Episode #223: TOXIC and Beyond with Dr. Neil Nathan, MD
In a Nutshell
Dr. Neil Nathan explains Long COVID as an "unmasker" revealing hidden mold toxicity, Lyme, Bartonella, and reactivated infections, often triggering POTS, dysautonomia, and mast cell activation via cell danger response (CDR) and limbic/vagal dysfunction. Key treatments prioritize mold/mycotoxin removal with binders and urine testing first, followed by infection protocols, hormonal supports like mineralocorticoids/Clomid, IV phosphatidylcholine, and later peptides/LDN; address sensitizers (EMFs, TMJ/CCI, secondary EDS) alongside inflammation markers (14-cytokine panel, TGF-beta1). Empirical approach: listen to body readiness, reboot immunity by reducing triggers, and maintain lifelong low-dose binders for ongoing toxins, resolving MCS, CFS/fibromyalgia, and related chronic illnesses in most patients.
These notes were generated by AI and may contain inaccuracies.
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Episode 223: Toxic and Beyond with Dr. Neil Nathan, MD. Dr. Nathan has practiced medicine for over 50 years, board certified in family practice and pain management, founding diplomate of the American Board of Integrative Holistic Medicine and ICI.
Books:
- Healing is Possible, New Hope for Chronic Fatigue, Fibromyalgia, Persistent Pain, and Other Chronic Illnesses
- On Hope and Healing for Those Who Have Fallen Through the Medical Cracks
- eBook: Mold and Mycotoxins: Current Evaluation and Treatment (2016, updated 2022)
- Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illness (best-selling, 1st ed.; 2nd ed. late 2025 with new information on complex chronic conditions)
- Energetic Diagnosis (2021, on intuition and energetic devices for diagnosis/treatment)
- The Sensitive Patient's Healing Guide (2024, on treating sensitive patients)
Treats chronic complex illnesses for 30 years, Lyme for 20 years. Focuses on highly sensitive, toxic patients intolerant to usual treatments, finding unique recovery methods.
Dr. Nathan's 7th appearance:
- Episode 19: Cutting edge medicine
- Episode 85: 1st edition of Toxic
- Episode 121: Cell danger response
- Episode 122: Precision mycotoxin detoxification
- Episode 160: Energetic Diagnosis
- Episode 200: Sensitive Patient's Healing Guide
Urges listening to Episode 85 for Toxic basics. This episode focuses on 2nd edition updates and listener questions.
Long COVID impacts over 35 million in US. Lyme was 'great masquerader'; COVID as 'great unmasker'—exposing mold, Bartonella, Mycoplasma, Epstein-Barr. Pre-existing issues well-managed until COVID/spike protein overflows the bucket; some unaware of prior mold/Lyme until long COVID.
Dr. Nathan's view: Combination. Exposure to toxic/infectious agents (mold, Lyme) tolerable with robust immune system, like latent viruses kept in check. Immune hit (COVID, flu, infection, childbirth, surgery, emotional stress, betrayal, loss, abuse) loses containment, allowing emergence.
COVID major player in weakening immune system, losing containment of prior mold toxins, Lyme/co-infections.
Increased POTS (postural orthostatic tachycardia syndrome)/dysautonomia since pandemic.
Dr. Nathan: Result of body perturbations. Two main components:
- Dysfunction of autonomic nervous system.
- Triggers (mold toxicity, Lyme, Bartonella) impair pituitary hormone regulation, including mineralocorticoids (adrenal hormones regulating blood pressure). Common mineralocorticoid deficiency lowers blood pressure, causing fatigue, lightheadedness (low perfusion like trickle from low water pressure). Standing/moving suddenly drops pressure, pulse rises to compensate.
Treatment from both angles:
- Fludrocortisone (synthetic mineralocorticoid): Raises systolic/diastolic ~10 points each, improves perfusion/comfort without causing high BP.
- Reboot autonomic nervous system.
Address root: Mold toxicity, Bartonella, Lyme, infections messing with vagal system.
Limbic system (fear response) and vagal system interwoven. COVID freaked world out via media (overloaded ERs, respirator shortages), causing persistent limbic dysfunction + vagal dysfunction + mineralocorticoid deficiency = POTS.
POTS clinics give midodrine/fludrocortisone, salt/fluids, but ignore causes like mold/Lyme.
Excited about COVID-19 long hauler test distinguishing long COVID, post-vaccine injury, chronic Lyme (future: mold).
S1 subunit of spike protein stuck in monocytes drives long COVID. Treatment: Maraviroc + pravastatin.
Dr. Nathan/Patterson collaboration: Cytokine patterns for mold illness. Game-changer for complex patients (weak immune system + Lyme/co-infections + mold + reactivated viruses: EBV, CMV, HHV6, Chlamydia, Mycoplasma = 'infectious toxic soup').
Symptoms overlap (fatigue, brain fog, anxiety, depression, neuropathy, GI, shortness of breath, palpitations)—history gives hints, but cytokine panel teases drivers.
Mold/Lyme biggest, but rule out long COVID. Physicians misattribute to long COVID without mold/Lyme knowledge.
Panel shows immune wrestling priority:
- High long-haul index = long COVID.
- Else, Lyme or mold cytokines.
- Preliminary mold markers: RANTES, sCD40L (less in Lyme).
Data collection/AI analysis ongoing for validation/publication.
First-line for complicated patients: Order panel, then targeted tests (urine mycotoxins for mold; IGeneX immunoblots or Dr. Mozayeni's T-Detect for Lyme).
Spike protein/mold toxins/Lyme/Bartonella all trigger immune response causing symptoms. Treatment quiets inflammation differently per condition (not same for Lyme/mold/long COVID).
Maraviroc: Antiviral, shuts down toll-like receptors driving inflammation. + Statin quiets inflammation; immune reboots.
Mold: Binders/antifungals reduce load for immune reboot. Lyme: Antibiotics/herbals reduce load for immune reboot.
Goal: Strengthen immune system by removing impediments, appealing to innate healing.
Removing stressors brings immune discernment (not 'ready, fire, aim'). Opportunistic infections resolve post-reboot.
LabCorp spike protein antibody test: Valuable if pathology present. Robust immune tolerates spike/mold without issue. But if symptomatic, treat as 'ticking time bomb'.
Helpful: Nattokinase, ivermectin, other supplements break down spike.
Dr. Jill Crista: Spike affects acetylcholine receptors (loss of taste/smell). Tiny nicotine doses (cut patch to 1/4 or 1/8, titrate up) aids symptomatic/physiological recovery; may help mast cell activation, Ehlers-Danlos.
Episode 121 detailed Dr. Robert Naviaux's cell danger response (CDR): Cells enter protective hypometabolic survival mode; extracellular ATP as danger signal (not energy).
No closer to tests for CDR1/2/3 phases. Clinician judgment needed.
Key concept: Can't use mitochondrial supports until shift from CDR1 to healthier CDR2 (mitochondria monitor safety, shut down if unsafe).
~50% improvement: Trial mitochondrial aids (CoQ10, L-carnitine, L-taurine, malic acid, D-ribose)—ineffective if not ready (frustrates patients/doctors).
Still in love with CDR as overriding understanding of chronic illness. All about mitochondria restoring safety.
All the things you're giving me is all well and good. I can't use that. I'm freaking out here. I've got to get safer, meaning less mold, less mold toxin, less of an infection to whatever is triggering that to the point that now I can respond. That concept would help a whole lot of physicians who are otherwise confused about, well, you have zinc deficiency. I'm giving you zinc and it's not doing anything. Why is that? Or you're not methylating, so I'm giving you the supplements for methylation and you're getting worse. How is that possible? The answer is because you're not in tune with what that body needs at that moment. In my own practice really helped me to understand that, okay, I tried this and it's not working. I'm not going to keep hammering away at that, thinking, well, if I give you more of that, that'll work. Your body is saying not ready for it yet. I need to listen to that and then I can help you optimally.
Suramin is particularly amazing because there are 19 known purinergic receptors. Purinergic refers to things like ATP which is a purine and with everything in the body you need a receptor on a cell to accept what it's being given so it can do something with that. The beauty of suramin is it blocks all of them. So that we're literally shutting down this inflammatory response and potentially reassuring the cell that it is now safe. Suramin won't work until the body is safer also because it's still shut down. It's not like this is the cure all that all we ever need to do from now on is give everyone suramin and we'll reboot their response and they'll get well. We still have to get rid of the toxins and treat the infections enough that now these shutting down of the immune system will be effective to it. All of the things you mentioned work on one purinergic receptor and Dr. Naviaux has studied specifically many of those materials as to whether or not it shuts down the process and they don't by themselves. Many of things you mentioned have multiple beneficial effects. Many of them free radical binders will take care of that. Many of them have multiple benefits for multiple reasons. They're really good supplements, but from a purinergic receptor perspective, not enough.
We know that some hormone related interventions could be working in opposition to the cell danger response, maybe against the innate intelligence of the body. We see people all the time, I'm going to start testosterone replacement or thyroid medication. Those are kind of pushing on the accelerator when the body is intelligently tapping on the brake or slamming on the brake. When do you incorporate tools for the adrenals, the thyroid, and potentially for sex hormones relative to where the patient is in the cell danger response.
The way that mold toxicity and Lyme affect the pituitary's ability to regulate hormones, it's hitting a moving target. Fluctuating levels of mold toxin means fluctuating effect on the pituitary. It means fluctuating effect on all the hormones regulated by the pituitary, most importantly thyroid, adrenal, and sex hormones.
Hormonal Support as Deficiency Correction
I don't think of hormonal treatments as a band-aid. Rather, I think of them as supporting a deficiency that will help that patient to heal faster while we're fixing what's really wrong with them. If someone has a DHEA adrenal deficiency, giving that helps. If they have a cortisol deficiency, giving that helps. If they have a thyroid imbalance, getting the thyroid into better balance helps. Same thing with estrogen, progesterone, and testosterone. All of that helps. But it's important that physicians not try to be precise about that because you can't because you're hitting a moving target. You can get them into the arena of balance, but that's as good as you can hope to get and that will be helpful.
Concerns with Testosterone Replacement in Young Men
When it comes to testosterone specifically, I have concerns when young men are given testosterone directly because when they take testosterone, the biofeedback mechanisms of the body go, "Oh, you've got all the testosterone you need. I'll stop making it." In young men, I have had quite a few who were given testosterone directly. When they were done with that and no longer needed it, they found they couldn't get off because their body had shut down so completely. Other things than testosterone would be my way of working on that specifically namely Clomid which helps the body make more luteinizing hormone. It's not directly testosterone so it doesn't get into that biofeedback loop. Some people have this simplistic oh I am low in testosterone I'll take it. Bodies are not that simple. You need to understand the biochemistry quite a bit at a deeper level to know what kind of intervention you want to give in order to really help that person and not mess them up further down the road. If some is good, more is not necessarily better. We see people a lot of times pushing their testosterone really high, which may not be ideal.
One of our listeners noted that you have consistently professed your love for phosphatidyl choline. Wondering how one might know when the right time could be to introduce PC. There is that kind of cellular rigidity that happens as part of the cell danger response. Can phosphatidylcholine be helpful when someone is in that CDR and potentially move them out of it?
Benefits and Dosing of IV Phosphatidylcholine
I have repeatedly said that I love intravenous phosphatidylcholine. Every cell membrane in the body is largely composed of phosphatidylcholine. When the body holds on to toxins, it often holds them on the cell membrane. Patricia Kane who popularized intravenous phosphatidylcholine showed some electron micrographs of cells that were exposed to toxin and you could see on the outside of the cell it was chalk full of these little dots of toxin all just almost like it became super saturated on the outside. Using phosphatidylcholine is a great way to assist the body in unloading some of those toxins. In very sensitive people if you do that too quickly or with too much of a dose you can make them very sick by offloading that toxin faster than their body can process it. For very sensitive people sometimes we have to start with a half a cc or 1 cc phosphatidylcholine. Typically 5 cc's is 250 milligrams. Comes in these little vials. Other people you could start much higher doses. You could give them a full vial two three. A number of people are giving much much more than that. I don't find super high doses that helpful. You can help reestablish the flexibility of the membrane. You can specifically reduce the toxicity. You can make the membranes healthy. Membrane health is super important to the entire healing process. Each person is different. You have to figure out for each person how much can you take. You can start it at whatever dose as soon as it's available. Not everyone has access to it. Some clinics have access to it and some don't, but if you have access to it, it's a great tool.
The other tool that you mentioned was VIP, vasoactive intestinal peptide. This was a material which was popularized by Dr. Richie Shoemaker as something that could reboot this process. VIP has some profound effects on rebooting the immune system. In my experience, when the mold is out of the system, about 20% of our patients will respond with an obvious reboot of their immune system. Most specifically, energy gets better, pain gets less, and cognition improves. Sometimes those are dramatic. I've even seen an occasional patient where they get their IV and by the time the IV is almost done, their eyes are open. They're going, "Wow, my brain feels clear for the first time in years." When he started using VIP it was very clear it should not be used when people still had active mold toxicity because it wasn't going to work. Since then he has revised that and has started using VIP earlier on and in much higher doses than we used before. I have tried that approach. I have not seen it work very well. Do I like VIP? Yes. But it needs to be used when patients are well along on the healing curve to optimize its value because it is somewhat expensive.
In episode 85, we talked about the toxic versus the sensitive patient. One could have mold toxicity without sensitivity, but toxicity can also be a driver of sensitivity. There probably aren't too many sensitive people who are not also toxic. Sensitive people are more reactive to toxins. Toxic people become more sensitive. The exact treatments that you may need to support that patient may not be tolerated. One of the wonderful things was shifting my thought process to put that foundation of limbic system retraining, vagal tonification and stabilizing mast cells really early in the process so that the toolbox of therapeutic interventions grew that the patient could potentially tolerate.
Common Sensitizers and Drivers of Mast Cell Activation
Based on your work, I tend to think of the more common sensitizers as mold, bartonella, mast cell activation, and limbic and vagal dysfunction. Drivers of mast cell activation being mold, Lyme, bartonella, babesia, EMFs, viruses like COVID. We certainly see COVID triggering mast cells for some people, parasites in some people as well. What might you add to those more common sensitizers of sensitive patients or to the more common drivers of mast cell activation from your patient population?
That's the entire subject of my book The Sensitive Patient's Healing Guide. Once you have looked at what I call the basics so the basics of sensitization are without any question limbic vagal and mast cell dysfunction and I'm going to add EMFs to that as well. Those are super basic. But there are many people that once they get sensitized other systems become affected and add that to the sensitization process. To be specific some people will develop oxalate sensitivity, salicylate sensitivity. Some people are withdrawing from some of the medications that they've taken like benzodiazepines and SSRIs and they're in a withdrawal effect which dramatically increases their sensitivity.
Structural Components: Jaw and TMJ Issues
There are some structural components to sensitization most specifically two that I want to comment on. One is the structure of the face and jaw. The body prioritizes that our teeth occlude comfortably and correctly, that our bite is just fine. If it isn't, the body freaks out. It goes, I'm not balanced here. I'm totally out of balance. I've got to fix this. It will move heaven and earth to try to find a comfortable position. If someone has a fairly severe case of TMJ or they've had dental surgery when they were younger and actually had jaw resection and had all kinds of things done to their jaw. Often those folks never got put in position correctly and they can't get aligned correctly. When that happens, their sympathetic nervous system goes freaking out. This is cell danger response from that perspective, which is I can't calm down. I cannot get quiet until my jaw is balanced. You can do all the limbic vagal mast cell rebooting you want. They can't quiet down. They stay in this absolutely fired up position. They need to get into the hands of a dentist who can do like an ALF appliance coupled with osteopathic cranial work to very slowly bring that jaw back into alignment. It cannot happen quickly. It has to be a very careful, orchestrated, slow process. When those people have gotten their jaw aligned, then every other treatment they do works like a charm and they can then heal.
Cranial Cervical Instability (CCI)
A second one is what's called cranial cervical instability nicknamed CCI in which the ligaments at the base of the skull where the skull attaches to the first cervical vertebrae are loose and the skull collapses on it compressing lymphatics, veins, arteries, nerves and in that process again the body goes into freakout mode going I can't until this is comfortable I cannot relax I cannot be comfortable and some people will need some kind of treatment for that area which may even require surgery before their system can calm down and then they can move forward and all the other treatments that we have then begin to work.
This will segue into what causes ligamentous weakness and instability which often goes currently under the name of EDS Ehlers-Danlos syndrome. Years ago that was considered to be a genetic rare unusual condition and now we're seeing it very very commonly and I believe that again the genetic form is rare but that we're now seeing the inflammation triggered by the things we're talking about treating weakening those ligaments triggering a danlos like condition. You can take your thumb and put it and touch it down to here and their ligaments have gotten loose. The proposed understanding of that is the mold toxicity and or Lyme disease is triggering mast cell activation. In mast cell activation, we have over a thousand different biochemical mediators released, some of which are specifically inflammatory to the ligaments of the body, making them loose. It is the mast cell activation triggered by mold and Lyme that is causing this. I will call it a secondary, not primary EDS. The treatment for that is fix what's causing this. There's no real treatment for EDS, but we can fix what's triggering it. The majority of the people who had it no longer have it when we get the mold and Lyme out of their body.
You've talked more recently about the role of inflammation in disease and your approach to inflammation largely mirrors how we approach mast cell activation syndrome meaning do we both need to use anti-inflammatories and at the same time get to the root causes or triggers and how much of inflammation that we have in the body is the result of a poorly modulated or dysregulated immune system. What are some of the tools you're finding most helpful in your patients for reducing inflammation? Do peptides play a role? Are they more supportive therapies? Are they more core at this point?
Inflammation as Common Thread in Chronic Diseases
Inflammation is increasingly being recognized as the underlying process of almost all chronic illness. There's virtually no illness that you can name that's chronic that doesn't have an inflammatory component. That helps us to get a better handle on how to treat it. Until now we viewed things like chronic obstructive pulmonary disease and chronic kidney disease and cardiovascular disease and chronic fatigue syndrome and fibromyalgia as separate things. What ties them all together is inflammation. In medicine traditionally inflammation has been measured with two simple tests. The erythrocyte sedimentation rate often nicknamed the sed rate and highly sensitive CRP C reactive protein those are measurements of a kind of inflammation and conventional medicine has not really recognized that so it's pretty typical for someone to say I'm inflamed you'll measure those things they're normal and someone will say no you're not inflamed well that's only a kind of inflammation. We're now recognizing that there's all kinds of different inflammations and that we need to intervene differently in those inflammations to make a difference.
Inflammation in Cardiovascular Disease
Let's take cardiovascular disease for example. The essence of cardiovascular disease is inflammation of the endothelial lining of blood vessels. When that inflammation occurs, it allows LDL the low density lipoprotein particle to migrate past the endothelial lining into the muscular layer of a blood vessel. A blood vessel very simply is a tube with a thin lining of skin on the inside called endothelium and muscular coats on the outside which help to pump the blood through the body and then another layer of skin on the outside. Our digestive system by the way is the same kind of a tube same kind of a design to it. When the endothelium gets inflamed, LDL can migrate into the muscular layer causing what are called foam cells. There's no problem if the LDL is not oxidized. But if the LDL is oxidized, it creates these foam cells which run the risk of bursting. That will then set off a clotting process so that the clots will cause strokes and heart attacks or it can cause a blockage of the artery by the way the foam cells accumulate so that it literally pushes out and blocks the arterial blood flow. All of that's inflammation. There are a bunch of very clear tests that we now have which can help us identify that this is happening at a very early stage so we can do something about it long before anybody's at risk of having a heart attack or a stroke.
Inflammatory Markers in Mold and Lyme
That is different than the inflammation that we've been talking about with mold toxicity, Lyme disease, chronic fatigue, fibromyalgia in which other inflammatory markers are present. Dr. Shoemaker early on discovered TGF beta 1 and C4A and MMP9 were markers that if elevated would indicate that there was the possibility of an inflammatory condition like mold. Those are not specific for mold. They can show other things as well. The science of inflammation is right now in its infancy and that will be where we want to go with it.
When we're talking about treating mold toxicity and/or Lyme disease people tend to fall into two different camps. One camp is in mold toxicity, just get the mold out of the system. That's it. Then you'll be cured. In Lyme disease, just use antibiotics or botanicals. Get the bugs out of the system and then you'll be cured. The other camp is no, what's really happening here is it's an inflammatory process and you need to quiet the inflammation and then the body will heal itself. People often are polarized into these two different camps. But to me, it's obvious that both apply. You have a situation where you have inflammation and you have to fix what is triggering that inflammation. Be it a toxin or an infectious agent and somewhere in that process, you need to reverse the inflammatory process. You may get the mold toxin out and some people still need their inflammatory process rebooted and that it wasn't sufficient to get the toxin out. Same thing with Lyme. Some people have treated their Lyme for dozen years with antibiotics and they were not working on the inflammatory process as well. Sometimes that needs to be rebooted. Both need to be included in the way we conceptualize doing this. That is going to be key in terms of how we improve our ability to do all of this.
For many people, peptides are still not what the body needs while it's in cell danger response one. In my experience with most of the people we work with, if you take BPC 157, thymosin alpha, thymosin beta 4, KPV are some of the common ones we're using. They often don't work particularly well early on. Later as the toxin is dissipated as the infection comes under control they become extremely potentially helpful in reversing this whole process. LDN is a particularly helpful material in that concept because LDN again blocks the toll-like receptors which are a major driver of the entire infectious process. If you take it early on, it may not do much. The art of medicine is knowing when to do these things. I have a whole toolbox of good things to use. The art is knowing when to use it. Most of the peptides are much better used later on in the course of treatment and they will work much better then. They're kind of expensive. It isn't something that you want to bankrupt someone with by taking it before their body's ready to use it. Some of my colleagues have found an occasional patient where when they take the peptides, it makes an obvious difference and patients do improve with it earlier on. They have a role. They are valuable and the art is knowing when to incorporate that into the healing process.
As we wrap up our conversation on sensitivity, multiple chemical sensitivity and whether or not you currently view that as being driven by mast cells. Is multiple chemical sensitivity essentially the same or significantly overlapping with mast cell activation with limbic dysregulation?
MCS as Limbic and Mast Cell Driven
Yes. Yes. And yes. Claudia Miller recently with Tanya Dempsey and Larry Afrin wrote a paper a couple of years ago showing that there is a profound connection between mast cells and multiple chemical sensitivity. I have viewed multiple chemical sensitivity for years as the result of a limbic system, mast cell system that has been triggered by the things that we've been talking about. In my experience with multiple chemical sensitivity, the vast majority have mold toxicity as a primary driver. When we cured the mold and we worked on the limbic and mast cell systems, the vast majority of those people got cured, not better, cured. I really want to emphasize that I see chemical sensitivity as simply another sensitization process not different than sensitization to light, sound, touch, food, EMF all are driven by the limbic system and the limbic system is profoundly interfacing with the mast cell activation and we cure what's causing it and we quiet those systems down and people aren't sick anymore.
Limbic Retraining Alone vs. Addressing Drivers
Too often I see people as helping those things and even some of the folks who teach in the limbic rebooting view those as standalone techniques to treat it and they do for a few people. For a few people, limbic rebooting will cure multiple chemical sensitivity, but for most, you have to figure out what the driver is and get that also if you're going to really get that cured. You have now have a nervous system which is no longer wired to overreact to these stimuli.
Resolving Mast Cell Activation Syndrome
What I also heard you say in that is that mast cell activation syndrome itself is not the core issue. It is not something we have to have for the duration of our life. It is also a symptom or a presentation of something else. If we can address the something else while also calming down that mast cell response, we can fully resolve mast cell activation syndrome.
Mass cell clinics exist in every major university center, similar to POTS clinics. Academic centers often require elevated biochemical markers like tryptase for diagnosis. Many patients with normal tryptase have mass cell activation. Relying on tests out of context misses cases. Clinics rarely address drivers, instead prescribing H1 blocker, H2 blocker, and mast cell stabilizer lifelong, without fixing causes.
Limbic system work should be active, participatory (driver's seat), e.g., DNRS, Gupta, Primal Trust. Vagal tonification can be active or passive; passive tools work better for vagal than limbic. Patients often arrive undiagnosed/untreated for years, bedridden or hopeless. Empower them with lifelong skills, not dependency on doctors or devices. Assess functioning level to choose tools promoting self-control of limbic and vagal systems, shifting from victimhood to "I can control my limbic system. I can control my vagal system. I can get well."
Dr. Nathan was an early voice on mold illness with Dr. Richie Shoemaker. Dr. Dale Bredesen estimates 90% of Alzheimer's patients have mold/mycotoxin component (previously 60%). HLA-DR may predispose to biotoxin illness but does not correlate with treatment difficulty or recovery. Early with Shoemaker, HLA-DR (e.g., 11-52, 17-2-53? misheard as 4353) was thought decisive; patients without it recovered as fast or faster. No correlation observed; testing scares people or excuses failure. Comprehensive treatment cures vast majority regardless of genetics (observation 10 years ago, now consensus).
Urine mycotoxin testing (e.g., RealTime) is key tool; food role insignificant. First test often tip of iceberg; detoxification raises levels (good sign if symptoms improve). For suspected mold/mycotoxins with negative tests but exposure history, symptoms fit, compromised detox: treat empirically as vast majority respond, later tests elevate. Use multiple labs: RealTime (ELISA), Vibrant (mass spec, liquid chromatography), MyMyco (different antibody). Positive on any confirms; RealTime best for follow-up. Clinical experience trumps tests (like Lyme: CDC says clinical diagnosis; mass cell tests weak).
Mycophenolic acid: Indicates current exposure; clears quickly post-removal. Binders for ochratoxin also work (observation, no studies). Likely environmental, not colonization.
Chaetoglobosin (chaetomium): Basic binders (charcoal, clay, chlorella) clear it clinically (no studies).
Bentonite clay: Binds most mycotoxins but contains trivial heavy metals. No toxicity seen even after 3-5 years daily use; benefits outweigh risks.
Gallbladder concentrates bile (made by liver); absence doesn't stop bile production/flow via hepatic ducts (less concentrated). No change in mycotoxin binding in intestines; binders work fine.
Support fat digestion sans gallbladder: healthy oils, phosphatidylcholine.
Gliotoxin (Aspergillus, Candida, Penicillium?): Usually Candida primarily. Treat with nystatin + D-glucan lowers levels faster. Candida/mold coexist commonly. Tests: gliotoxin urine, arabinitol (OAT); elevated both drop with anti-Candida. Stool tests inconsistent; antibodies show past exposure only.
Glucuronidation more important than methylation for mycotoxins (table in Toxic with Beth O'Hara, Emily Gibler, p.79: phases by mycotoxin). MTHFR/SNPs overblown; 39 SNPs affect methylation complexly. Sensitive patients worsen on methyl support initially. Body has other pathways; methylation compromised by cell danger response (downstream, not cause). Use when ready.
Emotional internalization of "brokenness" (MTHFR/HLA-DR) has broader epigenetic impact than genes alone.
Bioflavonoids support kidneys (mycotoxins exit via urine). Previously liver-focused; kidneys underemphasized. Supports: homeopathic renal, frequency specific microcurrent, adequate fluids, peptides like KPV. Dr. Jill Crista contributed mold chapter expertise.
Start binders 6-8+ weeks. High colonization in referrals (complex cases). Recent exposures may resolve with binders alone.
If urine mycotoxins don't drop profoundly: suspect colonization.
- Prioritize symptomatic area: GI (gastro symptoms) or sinuses (chronic infections, CT thickening).
- Both often needed; Joe Brewer emphasized sinuses primary (disagrees; both occur).
Lung (aspergillosis): Rare (~12 cases/20 yrs); diagnose via bronchoscopy culture; months strong antifungals.
Brain: Likely mycotoxins causing inflammation (Alzheimer's/Parkinson's), not fungus (treatments don't cross BBB well; Bredesen's hundreds improved cognition).
Tests: OAT fungal markers weak (positive supports, negative rules out nothing).
1-2 years typical (up to 4-5); fungi thrive in body (warm, moist, nutrients). Continue until RealTime all categories "not present".
Endpoint: Normalization not just symptoms/OAT; negative urine mycotoxins.
Prevent recurrence: Dr. Crista suggests medicinal mushrooms; probiotic nasal sprays.
Then when that happens, I encourage people to
Encourage continuing treatment for three more months after clearance. This is an empirical observation: early clearance led to 15-20% relapse rate. Continuing antifungals and binders for three months post-clearance prevented relapse, unless re-exposed to mold in a major way.
Live in a toxic world; encourage low-dose binders forever: one charcoal, one clay, one chlorella daily. This helps eliminate massive toxin load despite organic eating and caution—exposure is unavoidable.
Discussion in biotoxin illness world on actinobacteria and endotoxins as causative in CIRS. Endogenously created endotoxins or lipopolysaccharides (LPS) not currently considered. Studying them but not impressed: high ectoines or endotoxins fixed alone (without mycotoxins) hasn't helped patients. Removing mycotoxins leads to universal recovery. Endotoxins/ectoines part of inflammatory soup from mold exposure, but not key players. Treatments like cholestyramine bind endotoxins excellently.
Bartonella is a key sensitizing microbe in vector-borne infections, difficult to treat.
- Interventions: antibiotics primary tool; fond of Dr. Marty Ross's (likely Mosconi) approach, similar to his own. For persister cells, Dr. Horowitz's dapsone program effective.
- Purely herbal (Buener herbs, Lee's, Beyond Balance, Byron White) insufficient as standalone, even combined; add to antibiotic programs.
In absence of mold, Bartonella very common main driver of sensitivity; gram-negative, produces endotoxins.
Vast majority of sensitive Bartonella patients also have mold.
Secondary pyroluria common trigger from Chlamydia pneumoniae treatment; antimicrobials broad-acting.
- Pyroluria may signal overly aggressive antimicrobial working well, body not ready.
- No new advances; tricky—requires high-carb diet (opposite of mold treatment).
- Tip-off: Herxheimer lasting weeks with severe nausea, vomiting, intense anxiety; high pyrolle levels; IV glucose improves.
- More common than realized when tested; from antibiotics for Bartonella/ Chlamydia.
- Manage: cut antibiotic dose, switch (some less prone), IV glucose/dextrose for acute phase, then resume normal treatment.
Generally address mold/environment/mycotoxins first: modulates immunity, strengthens for Lyme, Bartonella, Babesia. Rarely resolves infections without treatment. After mold, Lyme/co-infection treatment shorter, more effective (50-80% better post-mold, residual symptoms guide).
All exposed everywhere.
- Daily binders.
- Sweating (sauna, hot tub).
- Fiber (Joe Pizzorno: #1 for toxin removal).
- Organic eating, clean water, minimize toxic air.
Glyphosate substitutes for glycine; likely role in connective tissue disorders, hypermobility, EDS. Ate organic 30 years, still 95th percentile glyphosate. Removal: ion cleanse foot bath, biotoxin binder; with glycine replaces it (Jill Crista trick). Now normal range. Even organic insufficient.
Future: envirobiomics to measure hundreds of exposures for blueprint.
EMF sensitivity another limbic sensitization component, modulated by limbic system; often triggered by mold toxicity (huge percentage). Treat mold, limbic, mast cells—majority recover. Ask all patients about EMF exposure; recommend EMF meter to measure/shield devices. Exposure risen exponentially last 20 years. Smart meters devastated some (brain dead, cognitive shutdown; some fled to woods).
Much SIBO fungal-derived (SIFO); from sinuses/oral cavity seeding gut. One Xifaxan course works if uncolonized; recurrent needs fungal/Candida addressed first, then gut treatments succeed.
Parasites rarely play role; aggressive treatment (Simon Yu/Dietrich Klinghardt protocol) didn't help his patients. Attributes to patient selection; doesn't doubt colleagues seeing it more.
ME/CFS/fibromyalgia spectrum: milder = CFS, worse = fibro; specific elevated cytokines confirm, not psychological.
Joe Brewer 2013: 112 CFS patients, 92% positive urine mycotoxins; mold protocol healed vast majority. Majority labeled CFS/fibro actually have undiagnosed mold/Lyme.
Spectrum: autism in kids, CFS/fibro adults, neurodegenerative (Alzheimer's, MS, Parkinson's, ALS) elderly—from same inflammation/nervous system state (Amy Yasko 1990s). Same triggers: mold, Lyme, unrecognized infections/exposures. Autism epidemic: 1 in 30 births some states, California boys now 1 in 12; pediatrics not alarmed enough.
Nitric oxide → peroxynitrite (free radical); tried personally/patients 15 years ago—no benefit. Biochemical player but minor. 40 years antioxidants rarely helpful alone—treat cause (not just free radicals). Body uses oxidation vs. infection/cancer; excess antioxidants may hinder (Bob Naviaux oxidative shielding paper).
Long-ill develop illness consciousness; body threatened by health. Discuss: if well, what life looks like? Meaning/purpose? Introduce wellness consciousness. Some freak out at change, can't accept healing—complicated process.
Motto: be mindful, be grateful, be of service. Life of love: adores wife, kids, dogs; small coastal Oregon town, clean air. Helps people. More supplements/diet attention with age/medical issues. Walks 2-3 miles/day, tai chi, Pilates, bike, beach walks.
Living in gratitude feels right: "I am just blessed and so grateful for it that living this way just feels right."
I love that.
Check out the second edition of the book Toxic. It is incredible and provides new learnings from the book and this conversation.
One of the biggest blessings in life has been knowing Dr. Neil Nathan and learning from him. Honoring and appreciating all he has done to make lives better in the community and the world.
Thank you.
And I'm right back at you, Scott. Your tireless work at delving into the depths of healing has affected countless tens of thousands of people. And just stay with it.
To learn more about Dr. Neil Nathan, visit neilnathanmd.com.
To get a copy of the second edition of Toxic, find the link in the show notes.
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