoms that occur in susceptible individuals who have been exposed to a water-damaged building and any subsequent mycotoxins that come from that. And it really comes from an inflammatory response to that.

So that’s the chronic inflammatory response syndrome. Some of the key things that you might see in CIRS are things like fatigue and weakness. And there’s a number of other symptoms which we can go through if you like.

Andrew: Yeah, sure, absolutely. You know, straight off the bat, I’ve go to ask. So when we are talking about CIRS, are we talking about a genetic predilection for an inflammatory response to these mould toxins, whereas others who don’t have this are still exposed to them but just don’t react?

Lisa: Yeah, that’s right. And I guess that’s what I mean by susceptible individuals. So an entire family could be exposed to a water-damaged building in their home and maybe one or two of the family members will be affected by CIRS and the others may not, or they may have other things that may be more allergy-related. But there is…some of the research that Dr. Shoemaker did suggests that there is a genetic susceptibility and that’s genes related to antigens, which is the HLA DQ/DR genes. And there’s certain combinations of haplotypes of those genes that will indicate whether someone may be susceptible. I have seen handfuls of people who may not necessarily have that susceptibility and still get CIRS, but, on the most part, that is what is part of the genetic susceptibility.

Andrew: Okay, gotcha. So we are sort of seeing a kind of picture, and it’s not the same, I get it, but it’s a kind of picture like the predilection for autoimmunity, the kind of picture for, you know, gluten intolerance, that sort of thing. Is that correct?

Lisa: Yes, absolutely. So it’s a susceptibility. So it’s not a diagnostic tool, but it’s something that may mean that that person is susceptible. And really the reason is, is because it’s to do with your ability to be able to form an auto…I guess, to trigger off the adaptive immune system, or the part of the immune system that creates antigens. People with specific… HLA DQ haplotype combinations, they tend to not be able to do that. So what happens is the innate immune system gets triggered and the innate immune system gets triggered with most people. But what happens with a normal population is that then that converts into…triggers off the adaptive immune system, and then you form antigens and you get rid of the mycotoxins out of your body.

But what happens with those that have this susceptibility gene is that the innate immune system just keeps on going and it doesn’t necessarily trigger off the adaptive immune system. And then, as a result, there’s this indiscriminate inflammation cascade that happens in different parts of the body, and that’s why it’s multisystem.

Andrew: Right. So let’s discuss some of those systems because, you know, we’re talking immunity inflammation. So, one would immediately think of, you know, the allergy-type scenarios, the dermatoses-type issue, perhaps some joint pain even, or energetics, stuff like that, but it goes far further than that, doesn’t it?

Lisa: Yeah. I mean, I guess the trick with CIRS is that it sets off the innate immune system, and often some of the more common inflammatory markers we might use, like C-reactive protein or ESR, actually are normal in CIRS patients. So there’s actually specific inflammatory markers that we use in CIRS to actually help us ascertain whether that’s part of the picture. So it’s kind of a bit tricky like that. And it doesn’t even necessarily trigger off autoimmune markers, although I do sometimes see that concurrently happening with individuals. But yeah, there’s a whole cascade of inflammation.

Andrew: Okay. What sort of markers do you look for then? What sort of things?

Lisa: Well, interestingly, there’s no one test for CIRS. There’s no one test for mycotoxins, but what we do look at is we have to look at a number of different markers that are available to us in combination with a good case history and meeting the symptom criteria, and actually having exposure, so it’s kinda like a clinical analysis in a lot of ways. But if you’re going to look at some of those markers, they’re things…like the leptin goes high and your vasointestinal peptide goes low. There’s high osmolality, there’s the antidiuretic hormone goes out of whack and that goes low. So there’s a number of markers that we can use.

The only problem in Australia for us, and it’s different when it comes to places like the U.S., but in Australia, we can’t do all of those markers, so there’s only some that are at hand. And so, sometimes we might have to utilize other markers that just tell us whether there’s been a mycotoxin exposure, like the urinary mycotoxin test, but that’s not necessarily an indicator of inflammation, but it’s an additional piece of information. So you kinda have what we can in Australia plus case study plus symptoms, you know, and what information we have at hand to then bring it all together and then understand that it’s CIRS.

Andrew: Gotcha. Forgive me, when we are talking about, like, measuring antidiuretic hormone, so ADH, does that go in hand with things like glomerular filtration rate eGFR? Do you measure that sort of thing? Do you have issues with hypertension? Do you have issues with…what’s that? Postural…

Lisa: Orthostatic tachycardia syndrome.

Andrew: … tachycardic syndrome? Thank you. Thank you.

Lisa: Yeah, that one.

Andrew: That one. Sort of… Yeah, so is it more POTS, or is it more hypertension? It would be POTS, wouldn’t it?

Lisa: Yeah, it’s more POTS. So, you know, that’s just one of the many markers. So what happens as part of CIRS is that you get low melanocyte-stimulating hormone, which actually then has a relationship with some of these things like antidiuretic hormone. And so when there’s a dysregulation basically, it dysregulates all your electrolytes. So you do have a problem with potassium and sodium and things like that. And often, you know, you see in patients, they also end up having POTS as well.

So there’s quite a number of concurrent things that happen when you have CIRS, and in a mouldy environment, you see mass cell activation, you see POTS as well. Everyone doesn’t always get those things as well, but it’s worth mentioning because they are things that you see. So if someone does present to you that suddenly has POTS, you know, that only seems to have come on over the last year or two, and then it’s really important then to do a timeline with that patient and to understand, “Oh, did that line up with when they, you know, moved into that home, or there was a storm or flood in their home?”

Andrew: Right. Gotcha. And sorry, you mentioned alpha-melanocytes stimulating hormone, alpha-MSH, so that’s also tied in with weight control as well.

Lisa: That’s correct. And so this is where… well, this is why we look at leptin. Yeah. So leptin tends to be high, vasointestinal peptide tends to be low. So this is what I mean about you kinda need to look at the pattern of results. So if you looked at leptin on its own, lots of people can have high leptin for all sorts of different reasons. But if at the same time, they also have low VIP and some of the other things, it’s, like, well, this is the pattern that you tend to see. So what happens is those hormones get dysregulated and they do the wrong thing per se. So they’re giving each other the wrong signals, and so then it just perpetuates this dysregulation, and that really comes as a result of all the cytokine storm that happens.

Andrew: Good old inflammation, here we go again. So the seat of inflammation, of course, is the gut. So let’s talk about this because you encompass so many things here. It’s not just the reactivity, but the programming as well of the immune system, and more than the immune system. So take us through how important the gut is in looking at mould toxicity.

Lisa: So, you know, one of the things that…I mean, there’s lots of different systems that get affected. We only just touched on a couple of them. You know, the gut also gets affected. And I guess in the official symptoms, you know, it suggests things like abdominal pain and diarrhea. But in practice, what I often see is also constipation and a number of other things like SIBO and leaky gut. And so, you know, what people will see when they go and have a look at what CIRS is and what some of the treatment protocols are, one of the number one things, apart from actually getting away from the mould…so we must always remember that the number one thing is the person actually has to get away from the mould. That’s really important because if they sit in the mouldy home and they expect your treatment to work, it will help them sort of get through, perhaps having to then deal with that remediation or moving, but it certainly is not sustainable while they’re still being exposed.

So, yes. Then secondary to that, I guess the key thing is the binders. So, because, like I was saying before, those that are susceptible aren’t great at then binding the mycotoxins and getting them out of the system, what we need to do is help their body to do that. And one of the ways to do that is the binders. So cholestyramine is the pharmaceutical binder that Dr. Shoemaker has always recommended and we’ve been, you know, using that over the years. Obviously, being a naturopath, you know, I can’t prescribe that, but also what we found in practice is that natural binders are very effective as well. They just take a little bit longer.

And so the issue with binders is that it actually relies on, one, that you’re having bowel movements, and two, that you’re actually producing bile. So, using something like the pharmaceutical binder, what that is is actually a bile sequestrant. So you actually need to be producing bile for it to work properly. And then the other thing is is that sometimes some of those drugs can also interfere with B12 absorption and processing, which, you know, they may already have a problem with that. It has other side effects. So, I guess the number one thing before you can even start the binders is you have to get the gut moving, right?

So, you know, making sure the person is actually, you know, having a bowel movement and bile production is important. But maybe before we go there maybe I can talk a little bit about actually how mould itself affects the gut. So, even though, like I said, there’s just a couple of symptoms in the symptom cluster analysis for CIRS, you know, in practice, we see so many things. And so over the years, you start noticing patterns. So I notice that pretty much most people had SIBO or everyone had leaky gut, etc. So, that then leads us to think of, well, what are these mycotoxins actually doing to the gut?

So I guess there’s probably two key…like, to summarize, the two key areas that affects the gut, it’s both structural and functional. So aflatoxins and a couple of other mycotoxins, they can actually damage the intestinal line. So they can actually interfere with the protein that links the epithelial cells together in the intestinal barrier. And so that’s how it kinda impacts the leaky gut. It also reduces the gut protective mucin production. And then, I guess as a result of that, then you get the intestinal, you know, permeability don’t you?

And then the other thing that affects is things like the microbiome. So exposure to some mycotoxins can actually increase the bacteroides, and, you know, ochratoxin, for example can reduce [00:13:47] and bifido species. And then, of course, the whole inflammatory cascade then affects the migrating motor complex. So, as you can see, there’s quite a different…quite a number of ways that affects the gut, just even actually being exposed to the mycotoxin themselves.

Andrew: Yeah. Just going back to cholestyramine. I mean, this was the cholesterol-lowering agent or drug of choice before statins made their boom onto the market. And indeed, you know, the use of them is not without their precautions. I remember there was, like, quite dire circumstances in some instances. So it really does require the intervention of a medical practitioner, if for no other reason than medical illegally.

But I do take your point though. It’s kind of like, if you haven’t got the bile flow for the cholestyramine to work on as a binder, it’s sort of like that scenario that we talk about with say taking an antidepressant. If you haven’t got enough serotonin, you can’t reuptake it. So you need to make the serotonin to have it reuptaked. In this case, you need the bile flow in order for it to act as a binding agent for that bile. So that being the case, do we have to go right back to the very simple naturopathic axioms about move the guts, water, you know, exercise, sleep, movement, so that the bowels keep moving in a normal pattern? Or has it just gone too far and there’s like this pathophysiological issue causing the constipation now?

Lisa: I think it’s actually a bit of a combination. I think that we definitely need to focus on the gut and help support that, and particularly bile production. But it doesn’t take away from the fact that they still need to get away from the mycotoxins in the first place. So yeah, it is really important. And, of course, you also need to see where that person’s at. So they might have been living in this mouldy environment for a long time and they might have had constipation for a long time.

And so, you know, sometimes you’ll get patients where basically their gut is asleep, you know. You’ve got this pretty much gastroparesis, you know? And so, we have to really work to try and make sure that there’s some movement. And sometimes I’ve had people even come to me who had their gallbladder removed. So they’ve obviously had all these issues and there’s been no connection to the environment, which, you know, to be fair, if someone’s got gut problems, you’re not always gonna go and look at their environment, but if they’ve got gut problems and a whole load of other things, you’ve gotta think about it.

Andrew: Ah, so that was gonna be my question. Like, when do you tease it apart to being a functional gastrointestinal disorder and when is it really a mould issue? So I think you’ve just answered that, and that is that you see the symptoms, you see the signs of a mould-damaged building. Is that right? Is there sort of physical hints that you might…

Lisa: Well, I mean, I think…

Andrew: …be alerted to?

Lisa: Look, I think there’s a couple of things that, so if you were a practitioner that focused on gut health and you had a patient that came to you, there’s a couple of things that would be a red flag. One would be if they’ve had SIBO over and over again and it doesn’t resolve. So unresolving SIBO is one of the red flags. The other thing is that they, in some cases, depending on whether they’re they… So when people are exposed to mould, they can also not just have CIRS, but they can also be what we call colonized by some sort of effect by breathing in the mould, so they can get candida and, you know, they can have internal fungal infections, so they might have that as well.

And then the other thing that’s a bit of a sign is if they have multisystem. So if it’s not just their gut but you’re noticing there’s other things, like they’re getting severe fatigue, they’re forgetting stuff, they’ve got sinus problems, or they’re getting dizziness and other things that you may have originally thought might have been to do with their gut, but if it’s affecting a number of different systems. And the reason why I’m saying this is because having mould in your home is not always obvious.

So, you know, even in my own experience, in the second time we were affected, it was a pristine white room. There was no mould visible whatsoever. And so people can…it doesn’t even occur to people that there might be some mould in their house. So sometimes it takes a bit of digging, but, you know, this is what I mean about red flags.

Andrew: I’m remembering things that Nicole Bijlsma alerted me to about the prevalence of water-damaged buildings, and I went, “Nah, I don’t have water damage in this building.” Yeah, I do. When I looked around, it was like, “Oh, it’s there and there, and, you know, whenever it rains.” And there’s all of these issues that we just don’t attribute a significance to. It tends to be a trivialized thing, and yet it can be quite traumatic for some people.

Lisa: That’s right. And I think some people also think it’s just the black mould. “Well, it’s not black. It’s just that white stuff, or it’s just the green stuff or the yellow stuff, whatever, you know.” So culturally, we are not necessarily used to looking at mould and thinking, actually, it’s not just the black mould, it’s other moulds as well.

So the other thing that might be worth, you know, considering too is that if you have been treating a patient for gut issues and you might run like a DNA, you know, comprehensive gut test, for example, you might see some things in that test too that might even make you have a little bit of a think. So, for example, if they have high β-glucuronidase in the comprehensive stool test.

And the reason why I mentioned that is because, you know, elevated β-glucuronidase is to do with poor glucuronidation, right? And so, one of the key pathways that is utilized to detoxify mycotoxins is through glucuronidation. So if somebody has got poor glucuronidation, you’re gonna see high β-glucuronidase in their stool test. So, you know, that’s one of the things, you know, that’s a marker.

The other markers you might see are things like the enterococcus and bacillus species might be elevated, and they’re associated with poor bile production or HCL production and/or SBO. So again, you might see that elevated because, you know, their body’s trying to break…they’re not producing enough bile basically. Yeah. So there’s, you know, a number of things you can see and go, “Oh, that’s interesting.” And the odd person might have elevated candida, but it’s not necessarily a thing because, you know, you can still have CIRS and it’s nothing to do with candida. But candida isn’t a marker of CIRS per se, but you might see that in there too.

Andrew: Right. Gotcha. Yeah. Because candida is a commensal in many people without issue. But if we talk about clinical tools for a moment, like, you know, I mentioned talking about supporting the liver bile flow, for instance, so simple things like choline, like taurine, like vitamin E, water, as I mentioned before, very, very simple things that affect the cholesterol triad. Do you employ these? What other tools, what other clinical tools do you find most useful in helping even just the simplest thing like bile flow?

Lisa: Yeah, look, it’s a good point you’ve raised. Look, choline is awesome because choline not only helps with that, but it also helps with the liver and it also helps with brain function. So, you know, you’ve got people who have got terrible concentration and memory and fatigue, etc. So choline’s actually really important. And so, yeah. So there’s simple things like that. So, of course, any of your cholagogues. So, you know, those out there who are herbalist or naturopaths and who work with herbal medicine, you know, those herbs that have cholagogue properties in them are also helpful because that will help with bile production. And also, you might have to get them going because they might be really stuck. So you might need to give them some digestive enzymes as well. So digestive enzymes are really helpful. They might need some HCL as part of it.

So yeah, so those kind of things. And I guess if they have SIBO as part of the picture, something that has like a berberine in it is probably helpful, because berberine is not only good for SIBO but it’s also good for, you know, depending on which plant you’re using with berberine in it, but it’s good for the leaky gut, it’s helpful for the liver, etc, etc. So, you know, there’s quite a few things that can be used there.

Andrew: Yeah. I think we are learning a lot more about berberine with its cardiovascular protection if you like, from reduction of lipids, but also its use in diabetes as well. So it’s a herb that we used to compartmentalize and now its use is expanding. It’s really interesting. It’s like a curcumin story, isn’t it? You know?

Lisa: Yeah, absolutely. It’s an awesome herb. The other thing… Oh, sorry, go on.

Andrew: I was just gonna ask, do you find that…you mentioned β-glucuronidase increases before. Do you therefore employ like copious amounts of, say, calcium D-glucarate, or do you use quite, you know, tiptoeing doses and ease your way into this because of overload?

Lisa: Well, it depends on where the person’s at. So, one of the confounding issues with CIRS is that it also affects hormones. So I usually get one of two things in a patient. There’re either poor estrogen metabolism. They have signs of having poor estrogen metabolism and high estrogen, or I have people who have no…their hormones have bottomed out. So, one of the things that obviously if you are wanting to process estrogens, you need glucuronidation, right? So in those patients, yeah, I might step a bit further with the calcium D-glucarate with those patients, but generally speaking, I do do it,

The other thing that sometimes is used is sulforaphane. So products with sulforaphane in them as well are also helpful because that’s not only helping with that pathway, but it’s also helping with the gut microbiome and, you know, it has a number of benefits sulforaphane. So it depends on the patient really. Yeah.

But just going back to the cholesterol thing for a moment, is that one of the other things that I also see is that sometimes people actually have low cholesterol. And so, again, importantly, in terms of binders that we also choose binders that aren’t necessarily pharmaceutical that might then further reduce that. And particularly in a situation where those people who have got the low hormones, you know, we don’t wanna have to further reduce their cholesterol. So also really important to have fat-soluble vitamins as well. So they need vitamin D, they need vitamin A, they need vitamin E and K, you know. So it’s also you need to replenish some of the fat-soluble vitamins as well.

Andrew: Yeah. Great. Okay. Good point. With regards to that, now, we spoke about cholesterol being low and being high and that sort of thing. So do you ever employ, you know…like we spoke… Forgive me. We spoke about vitamin E with regards to the cholesterol triad, and I’ve gotta say, my knowledge of vitamin E over the years has just changed from what…you know, it was the alpha-tocopherol. You know, we knew it had to be the DL-alpha-tocopherol. Forgive me, the D-alpha-Tocopherol, the natural form, not the synthetic DL. And it’s moved totally from that to the tocotrienols. And now, we’ve got the high-delta forms available to us and things like that, delta gamma. So, it’s really interesting how the story of vitamin E has just changed over the years. Do you move with this? Like, have you changed how you used vitamin E?

Lisa: Well, it’s interesting to say that, because I think after listening to some of the presentations from the CASI conference that Designs for Health was facilitating a lot of practitioners being able to watch that, which was awesome. The vitamin E that was discussed there sounded…just like you said, it has progressed and it is something that is useful in practice. In terms of priorities, I probably…it depends on the patient as to when I would use that, because, you know, obviously, I need to get their bile and all those sorts of things going, and definitely if they’re on Cholestyramine. So if they’re concurrently having Cholestyramine as well as the treatment that I’m doing, I definitely would use the vitamin E and the D and the K. So, yeah, absolutely.

Andrew: Yeah. Got it. Okay. And, sorry, just to recap on what you said there, it was Barrie Tan, Dr. Barrie Tan, talk about a.

Lisa: Thank you. Yes.

Andrew: I love that guy. What a genuine man, just dedicated to researching for humanity, like so impressed with him.

Lisa: Yeah, he’s awesome.

Andrew: Okay, so we’ve covered some things that you use. What about probiotics? What about fibers?

Lisa: Yeah, I mean, that’s really interesting. Look, I think that as part of their overall treatment, you know, like I said before, you know, when you look at their stool tests, I don’t think I may have mentioned, but sometimes the secretory IgA is also out of whack as well. So, you know, reflecting on what I was saying before about how some of the microbiome gets affected by the mycotoxins themselves, it definitely needs some bifido species, you know, we need lacto species, some of the lacto species, and saccharomyces boulardii. So yeah, that is helpful. And yeah, I use that from the outset really with whatever else I’m doing, because they’re usually not in a good way.

Andrew: I’ve gotta say, saccharomyces boulardii is always my go-to probiotic before any other probiotic. And if I need an immediate effect…I know there’s those people that need to avoid milk. I get it. But if I have an infection or some sort of acute thing going on, it’s colostrum straight up. But saccharomyces boulardii does so many things. It’s a wonderful organism from the lychee and…what is it? Lychee and mangosteen fruit skins. We keep forgetting that it’s actually a TCM. So what about pitfalls? You know, like, everything can’t be good and safe. Is there any traps that you find practitioners falling in when they’re treating mould illness? You’ve mentioned one straight off the bat and that’s SIBO.

Lisa: Yeah, look, I think some of the pitfalls actually is perhaps seeking to treat something like SIBO over and over again and not getting a result, and some of that might be because actually they’re still not out of a mouldy environment. So, you know, there’s some pitfalls around there. And again, that kinda links into what I was saying before. If you didn’t realize that mould was part of their picture and you were treating SIBO and it kept still not being resolved, and that would be a red flag. But the pitfalls I think with mould illnesses, not to get too overwhelmed, you know, I think always go back to our naturopathic training around, you know, systems, because this is a multi-system illness. And so you need to make sure…and it’s holistic.

So we need to make sure that we don’t get fixated on one area and forget the other things and forget the person that’s in front of you and forget that they might need resuscitating for want of a better term. And I think, as part of that, one of the pitfalls is perhaps not recognizing the effect of mental health with the person in front of you. And, you know, validating them is really important as part of it, becuse they’ve usually been going through these symptoms for ages and they’ve been to every specialist under the sun and no one can figure out what’s going on. So validation is something there. But I think the pitfalls is that just assuming that the person’s okay and/or that by just giving them all the supplements and all the physical stuff, it’s all gonna be all right.

But actually, part of the problem is also part of the autonomic nervous system, because the autonomic nervous system also gets really hyper and stimulated as part of the whole process. And you’ve gotta remember, if you go home and you look around and you think, “This home is making me sick,” that’s massive. You know, that’s that’s a trauma in itself, a massive source of stress. And so I think one of the pitfalls is not…it’s forgetting the psycho-spiritual side of things for people and making sure that you also support them on the mental health side and that also, you know, either they have another appropriately qualified people around you who can help them with that and also moving through the trauma. So I think that’s one of the things it’s not forgetting that, you know, there’s some nervous system work that needs to be done as well.

Andrew: Yeah. I mean, how often do we ourselves as natural medicine practitioners berate those orthodox practitioners who might be specialists in one area and not think or not pay homage to the interconnectedness of the human body. And yet we ourselves fall into that trap when we are looking at something like CIRS or mould toxicity, and instead of that, we are just treating the gut, or just treating the mind, or just treating the immune system. It’s really interesting how we really need to be on our game all the time with the potential issues that might be the cause or a cause of a condition presenting in a patient. It’s really interesting stuff, Lisa.

Lisa: Yeah, absolutely.

Andrew: So I gotta ask last question, where can we learn more? Because this is obviously not a podcast issue. This is a lifetime. This is a career-type issue. I think even a seminar, like let’s say a weekend seminar, that really would be scratching the surface because of how complex it will be.

Lisa: Yeah, absolutely. Yeah, absolutely. And because it’s multisystem and there’s lots of different systems that get affected as well, and, you know, it is looking as the whole person. Look, I guess in terms of…if listeners are wanting to understand more about CIRS or maybe deep dive into a little bit more, there’ll be some resources on my website, which is indigosagehealth.com.au. And I also have another website, lisamcdonald.com.au. And on that website, there’ll be some resources that you can link into and there’ll be some upcoming webinars that if you sign up, you’ll find out more about those as well.

Andrew: Lisa, thanks so much for taking this. This is a conundrum, and that’s an understatement, CIRS and mould toxicity, certainly, for those patients who are suffering this. And I’m remembering… Forgive me, I can’t remember her first name, but her last name was Hudgins. And what she went through was nothing more than atrocious with how she was just handed to the medical professionals, told it’s all in her head. It was a horrible story.

I can’t remember… Rebecca Hudgins? No, fantastic woman. And it shows her physical changes from a corporate person in New York and how that mould and the illness really took her. And I just hope she’s doing well now. So she found a great doctor in the end. But Lisa, thank you so much for taking us through at least part of this conundrum today and how important it is to look after the gut in a holistic way, not just treating conditions. Thanks so much for joining us on “Wellness by Designs.”

Lisa: Thanks, Andrew. It was a pleasure.

Andrew: And thank you for your company today. Remember you can catch up on all of the other podcasts and especially the resources that we’re gonna be posting up on the Designs for Health website as well as Lisa’s websites as well. Thanks so much for joining us today. This is “Wellness by Designs,” and I’m Andrew Whitfield-Cook.