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Dr. Hoffman

Well welcome everybody. Today I’m going to be talking about complex patients and in the setting of mold illness, but I want you to know that this isn’t going to be about how to diagnose mold illness, sirs, and the steps A, B, C, D, E, F, G, which you can get, and I’ve listed some of the fabulous sites that are out there that you can go to to reference some of the logistics of how to diagnose mold illness and what to do about it every step of the way. This is more of just about what I, as a physician who treats complex illness, find when people present to me with a diagnosis or suspicion of having mold illness as a trigger for the complex symptomatology. And what I found problematic and difficult sometimes to negotiate when trying to understand where the mold may fit into the complex scenario. So these are some websites that you can go to Dr. Andrew hymens YouTube videos on SIRs are fabulous. Richie Shoemaker has been teaching mold illness for a very long time. The ici website has got some amazing people that belong to that group and present on mold all the time. They have an annual conference coming up soon. And then many of you may know Neil Nathan and his approach, real time lab have lots of information. And Dr. Dennis is an EMT surgeon who does a lot of work on sinus colonization of mold and performance surgery and treats mold illness as a occupant of hollow spaces. So those are some references for you.

But here’s the scenario. A patient presents at your office, this is what I see. This is what I see all day, every day. I’ve seen patients this week already with this type of presentation. patient presents, they say I have mold illness. So I suspect mold is playing a role in my symptomatology. And they’ve got many symptoms. You know, as we all know, when dealing with chronically ill people, they fatigue, they got body pain, they got brain fog, mood disorders, got GI tract is always involved, immune systems always involved, they feel inflamed, they hurt, they saw, they ache, and they very symptomatic. And they’ve often been that way for a very long time and have seen every specialist in the book and seen many times many naturopaths, chiropractors, you name it. They’ve been there. And then they show up with a host of lab tests and specialist letters and special investigations.

And now I once but to sort of sift through this and try and make sense of it and see where does mold fit into this complexity. So this is a common thing I get patients say I’ve got mold illness, and they’ve seen everybody. They’ve tried everything, and they always want to get onto Colas tyramine. I don’t know why. It’s a very common presentation. Can I get a colostomy today? Can you prescribe it for me, and I’ll show you as this presentation progresses, that this is probably the very last thing that you want to be doing. So the most common way people are presenting now is with a mold urine test. And they think that from this urine test of the mycotoxin, which is a toxic byproduct of mold, that they could have mold illness, and this is one of the biggest mistakes ever made. In my clinical career when it comes to dealing with complex patients and etiology of disease processes. This test cannot determine whether you have mold illness or not. And I hope my presentation will enunciate why I say that.

So where do we begin? So I’m not going to go straight into SIRs or mold illness right away. I’m going to just give you some background to how I sort of orient myself to these complex patients. You know, where do we practically begin? When we know in systems biology that everything’s connected to everything else? Everything’s embedded in deep chains and networks and systems and we are very tempted as physicians or clinicians to plunge into the typical n square D square approach to medicine, name of disease, name of drug, and this sort of prescribing an allopathic way, something to help relieve the patient’s symptomatology.

But over the years, I’ve developed a system of trying to work through complexity. And I adapted the eidetic model of the cultures or bodies, these different layers or levels to our reality model somewhat on a bit antic literature. It is very training that I’ve done in the past and also German biological medicine as developed by Dr. Dietrich Klinghardt. So I’ve sort of melded all these models together. And I look at the person presenting in front of me having different layers and levels of of their, to their reality.

So the first level is the environment. Outside, we can’t just do an exchange with our environment. So we all the toxicology issues come into play. Level two is the biochemistry and the structure, the physicality of our being. Level three is the energetics the sort of biophotons that radiate from us squeeze DNA, and the interaction with our nervous systems and brains. Stage four has everything to do with our emotional body and how we’ve been seen or not seen in our early developmental years, and what our attachment disorders may or may not be, and how we’ve oriented ourselves to the world in terms of developing a window of tolerance for self regulation in the midst of complexity and challenge. Level five is the the ego, the the operational sense of self that gets us through life. And that has our value systems, our defenses, our beliefs, or morals or values. And there’s a lot that goes on at that level.

And then level six is the so called Soul the most authentic part of yourself, that part of you, which is calling union, psychology the daemon. It’s your true authentic self that sort of, sort of holds yourself together consciously or unconsciously, it’s usually only accessible in the second half of life, I’m afraid to say. And I don’t mean that flippantly, it just seems to be that as we progress through life, the first 30 years or ego based, we driven to become something. And so we have these drives that that force us to be seen by our parents to be seen by our peers, to find a mate to procreate to educate and create some stability and safety in the world. But the second half of life is all to do with authenticity. Who are we really, and how much of our true self that we leave behind in this in this search for authenticity, or in the search for gaining something in the world and procreating the species.

And then the last level is that which is above and beyond and has nothing to do with our individual reality, which we call God or the grand organized design. And some people are very connected to that aspect of their non-local reality and other people aren’t. And it plays a role in diagnosis and therapeutics. So this is the model I use. When a person sits in front of me, can I use a practically very practically. And it looks like this on a map. Where we this is what it looks like when I when my book eventually comes out, this will be there. But this so these are the seven stages of reality and all the experiences anatomical designation sciences, diagnostic methods and treatment methods. And so here we have a lady to make it more practical and less easy to Tarek, a woman may present say, in her 50s with mold illness. And she’s got all these complex, additive diagnostics. That when you go through the layers and levels, they sort of show up. At the first level. Yes, she’s been exposed to mold. She’s lived in a moldy environment for 10 years and it’s deadly well since. But she also has other toxic exposures, mercury from fillings. organophosphates because she like lives next to a farmer’s field. She got a lot of dental issues, she’s lived in tick, bite country, and so forth and so on. You’ll see a lot of these different in functional medicine we call them antecedents, mediators and triggers of illness. Level two or two you know, we all know about food, gut, brain immune system issues, level three auditor electromagnetics and, and brain function, level four all about early trauma and inherited trauma from ancestors, level five or to do with ego strengths, personality disorders or mood disorders, and then level, that’s level five, and then level six, inherited family trauma, meaning and purpose in life.

Some people have no idea why they get up every day. And so people without that drive to, towards what we call a strange attractor, people get driven, there’s a biological urge to become something. And some people feel very disconnected from that, and that has vast diagnostic and therapeutic implications. And then at level seven, this woman had no connection to anything outside of her own reality. And so these sort of these, this sort of presentation becomes very palpable, very practical. I had a patient just last week, and she came to see me with severe muscle activation syndrome and reacting to foods she had, she was eating like three foods, she was breastfeeding her 15 month old son, who was also had very little to eat. Because everything was rejected.

He vomited continuously, she could only hold on a few foods. And this person was never sleeping through the night. She lived in a moldy home food was an obvious trigger as well electromagnetic fields, which as you’ll see are huge triggers of my cell activation and the so called Cell danger response, which we’ll get to in a minute. In a bit upon deep inquiry, it was apparent that she’d had a tumultuous upbringing with with lots of trauma, and interrupted bonds with the parents, their parents got divorced when she was three. And she spent the next two decades going to court and having to choose sides between her wearing parents. And she had allergies from a very young age.

And then I was just talking to her and I said, Oh, you know, I think we’re going to have to use a tighter, firmer h1, first generation h1 blocker for your son at night to help him with his micelle quietening. And to help him sleep. But she said to me, I just Google that in my chat group, and I heard that it’s gonna induce rage in children. So immediately, her fear based brain her amygdala was on high alert, she was already rejecting a potent life transforming treatment. Ketotifen is amazing when it works. And she had no trust in any allopathic intervention, she already had rejected it. And this you will see, when children had Don’t be unseen, and don’t have limbic resonance with parents, they often have, they’re not able to self regulate, and inhibit, they fear or they fight flight responses. And so they see everything as a threat. And they often have these very distorted relationships with their parents and projected onto therapists, doctors naturopaths, because our profession is very paternalistic, to put it mildly, in that we direct and tell people what to do. And so we act as authority figures. And if this person from a very young age has not been regulated appropriately by the parental influences, and there’s a lot of confusion and inability to self regulate, she will project her fear onto you as a parental figure. And she won’t be able to take anything in. So no matter if she has mold illness or anything else, it doesn’t matter what the diagnoses are, if no trust is established, and if no limbic resonance is established with her as a client, and no stable ability to self regulate is established, you will never get anywhere, no matter what the illness, you have to start at a much deeper level to try and really see that patient and understand the defense’s and understand the trauma before we drop into western or alternative functional medicine diagnostics.

So that’s one of the clinical pearls I would like to introduce when dealing with complex patients when they come in with a urine mycotoxin panel and say can we use code and stymied take a deep take a big step backwards we you know, we familiar with ranch rushing in and going you know, we take functional medicine, even a western medicine diagnosis and then we we want to treat it in diagnosis and then treat it but use a much larger or wider lens when you’re sitting in In front of these people and really start to see who this person is that’s sitting in front of you, what story is wanting to be told through this presentation? And where do you have to really start relating to this person? How many layers and levels are at play? Do they trust you?

Now, obviously, trust is a huge issue. And nobody’s going to trust you on their first visit, they’re going to not trust you on their first visit. So trust is earned. But if they were never seen by their mothers or their fathers, they won’t trust you. And so you can’t come on all strongly occupying the hero archetype and say, you know, I know what’s going on. And I’ll just, let’s do this and that, you have to really enter into the field and create the limbic resonance with them, and hear them and listen to them. They are dying to be heard and seen. So please don’t make that fundamental error of imposing all your knowledge on them. Right out the gate, really, really hear what they say. And these people, as you all know, have been to so many places and just got a sliver of information and not being able to do anything with it. Because in systems biology, there’s nobody practicing systems biology work. It’s all compartmentalized into silos, and square d squared, kind of organ systems.

Very few people are doing complex workups and treating them in a complex way. And again, be aware of the projection of unresolved early issues, the relationship to parents, because this is recreated in the clinical encounter, you will very often be the object of unresolved parental complexes. The other concept that becomes very important is to understand Robert Nivas work on the cell danger response. And also Steven Porges, his work with the polyvagal dorsal response, people who have been sick for a long time, their mitochondria are stuck, they are stuck in CD one or CD two roads famous responses, and they just can’t get out of it. They stuck. Even though the initial trigger may be gone, they stay stuck in this shutdown response. And in this collapsed response, and that’s a whole nother skill set to try and recognize if they in this shutdown cell danger response or if they you know, polyvagal, dorsal shut down, withdrawal from the world. And then you’ve also got to ask yourself, are they cognitively capable? And do they have enough ego strength to really take on the complex workup and treatment protocols?

So we do all sorts of things to try and help us we do heart rate variability, you can see this person is highly in high sympathetic dominance with parasympathetics in the Negative Zone, you can see her Moca score was 2323 out of 30 is not good, there are some you know, memory issues and the hippocampal decline in this person. And then we redid the CNS vital signs computerized executive functioning test, she was in the low average too low to very low functioning capacity. This is not normal for a young, you know, 50 year old person. And then we did the Toba which is a method of ability to concentrate and stay focused and fail this one miserably. And then looked at a Qt T and saw that she had very high the CETA brainwave which is a slowed brainwave, which occurs as a result often of toxic and capital apathy.

Oxidative stress and toxicity generally came from head injuries as well. And that was associated with very high beta brainwaves with joy, anxiety brainwaves. Often this whole part of the brain is lit up like a Christmas tree due to early trauma, which which shows up in brain to E G’s. And then if you look here at the Alpha brainwave this alpha brainwave, here is the brainwave that chills, people are to calms them down, and that’s deficient. That’s one to two standard deviations below normal. So this person’s in fight flight. Her brain is slowed. So she’s cognitively impaired and she can’t regulate her. Her her her physiology, her autonomic nervous system, she’s really, you know, very ill and very depressed and very anxious and can’t sleep and fatigue and so forth and so on. So without these additive insights, you know, if somebody just walks in the room and they go mold illness put me on Curtis datamine and you don’t have some background data at the sort of higher levels of functioning.

You can really run into a lot of trouble and to, I don’t want to say harm, but really not be of much help. In the autonomic nervous system, we meant to self regulate and have coherence between the sympathetic and parasympathetic nervous systems. But many of our patients are in this fight flight, or even hyper freeze where they are actually frozen, they just they shut down. This is poisonous polyvagal theory, dorsal vagal, shut down. They, they they freeze, they withdrawn, they dissociate, they really sick and they stack you can’t get out of it. So, so learn to recognize these states. What you will then want to do is help them build a window of tolerance. And this is a slow process, they often have to refer to particular practitioners like Somatic Experiencing practitioners and others. We do a lot of work with neuro biofeedback as well as refer to Somatic

Experiencing people and help these patients, you know, develop some capacity, some resilience, before they either hyper aroused or hyper arousal was completely shut down. Many of our patients they, you know, they are not thriving, they’re not incoherence, they’re not solving, self regulating. They are in crisis, they struggle, I can’t keep this up, I can’t survive, really learn to know these people and also learn how to diagnose and how to enter into a therapeutic relationship with them because you can’t go touch them mold, or their micelle or their life, you cannot go near those diagnoses, until this person has developed some resilience or some capacity to self regulate. So that’s the first sort of big insight. We’ve got three brains, as you know, the the reptilian brain, the mammalian brain and the human neocortex. It’s the it’s the neocortex, the executive function that learns to inhibit the fears of the amygdala, and the fight flight from early trauma and lack of trust. But many people’s prefrontal cortices are very damaged from mold exposure, and they can’t inhibit the impulses in their peers and they stay constantly upregulated. So the second sort of Pitfall, if you will, I don’t like after I wrote this, I thought, using the word pitfalls, pretty negative, but I hope you don’t take exception to this. It’s not implying it’s a pitfall, but it’s a sort of, it could be a stumbling block in your therapeutic encounter.

You’ve also got to know yourself a little bit. And you got to be attuned to your own blind spots, your unconscious complexes, your defenses, and where your knowledge begins and ends and don’t try and occupy the hero archetype and just be all knowing and impose everything without really relating to the individual. Are you present? Are you related? Are you resonant? Are you tuned? Your whole thing with these masks, you know, Porsche has has developed this polyvagal theory of social engagement. The ventral vagus is all to do with our tone of voice and eyes and facial muscles. And here we are walking. Two years we’ve all been unrelated and dissociated from each other for the last, it’s I think there’s significant consequences and, and a lot of parents notice, hence wanting to remove masks and things. So that’s another whole saga.

But there is a there’s a physiological price we pay when we don’t establish trust, by by looking at somebody in the eyes and looking at the gaze and, and seeing the smile and hearing the tone in the voice because those are the unconscious signals we used to attune to others missing for the last two years. The other thing I asked you is, symptoms aren’t, they don’t fall out of the sky. You’ll those of you who are more experienced know that symptoms often point to somewhere in the system of this individual where unconscious dynamics need to be made conscious. I take symptoms as highly highly teleological they have they have they have meaning and often teach my patients to actually go quiet and go into their symptoms and ask their symptoms. What is it I’m not seeing? And sort of like a conscious meditation if you will, and you’ll be shocked at how many patients will come back with saying you know, I did that and I heard something my dream showed me something some synchronistic activity showed up and guided me through the process.

So don’t take symptoms. There’s objective, like we learned, let’s call a symptom that has to be destroyed and gotten rid of No, you vote lean into your center, what is it, trying to tell you that you’re not making a conscious symptoms are often pointing to what is silent or hidden in a system, or highly defended against so, so use symptoms teleologically again, are you acting as a authority figure upon which your patient projects all the rage? You know, if you look at the stages of emotion, anxiety isn’t an emotion, it’s a defense against emotion. But beneath that comes sadness and depression, anger and rage, murderous rage. So people are often highly defended against feeling things they don’t want to feel because those things are so awful, or were awful. So they will suppress a lot of the emotional self. And then because it’s so uncomfortable projected on you because it was projected onto the parent that they couldn’t engage with for various reason.

Again, what stage of life are your patients in first half first, second half and what defenses are active in you and them when you when you find when you find yourself becoming dogmatic and insistent know that you probably in a defense, you you’re activating your own core complexes. And it’s very difficult sometimes to not become self righteous and sort of have that patriarchal approach. We trained to have that approach, forged. As we’re learning more about trauma and empathy. Many of us have done you know, our work on this and know that that patriarchal attitude doesn’t really get you very far. You wanted in an era when you have a heart attack, you want to patriarchal person takes control and does exactly what they need to do to save your life. But in a therapeutic encounter, it can be disastrous. So, again, establish who is in front of you established your body felt sensations or the way you feel in your own body in front of this person? Are you in limbic resonance with them? Or are you completely disconnected? Know when people are shut down, know when they struggling to even show up with appointment? Know what the ego strengths and cognitive abilities, if they’ve got low motor scores, and they’re not going to be able to take on your program, you’re going to have to make some decisions on how best to approach that.

Person personality disorders are which they are out there borderline personalities, narcissist, and those people are difficult, be careful and know your way around them. Because those are the three that threaten to be lentiginous they often aren’t. It’s just a threat that they can be they can take up a lot of your time. But do your very best to create a trusting relationship? Not? Not? You know, it’s not it’s a genuine relationship. It’s not a false sense of camaraderie or anything. It’s a genuine sense of getting to know this person and what’s really what’s it like for them? You know, what’s the internal dialogue? We have 60,000 thoughts a day? What’s What’s the content of that thought process? Is it despair? Is it rage, often, you know, because it’s hidden behind the fences, and then help them to self regulate and create windows of tolerance. To to coin a phrase from Somatic Experiencing world and learn about neuroplasticity and neuro modulation, how the brain changes it states, there’s a lovely video of a guy who learns to ride a bicycle. And when he turns right, bicycle goes left. And he took him. It’s like a party trick. He goes on stage and asked everyone to come up, nobody can do it. And he took eight months to learn how to change is fun when you turn right.

The bicycle went left and he learned how to ride this backwards bicycle but to him eight months to do it. And the same is with your brain and your neuroplasticity and your defenses and your psyche. You can’t just shift a person’s consciousness overnight. And you’ve got to really almost juice that relationship into being through multiple modalities of information and salience and education and empathy and referring out to the right people. So I mean, I’m not trying to make this complicated, but just be a healer first and not a doctor. You know, just just the healing archetype is very different from the from the doctor argue To become a very good doctor know your western based diagnosis and treatment protocols, but also approach it from an empathic point of view. And a related point of view and know that any change is going to be particularly with these complex people is not overnight. It takes time, and learn all the ways to treat this neuro plasticity and vagal tone. And many of you know all these modalities, but I just listed some of them. And then know about the cell danger response. It’s an incredibly important concept to take into account.

It’s the concept that Robert Novo has developed over the years of research, which basically says that, when you’re, you know, you’ve got 30 trillion cells. And each cell is surrounded by a cell membrane inside of which there’s been 100 to 2000. Mitochondria, also surrounded by membranes with an electrical charge of approximately 170 millivolts. And the mitochondria are the canaries in the coal mine are the first thing to detect oxidative damage or any incoming stress. And as the incoming toxins come in, the the voltage on the cell membrane changes. And then that launches a whole host of metabolic changes, which leads to mitochondrial autophagy, which leads to the intracellular contents of the mitochondria going outside the cell, which creates another whole pro inflammatory response, and then the body stays in the so called Cell danger response never being unstuck, because the triggers are never addressed, and the metabolic machinery is never addressed. And so learning the cell danger response, I think, has become a very therapeutically, almost essential, We fortunately have some labs now, that can show us some of this before it was just in the research phase. But now, we have labs that can show us how to note if somebody is in the cell danger response. And we have therapeutics that give assist body by being probably the main one that I know of anyway, to help repair cell membranes, and how the outer leaflet the inner leaflet, how to get rid of very long chain fats that are produced by toxic load.

By using beauty rates and taxes and things. We’ll get to that a bit later. The important thing I know this is a mold talk I’m getting. But the mold exposure initiates a cell danger response. If you’d see the CDR one, and that is initiated by chronic activation of the innate immune system, and that can stay stuck in the cell danger response. Long after the initial signal has passed, people can just stay there and not shift. Now Robert Navarro has incredibly listed a number of different scenarios like the cell danger response, one cell danger response to cell danger response, three different conditions that are in different phases of the so called Cell danger response. So he’s reframed this, as I said, the pathogenesis of chronic illness in this way as a biological systems response that maintains disease, rather than focusing only on the triggers or triggers that initiated the original injury. We want to run a chain and cheat mode, but what’s happened to the metabolism of the organism? How can we identify and treat that and that’s where cell membrane medicine in the body byproducts have a fantastic role to play?

Yeah, so that’s just some more graphs of the cell danger response. And he’s also came up with this incredible insight that you know, we’re always rushing in, in functional medicine to look at oxidative stress and antioxidant defenses. And this is the teeter totter. But he’s positive the theory that you know, and oxidative reactive oxygen species are released by the mitochondria to protect the cells from further damage in a dysfunctional cellular response, and it continues to be activated despite the neutralization of the threat and these reactive oxygen species act, dysfunctional, damaging healthy cells, and he says he had contrary to long held beliefs about the etiology of these diseases. This D redefines reactive oxygen species activity in the context as a defense mechanism and oxidative shield. Therefore reducing reactive oxygen species would not necessarily address the root cause of disease, which actually lies within the destruction of the mitochondria and they have normal cell danger metabolism. Many practitioners were rushing to quench free radicals. I know I did still do for various reasons, with antioxidants, but this can actually cause further harm, as these free radicals may be providing a protective response very important to keep that in. Here’s the oxidative stress markers we often measure.

These are the antioxidants we often use. Common. The another pitfall that we encounter when we rushed into diagnose mold illness, is we we don’t consider a background understanding of other possible differential diagnosis. I use a lot of questioners, this is the MS Q questionnaire, which you’re all familiar with, I believe from AFM. I really have found it essential to know about methylation. And I like to look at methylation through the eyes of William Walsh’s work that he he’s is still teaching right now. On is the old Carl Pfeiffer work with over and under methylation, zinc copper issues and crypto Pio issues. He’s done a fabulous job of initiating the whole methylation complexity. And we need to sort of know that when we addressing mold illness, whether the person’s under over methylator, whether they have cooked up piles, and that they they have copper overload or cryptic barrels.

And then we have to sort of know this methylation panel backwards, because if you see here, here’s the stressors and total toxic load of environmental toxicity level one in my model and stage one more is there more than juicers, peroxy, nitrate peroxy, nitrate being the or it’s also called no or No, which is sort of the nature of free radicals that initiates the destruction of the mitochondria. And we can measure peroxy nitrite. There it is right there. If you do a methylation panel, from a company called Health diagnostics, it measures the peroxy nitrate there we can see how high it is and how much damage is caused into the mitochondria and whether the mitochondrial contents are being released from the cell along with ATP and when that’s released, that then triggers the micelles that they perpetuate this ongoing cell danger response that goes round and round in circles.

So we do have to know our methylation pathways. In red all the bad guys or pro oxidant issues and in blue are all the sort of good guys good to find catalase superoxide, dismutase. We don’t want to go rushing in with all antioxidants, when we don’t understand the cell danger machinery and we don’t understand all the triggers that are initiating the cell dangerous buttons. But we do want to use them where we need to Lyme disease which is which is a biotoxin illness in the same camp as mold illness. Very important to differentiate between biotoxin illness and chemical toxicity. Explain that in a minute. I use a lot of questionnaires I use Dr harvesters, MC lime questionnaire, and I’ve made up my own sort of conglomerate of many other question is that the basis of the kanlaon questionnaire, this is an alternative activist, patient advocacy group in Canada called kanlaon. And I’ve used the equation added some things to I found the use of question is very helpful. And then you’ve got to know your mast cell activation issues, because most of these patients with illness can’t tolerate a lot of things.

And if you don’t down regulate and put a lid on my cell activation before you begin your therapeutics, this patient will never get better, just like if you don’t help them self regulate and go from sympathetic to parasympathetic, which is the healing state. You can’t you know, if you don’t help them and assist them in that process, and if you don’t help them damp and myself, my cells are a consequence of the cell danger response. They don’t have cause just like people walk in and say, Oh, I have mold. They also walk in and say oh, because I’ve written many blogs on myself. They will say, Oh, I’ve got my cell activation syndrome, and I’ll go really okay. What are the triggers? Then then starts the whole diagnostic complexity where the triggers of my selector, so my cell activation is a consequence of an upregulated oxidative stress pathways and it’s our task to find out all the triggers we have which there are many, in my cells being they release 1000 mediators of inflammation, which damage the mitochondria, as do mold toxins. If you don’t understand my cell activation, know how to dampen it.

That’s another patient you can’t treat because they can’t take anything. If you give them 10 supplements as a one sometimes forget about it, they won’t be able to handle, they will, you know, they’ll have all kinds of reactions, and you’ll get lots of phone calls. This is the paper Lawrence app. And one of the main researchers put out on on the consensus of my cell activation, which is different from there’s different ways to diagnose myself. And this is a paper a whole bunch of us, co authored with him, but he was the main author. It’s a good paper, it’s on my website, if you want to read it. Know About pots, POTS is extremely important. Postural Orthostatic Tachycardia Syndrome, if you don’t, if you’ve missed pots, that patient will never feel better. Learn about it, learn how to treat it. And always have somebody in your office do blood pressures, that 10 minute blood pressure test.

You get them to lie down, you take the pulse rate and blood pressure, get them to stay in that one minute, three minute, five minute 10 minutes pulse systolic diastolic blood pressure, and then you work out the difference between the two. If they’re stuck if they post rate increases by 30 beats per minute. That’s parts by definition. And this is this simple little test. This is as good as doing a talk table. And many people will come in with the pulse rate differential 4050 beats per minute, that person’s not diffusing their brain. They’re not confusing their periphery. They’re not confusing the mitochondria. They are sick, and they know they sick but nobody’s done the 10 Minute blood pressure test. So when I learned about it about 10 years ago, I now I won’t see a patient before this is done by my staff before they come in the door. And if I’m doing a zoom consult, they have to go by a blood pressure cap and do this. The question is do you get dizzy when you stand up? 50% of my patients with mold illness or myself illness? Say yes. You have to learn to differentiate between parts orthostatic hypotension and idiopathic Tachycardia Syndrome. That that’s another whole subset of issues know about hypermobility and Ehlers Danlos.

These patients are very different are very difficult sometimes to treat because they so loosey goosey and they got so much muscle activation and their collagen fibers I’m tired and so they got leaky guts and leaky brain barriers and they really can be in quite a lot of distress. And no Dr. Andrew Maxwell cardiologist has put together that triads and paint ads, people who have my cell activation pots and Ehlers Danlos, plus dysautonomia, plus autoimmunity. These are groups of patients that you’ll get to, you’ll get to see them over and over again. And if you go on his website, he’s done some beautiful PowerPoint presentations on this complexity of how to put these things together. Never work with a patient without knowing their dental history. The the lower jaw the job, the trigeminal nerve goes back into the brainstem. So toxins in the lower jaw affect the brain in a dramatic way, just like the vagus nerve in the gut goes back up into the brain. And the sinuses affect the brain tremendous way you can colonize hollow spaces with mold and Candida.

I think 80 to 90% of all chronic sinusitis is yeast or mold related. So you got to know this area of the body. A good panorex X ray or 3d Cone Beam or getting somebody to interpret it for you, a biological dentist who knows what to do can help you tremendously. Root canals cavitations these are all issues that you’ll learn about as you get more deeper into complexity. Know about sleep. This is you know everybody knows the sleep issue. You you don’t you know you don’t restore If you don’t go into deep sleep, you don’t restore a lot of your circadian rhythms and your detoxification through your glymphatic ‘s, this doesn’t, things don’t go very well if you don’t get enough sleep every night.

So I know how to assess the patient and know how to take a sleep apnea history and I refer probably 95% of my patients now to sleep clinics for sleep studies, 90 to 90 and then also know every diet in the book you got to be very clued up on your diets because everybody’s got something else going on. From carnivore to low oxalate to. It’s everywhere and low mode, Candida. Justin who works with me as a nutritionist health coach, and also is very connected to the body by a team. We use a mixture of paleo, Paleo autoimmune, low histamine and membrane stabilizing. Those are that sort of scenarios where we get our most benefit. When we start treating patients, we often have to do low FODMAPs, low oxalates. And most patients now seem to do better on a ketogenic approach. But some people are really sick. We go, we haven’t do carnivore diets for a month or two.

Now we get two more. Sorry, they took a little bit, but the topic was more and complexity. So I address the complexity part first, now we get into more. So this is a pitfall not understanding chronic inflammatory response syndrome. If you look at the immune system, here, we’ve got two new parts, the adaptive and the innate immune system. The innate immune system is the primitive, not too intelligent by the immune system. And it’s the first thing to go into action when any threat approaches. But the innate immune system hands off to the more sophisticated adaptive immune system to T cells, by the use of antigen presenting cells, when the antigen presenting cells of the innate immune system detected danger, they envelop little epitopes little DNA fragments and present them to the adaptive immune system to the T cell, which then triggers the B cells to create antibodies and memory cells. Now, this is this is SIRs or chronic inflammatory response syndrome. It’s a chronic, chronic more than six months inflammatory response, where people get sick and remain sick and don’t know why. And what happens is people with this condition often have a poor transfer of the innate to the nt body part of the immune system.

They have an inability to hand off to the adaptive immune system to call in the troops to put out the fires of inflammation, so they stay stuck in a chronic innate inflammatory response. They don’t create a transfer, they don’t create an anti inflammatory response. And this has been shown by Richie Shoemaker and others to be dependent on the nine gene sequence on chromosome six was houses the so called HLA set of genes, of which he believes about 22% of the population have this gene set. Now this, this theory of the HLA origin of innate immune activation has been contested by a number of practitioners who’ve sort of broken away from shoemakers original research. But I I’ve sort of returned to it recently, because when people have this set of genes is HLA a set of genes. I do think there’s something to be said by the fact that it is those set of people with those gene issues that don’t get out of the innate immune activation, they just don’t have an ability to turn off the inflammatory response.

And I do think there’s something to it, although as I said, it has been highly contested by other people as not being reproducible in terms of research. Once you stay in a chronic inflammatory response being triggered by mold exposures or any biotoxin, whether it be Lyme disease, secretario, or any, any biologically active substance. If this immune threat increases, you can’t turn it off. You’re constantly making inflammatory genes and proteins that circulate, they go to the liver, the biliary tract go emulsified by bile. Many people have Kali cystectomy. They don’t make bile, and it’s dumped into the GI tract. Then it either go out through the store, that’s your where people use their binders. And that’s where they want to call the stymy to bind the toxins or remove them, or it’s reabsorbed through the entropy circulation. And this goes round and round around in circles, you just can’t turn it off, you keep recycling toxins.

So what turns on this in the heat system is a biotoxin, an organism or a fragment of an organism? tick borne illnesses do it, some pathogens do it or multiple pathogens to turn on the innate immune system. This is not a chemical, it’s not a plastic. It’s not a heavy metal. It’s not an organic type. It’s not glyphosate. This is a biotoxin that turns on. It’s an organism this is important to realize. So pitfall number four, you confuse SIRs with chemical heavy metal toxicity. A biotoxin is not a toxin, as we learned, many people think this is a toxic problem, and they go rushing into detoxify without really understanding the biochemistry underneath it. So this is a chronic, persistent, innate inflammatory response induced by biotoxin. And these biotoxins can be mold. buildings contain over 30 Different inflammatory foods, many of which are bio toxins like actinomyces, etc. It’s mycoplasmas. They are not just mold, there’s many other inflammatory diseases can cause all kinds of trouble, really secretaria for stereo, and these people, they can’t turn off this innate inflammation due to these HLA gene problems. So it’s a genetic is genetically influenced, epigenetics turn on but genetically stays on, you won’t get these patients better by detoxifying them.

You won’t get them better by doing chelation therapy. So last thing you want to be doing, even though they may have a heavy metal burden that has to be addressed at some stage, you’ve got to address this chronic persistent innate immune system activation first, but you’ve got to measure it first before you can address it. So another problem that people often make is confusing mold allergy with SIRs are many of the mold remediation specialists, they end a lot of the even even practitioners risk virologists make this problem that patients will go see them with, say, I have sirs and they said no you don’t you’re IGE antibody to mold is negative, complete. The two ends of the spectrum serves as a chronic innate immune activation. mold allergy is an IGE antibody induced response to an allergen like mold. This shows up on an IGE test, which I do all the time. Very different from innate immune activation. If you’re allergic to mold, your immune system is overly sensitive to specific spores and treats them as an allergen. Ige is often upregulated. But the markers of serves the innate immune system, they’re not touched, and there’s no downstream damage to hormones and other parts of the body that occur with innate immune activation. And so the pitfall here is not fully grasping the subtleties of the SIRs diagnosis and the treatment options. Often, you’ve got to you got to ask yourself when you start treating and do these patients fit the SIRs criteria, and I’ll show you how to determine that in a minute.

There’s a patient for further criteria for a tick borne illness notoriously difficult to diagnose. Lab diagnostics are not reliable by any means. That the person get bitten by tick, turn on the HLA genes and then get exposed to mold very common. Are they still being exposed to mold or is it historical exposure? Often the disease the chronic disease, the ill health of the person, it’s the chronic inflammation itself. It’s not the mold of a lamp. It’s the fact that these HLA genes are turned on in a system which is just running with recirculation of the biotoxin nobody’s addressed it. Nobody knows what’s going on. And so there’s a lot of complexity involved in making the diagnosis and then how to treat it, which is on the other side of the slide, which I’ll get to. So how do we make a diagnosis for mold toxicity, or biotoxin illness? First of all, symptomatically. It’s a multiple unexplained multi system non responsive symptoms across many organs or regions of the body. And this question is that we use to determine that there must be a past or present history of exposure to a water damage building. You’ve got to exclude other diagnoses like putts, although they often coexist. And your mold score count the DNA probe for mold spores must pass a certain threshold the either it mustn’t be more than two, or the five molds that are pathogenic Aspergillus Penicillium IDs Aspergillus vesicular, ketone, yum, Stacie, vitalism Alinea together and there’s a scorecard they must be greater than 10 to 15.

These questions here and these diagnostic assumptions, they help you make the diagnosis. And then in order to assist you go over to the proteomics to the labs that help assist you in establishing, you’ve got to have three out of six do you have this HLA set of genes, this is a relative risk of susceptibility. Some people get sick from mold and they don’t have the HLA genes. Dr. Shoemaker said the prognosis is much better. But those of us who sort of broke away the ICI people that Neil Nathan people, we have found people with the so called dreaded gene that Dr. Shoemaker has spoken about get quite well. And we found people without that gene stay sick. So it’s not as cut and dried and as linear as one things. And then the next thing we need to measure are the direct and indirect markers of innate immune dysregulation. And sitting at the center of that is melanocytes stimulating hormone. This is a brain hormone that gets damaged by the innate immune system upregulation of cytokines that then cross the blood brain barrier and damage melanocytes stimulating hormone in the anterior pituitary. And that’s a neuro regulatory neuropeptide that is very much suppressed when the brain is on fire, which is in mold illness, and it starts to drop, and when it starts to drop, all sorts of things go haywire. I’ll enunciate those in a minute.

Another test is C four a, it’s an alternative pathway of complement activation, it’s an expression of huge inflammation. MMP nine is a is a molecule that gets expressed whenever there’s breakage in in blood band barriers, it it causes endothelial disruption and allows like the lime bags and the mold toxins and mycotoxins to penetrate your tissues, anti diuretic hormone and osmolality, which get affected by mold. These are people who pee a lot. They drop their blood pressure because they don’t concentrate the urine because they don’t retain salt. That’s where you get your pots. And they appear they pee a lot. And often those are the people who, when they touched door handles, I get shots quite frequently because of all the sodium that gets excreted because they don’t have that antidiuretic hormone. And then often when Msh drops, you get dysregulation of the ACTH and cortisol pathways with lack of loss of feedback, which is very closely related to the hippocampus in the brain. Cortisol originally goes up saturates the hippocampus, the hippocampus degrades, shrinks, and then you get hyper adrenal states. Now people come and say, Oh, but I’ve been diagnosed with low adrenals. Low adrenals are a consequence of chronic inflammation. They not a diagnosis. So if anybody says I got low adrenals No, there’s more going on. It’s a down regulation of the HPA Axis due to chronic ill health. It’s not a diagnosis, just like my cell activation is not a diagnosis. It’s a consequence of incoming toxicity not being regulated through the cell danger response and getting you out of being stuck. So these are the tests. Now this is the fabulous.

You must know this diagram to understand biotoxin illness and those of you who’ve dealt with mold or SIRs know this pathway backwards, and it sort of summarizes everything, if you will. Here’s the bio toxins in HLA systems trouble person 22 to 25% of the population affecting and inducing inflammation cytokines, those cytokines then have an inflammatory effect on the hypothalamus. And they down regulate leptin, leptin receptors called Dark. These are people who get heavier and heavier and heavier because they can’t regulate appetite. Not it doesn’t happen all the time, but it does happen occasionally. But most importantly, it reduces melanocytes stimulating hormone. This is the main neuropeptide, that when that goes haywire, the consequences are traumatic sleep gets affected, pain gets affected, and melanocytes stimulating hormone controls. Guess what? intestinal permeability, here’s your famous leaky gut or intestinal permeable gut, which is at the root of many chronic diseases is often because the melanocytes stimulating hormone has been suppressed due to a biotoxin load, that then creates a permeability issue. That also when your Msh is suppressed, it allows for the growth of resistant staph in the nose, which releases the toxin which goes up and affects the brain. And then here, it affects the antidiuretic hormone it affects is the sex hormones, you get decreased libido, and you go into premature menopause.

And here’s the cortisol and ACTH. And hear you get all these hormonal consequences to biotoxin illness, as opposed to the other 75 80% of people they have, they don’t, they don’t have the HLA gene, and they just get rid of toxins and they you know, husband of a spouse will go what are you complaining about I’m fine. And not understanding the genetic, multi heterogeneity of the gene process. They they, they just, they have an antigen presenting cell that sends it to the B cell. And a B cell mounts an anti inflammatory response. And that’s the end of it, they don’t get sick. But in 25% of the genetically predisposed, this is the scenario that’s installed for them. And all these cytokines are released. And you get all these immune system dysregulation, downregulated T reg cells and shifting of the th one th two axes, you also get hypoxia because of VEGF, another hormone. And oxygen isn’t delivered for the mitochondria to make use of to make ATP. And these are the people who can’t take a deep breath and often do well on oxygen supplementation. These you can really affect your hypoxia of your cellular tissue. Here’s the I mentioned this already. Another pitfall is not understanding other conditions, parts myself, hypermobility, etc, we’ve gone over that. And another pitfall is not using this questionnaire, I encourage you to fill out this questionnaire and get your patients all of them to fill it in.

If they come on this questionnaire, they’ve got 27 symptoms in 13 clusters. And they don’t pass the visual contrast test that Asians got says until proven otherwise. Very helpful. I had a patient this morning, who had this folded patient presented with a head injury. And this was form and no history of mold exposure. So no history of modern exposures. So this questionnaire of four, which is anything less than eight is considered a pass. I didn’t go down the mold pathway. I didn’t ask him. I asked him as a mold on the windows and things but there wasn’t so mold wasn’t an issue with him. But this question helped this questionnaire helped me. Now, you cannot, you cannot tell what the exposure is based on the surface questionnaire, all you can say is that if you have more than eight, you look here, the symptom clusters. If you have more than eight of these clusters symptoms in eight of these clusters, the probability of having SIRs goes up quite substantially and if you have the HLA set of genes, this confounds the diagnostic probability. And if you don’t pass the visual contrast test, or the visual contrast test this is a test that Dr. Shoemaker and Dr. Hudnall in 1997 they, they show that if you’re exposed to by a toxic illness, the neurological functioning of the optic nerve, from the retina to the cortex, you aren’t able to discriminate between shades of colors. And the more the by toxic load, the less the discrimination. And you want to pass a seven C and 60, you want this whole bottom part of the chart to be the tick mark. If you’ve got this all filled in the probability of having SIRs with a positive questionnaire, symptom cluster greater than age 98.5%, shown in multiple studies, first one in 2005.

So just by doing that, taking a history of knowledge pleasure. And doing this, you right there, you being launched into the probability of mold exposures being part of a differential diagnosis. And people. I do this a lot. And when people are being treated, I follow this. And you’ll see these bars clearing beautifully, and the patient feels better than they know. A few people 10% will pass the visual contrast but still show signs of inflammation. And some people have very good visual acuity. Professional baseball players apparently can have sirs and pass the test because they’re so used to having visual acuity. And some other occupational exposures can cause you to fail the visual acuity but generally speaking, it’s a very good test. And that can be done online at surviving mo.com $15 I believe. And then another pitfall is not doing some of the additional lab tests. Now encourage you to study with shoemakers group, or read up on this, I’m not going to go into all the different tests that we do in order to substantiate and gray the severity of the illness. But there’s certain ones that are very important. The Urmi test, which is a measure mold spores in the house essential marchands is a measure of the infected bacteria in your nose that that releases neurotoxin.

And then see for a TGF beta, I run these tests on most of my patients, if not all of them. And then the one at the bottom where it will do quite a lot is the neuro quant MRI, the neuro quant MRI pixelate the brain so that you can put the different areas of the brain the temporal lobes the frontal lobes, the gray matter, the white matter, you can put it into algorithms based on age match controls. And you can see if the brain swollen or atrophied and you get specific findings in mold illness of deterioration in some of the basal ganglia nuclear and inflammation of white matter. So I do neuro cleanse, and probably 80 to 90% of my chronically ill complex patients just to see the state of the brain as it’s been exposed to mold or head injuries. People with a lot of early trauma have a enlarged Amygdala on an MRI two to three standard deviations above normal because they’re always in a fear and fight flight response. You’ll see that all the time.

And that correlates with a beta brainwave being upregulated on the QE G, people with muscle activation syndrome will have very high thickened thalamus is because the thalamus is richly innovated with micelles, and those with head injuries will have asymmetry of between the two sides of the of the brain with the ventricles being different. It’s important to look at these things. If you if you need to know if that brains on fire or not, which you do need to know. One big pitfall is not looking through the lens of standard medicine and through functional medicine. And these are the list of you’re probably quite familiar with this list. I run many or most of these tests all the time on everybody. There’s a stupid thing which you’ve been exposed to that you can’t manage what you can’t measure. And it’s true. We try and do it because everybody, you know, nobody can afford the test. And that’s a given. It’s just a given that you’ve got to try and establish a practice whereby you are comfortable with the amount of labs you’re running, to give you insight to help the level of patients that you see. If you seen somebody just for hormones or leaky gut, then that’s fine. But if you see complex, sick people, we’ve been sick for 1020 years and we’ve got binders this thick and Mayo Clinic console.

You cannot run your practice by doing a few tests just I don’t encourage you to do that. So you have to find the ways and means to spread your diagnostics quite far and wide. Now some people have, who do you know, trickling hearts muscle testing protocols find that they can cut their costs by doing muscle testing, which is, if you skilled at it, I believe it has significant validity and I studied it for 10 years with Dieter, I prefer to work left brain with labs. But the drawback is the cost. People have been sick enough will often shift their value systems to find the means to pay for what they need in order to get better. And you really do need a broad diagnostic brush to bring a lot of this complexity together. You cannot do a stool test and treat these people do you know VCs and the urine mycotoxin test and hope to to help somebody it’s just impossible in my experience anyway. And so here’s some of the labs and all the links that I found helpful but again, that’s subject for another election.

And here’s the biggest bugbear I have is using the urine mycotoxin test is proof of diagnosis answers. I know neon Nathan and the real time people believe that this is enough. But I I think I think that’s too simplistic. Why? Because many healthy controls have lots of mycotoxin in the urine. So just because you’ve got mycotoxins in your urine doesn’t mean you’ve got mold illness. foods contain mycotoxins. You don’t know if you had mycotoxins in your urine, whether they were three years ago, one year ago last night what you had oatmeal for breakfast. And you don’t know if you’re good or poor excreta. I much prefer the next test which is coming up soon as the AGL test which actually measures cellular toxicity, whereby mold mycotoxins get attached to DNA and mitochondrial membranes, and they affect the translation of genes. And you may be a terribly terrible excreta of mycotoxins have a negative test. But if you do the ideal cell test, you’ll see that these micro toxins are sitting right on the DNA affecting translation of proteins and fats.

That’s a much sicker patient, often with neurodegenerative type diseases than somebody who’s got some mycotoxins in the urine. So please don’t make the mistake of just doing this test and diagnosing mold illness. And now that this, these tests have become popular, I see it, it’s everywhere. And I get this test all the time. And I get told I’ve got mold illness based on this one test. It’s not you can’t diagnose mold on this on this test. I hope I’m not sounding you know, the negative on this test, but I think it has to be. I think it has to be the truth has to be told on this one. If you join the ICI group, they debate this test back and forth in the States. It’s a fabulous dialogue to be part of, because Richie shoemakers work originally when he put this all together, he was most indignant that people were using this test and he made us made as those of us who pass these exams, write essays or why this test was so useful.

But then people left his group because some of the things that he said couldn’t be correlated with other evidence. And then those who left his group started to use this test and just use this test for diagnosis. And so the field is in its infancy, just bear with it. I’m sure over time, things will shake out in the wash you know. Many foods contain mycotoxins so one of the things we do you know, people outs and corn and peanuts, I mean, it’s full of market toxins. So these are everyday foods that people eat. So people do get put onto a low mold diet and sup to some benefit. But it’s, it’s really, you know, if you got my cell activation, you got to be on low histamine diet. I find that people got mold illness going on low mold diet isn’t isn’t the therapeutic input that makes the big difference.

Now, here we are back to the cell danger response and membrane medicine. See when these toxins come in which mold is one of the causes oxidative damage, they they destroy the cell membrane, and the sum of these toxins attached to the DNA. And this causes poor translation of messenger RNA into the ribosomes. And then often the cell due to this ongoing toxic insult, undergoes autophagy due to the DNA and the ATP go outside the cell becoming pro inflammatory, inducing my cell activation with 1000 mediators of inflammation and further destroying the cell. And this is this perpetuation of the cell danger response. And so, here we have a lot of research showing how mycotoxins which are the byproducts of mold spores affect the mitochondria, causing the cell danger response has been published. Here’s some of the publications and these mycotoxins disrupt the the Krebs cycle and the electron transport chain and many, many different sites. This is all being published. So we know mold damages, ATP production and citric acid and mitochondria. There’s many papers published presenting that by the way, there’s a very good presentation on the GPL Great Plains laboratory website by Kurt Warner, on mycotoxins and mitochondria.

It’s worth watching I got the slide from him. Sorry to say I didn’t obtain permission. But I do know him and I will seek permission when time permits but I’m acknowledging that I got the slide from him. And he got the slide from a publication. So mitochondria are these micro toxins they affect the mitochondria in many different pathways in this Krebs cycle, they you know, we have our macronutrients that have to be eaten, shut fats, for instance, shuttled through by carnitine into the mitochondria across the cell membrane, and all these mighty micronutrients that activate these enzymes that then activate NID, NADH, that then go through the electron transport chain on the inner membrane of the mitochondria that make your ATP here, and these mycotoxins disrupt these pathways in multiple sites, they are crud toxin A affects ATP production inhibits ATP production. Many studies done on this now. So here’s this test, which is sort of revolutionized the way I practice medicine the last five years is a German based test and you can actually measure it can measure mold, fungal species and mold, fungal metabolites, by measures measuring lymphocyte sensitivity to these mold toxins. And you can see here that all at the level of the genome and the mitochondrial membrane, you can get mold. You can get your lymphocytes being high, react highly reactive to mold species and to the mycotoxins. And this is this test is what I rely on now. Apart from doing my traditional shoemakers sort of workup, I look here to see if this person is has mold still in their system. I only saw two patients this morning. Because of preparing for the lecture and get everything set up. One of the patients was from Switzerland, chronic fatigue syndrome, 10 years, supposed to mold in Lyme disease. And she was here in Calgary in December doing very well in Calgary home. Normal. We’ve done me tests looking for mold spores. She went back to Switzerland.

And I got this test, which she had done a week after leaving Switzerland and she had dramatic levels of mycotoxins that had gone from her previous one we did two years ago. The levels jump from 1500 to 500 600. And I just looked at this and I said so and so you’ve you’ve been exposed to mold, you are highly mold, toxic. And she said I knew it. This house I’m living in in Switzerland, there’s mold everywhere. I’ve tried to clean it up and it keeps reappearing. It’s in my shower. It’s on my window. I said, and she was told she was in bed 90% of the time. That’s and she moved back to Switzerland two years, two months ago. She’s her levels of mold are gone up five times. So this test showed me at the level of a mitochondrial DNA. She had mold lymphocyte sensitivity, and she clinically confirmed it. She said, I know I’ve tried to clean it. I said you try to clean it, don’t go near it. So get out of that house right away. I can’t say very well. And then we had a big discussion about what to do because many of these people are chronically ill for prolonged periods. The innate immune systems go round and round around in circles and they stand exposed and they often it’s the home that’s causing them to be sick, or it’s the quality They took from the home or is the couch they took from the home or something that they took from a home.

And they just go around in circles and never get better until the cycle is broken. This test also allows us to measure ATP production to see how blocked it is. And here’s the beauty of the test. It also measures mitochondrial numbers so you can see if mitochondria undergoing destruction and is less numbers than they should be. It also can tell us whether it’s the mitochondria, mitochondria are expressing abnormal proteins and lipids, very long chain fats. And it can tell us about some of the mineral deficiencies that are contributing towards the cell membrane voltage being affected. Here’s the ATP blocking active sites 21% You don’t want that block more than 14%. And here you can see that the DNA which gets released when the mitochondria undergoing destruction is at a level of 17. It shouldn’t be more than nine. So they their DNA is outside the cell triggering micelle and further oxidative damage. And here you can see after a toxin you can see one of the mycotoxins from Aspergillus is sitting on cardio lipid and actually the the enzyme that makes the inner membrane of of your, of your cell in your mitochondria.

There’s a toxin sitting on on that enzyme affecting cardio lipid. And there’s your phospho title fo Alameen, which is found in the body by PC, low, the inner membrane along which the electron transport chain occurs. And there’s your plasma title choline, which is the external membrane. And this Melange, the height you can see that the fats, the lipids in the body are oxidized, deficient, and the cellular machinery that making the lipids is impaired. That enzyme also requires manganese to work that the manganese deficient. That’s why you use the body by minerals and electrolytes. So mineral sessions. And here on the DNA you’ve got sitting on the DNA, formaldehyde, and there’s aflatoxin, there is a micro toxin from mold affecting translation of messenger RNA sitting on the DNA. This is huge, you know, this is serious business. This is not lightweight testing.

This is serious. And when people it’s going to affect the metabolic machinery of the cell, and it’s going to put people into chronic ill health that gets a stain unless it’s dealt with. This person also had zinc deficiency was incorporations. Zinc is the largest role to play. Regulating DNA destruction, and immune function. And then you can also see here, I can’t see the slides so small that’s the same same one sorry. Keep repeating this. Here, you can also look at your antioxidant states glutathione. You can see that it’s low in the bloodstream, here superoxide dismutase, the good guy that is sis glutathione and putting up peroxy nitrate. Here you can see conatins low so shuttling your fat into the cell to active cellular energy is low. Here’s the mast cell membrane, the cell membrane of 159, the voltage of your cell is low. This is dramatic because the electron transport chain depends on the cell voltage being normal, and that’s low. This gets affected by mineral deficiency, intracellular calcium, intracellular calcium triggering the NMDA receptors and causing the excited toxicity and magnesium there, which is found in your minerals. Magnesium is a calcium channel blocker.

This person was highly exposed to electromagnetic fields, which induce high levels of intracellular calcium and mast cell activation, the cell membrane was depleted that phospholipids were depleted this this cell is in a lot of trouble. He has a heavy metal test, you can see the telephoning, which binds to heavy metals is high because it’s working overtime, binding to barium. And when the telethon is running around mopping of metals, it drops off zinc and you become zinc depleted. And here NID vitamin d3 which is central for the electron transport chain is depleted. That’s why everybody is now on to nitrogen and other NADH or energy supplements. And then another beauty of this testing is we can look at the cell membranes and we can see the deficiencies and excesses, we can tell what the saturated fats are doing this is not now the AGL test. This is the the test we do the Kennedy Krieger looking at lipid membranes, we call it the body by a red soul lipid membrane test. We can look at saturated fats and Omega sixes, look at total lipid content.

Now look at this total lipid content. The total lipid content of this person is completely negative. And I can’t tell you how many people come in. And they get put on colas, tyramine and crash. Because Patricia Kane, who initiated this therapy many years ago, made the statement I don’t know where she got it from. But she said that if your lipid content is less than minus 25, and you use curl to stymie, you’re going to crash that person’s lipid membranes and create tremendous damage to the mitochondria. And I believe that statement is true, because I’ve seen it. I’ve seen I’m treating a patient right now with an ALS condition and that that’s his total lipid profile. And he did have mold and he was put on polystyrene, and he’s much worse right now. So we had to repeat this lipid content. It is omega sixes up to scratch, saturated fats structural bets, we can also test by the myelinating, making making white matter. And we can also see how many abnormal oxidized bad renegade fats are being made. Here’s where your butyrate and your tadka come into play, because those help get rid of these very long chain fats. And as you get healthier and healthier, these go down and down. So this, this IGR test in the body via red cell membrane tests are extremely helpful. And this is where the whole membrane medicine comes into place. And we start to repeat cell membranes, sweep toxins off the DNA and repair as much as we can.

With various therapies, of which body via products take a central role, I can’t say enough about how I’ve benefited and how the patients have benefited by repeating outer inner membranes using peterites and tadka. Replacing minerals, just you know, I’ve developed a shake, which I’m sure tastes awful, but very competent is very beneficial. And to sell membranes, Justin has the job of making it taste pleasant by using the only thing that we use is coconut milk and, and blueberries because everything else most of our patients have my cell activation behind us much else that we put into the shake, you know, PC and body bio balance and electrolytes and minerals and glutathione and superoxide, dismutase and resveratrol. So we make a shake of it. And we use blueberries and chopped vegetables for poly phenols. And most people find this very nourishing if if they can get past the medicinal quality of it. So here’s another pitfall we’re nearing the end, so we’ll be done pretty soon. pitfall is using color styling, inappropriately, not only the synthetic color styling, which is full of aspartame. But if your lipid membranes are very low, using polystyrene will rarely crash a patient very quickly, so it’s not appropriate to use color stymie right out of the gate.

Just very quickly. Other pitfalls using the wrong test as sampling is absolute. No, no. The settle plates are worthless. tapeless, okay. But the real test is the Urmi test, which I’ll show you in a second. Another big mistake people make is I have a new home it doesn’t have mold. I live in Arizona, it’s not wet and damn. new constructions are often the worst. I had a new condo, which was put up in the boom they didn’t put events in a flat roof and I had mold in three floors, condensing down the sides. No visible mold does not mean the building is safe. No musty smell does not mean it does not have mold, or crawl spaces and basements usually have mold. ductwork is often contaminated. And this is the Urmi test where you measure dust spores by either swip upright or vacuum cleaner and you quantify that according to specific algorithms. People call in mold inspectors and they don’t do a thorough visual inspection. You’ve got to go from the attic to the basement and outside and have a look. And he has some of the questions you want to ask. If somebody comes in waves a sample meter and walks out and says you don’t have mold, run for the hills.

Look at baseboards, pull out dishwashers go up into the attic. Do you have a front end loader washing machine? Is there condensation? Did they use a water moisture meter, you know the day to do thermal imaging looking for wetness behind dry walls. Here’s some fabulous references for people who do good work, shall see acres with a whole bunch of web videos on YouTube about how she’s an architect you have mold on us. She’s very thorough, and patients report doing her series is very helpful. So, in summary, mold illness is ubiquitous. It’s everywhere. It involves genomics. transcriptomics. Proteomics involves abnormal regulation of micelles hormones, mitochondria, autonomic nervous system. These conditions are everywhere. Look around, you’ll find them. They’re ubiquitous. There’s just a summary of some of the pitfalls. Here’s some papers and links to articles I’ve written on mold. Things you can find. And that’s my details. And that’s it for me. Am I doing 68 minutes? I’m sorry.

Thank you so much. Dr. Ruffin, can you just click on can you make me the host again, so that I can go over some of these questions. I’m trying to turn on my video, but it doesn’t look like I’m able to unless you give me permission. What do I do you go to the top of your video, there’s three little circles. If you just click on that those three little circles it should show up to make me the host. If not, it’s okay. I’m I can say off camera as well.

Doesn’t say it says pause recording stop recording raise hand.

Okay, okay. We’ll just leave it as is I’ll go over there’s quite a few questions. So do you have a few more minutes to answer your question? Okay. So the first question is from Christy. And she just was asking what the German test costs? You can answer that one or I can choose?

No, it depends on how many panels you choose. So they range in price. If you just go to the Igel website, and you ask them for to send the cost the the extensive panel that I do, it’s 1000 or two euros. But you could do subsets of it to get what you want to look at. And then you go

in there they are. That lab is expensive. I mean, I think I just ran it in last year. And I think it was close to $2,000. Canadian for whatever panel I did. So it’s not an inexpensive lab, that’s for sure.

But remember that is many in when that’s not one panel that’s like 10 panels. So you can if you want to just know your first blood lipids, you can just do that little panel. But if you want to do a complex mitochondrial workup, then it’s going to cost a lot more.

So the question is what is the next question is what is the difference between ErmI and Emma testing?

The Emma testing measures mycotoxins and spores, whereas the Ermias just pause. I don’t do any testing because I just historically have stayed with micro metrics. I do use other lab for actinomyces. I haven’t run many Emma tests. I don’t think the tests been validated. And so I just stick with what’s been validated by the think by the FDA. Let me test

Okay, thank you. And then Shelley. Shelley Wilson, who we love. Thanks Dr. Hoffman to Justine excellent presentation. We adore you, Shelly. Um, okay. And then Chris, you had another question is Well, what is the extensive

sorry, surely didn’t ask me a bone crushing question.

So, if you have a question I’m Christy I will find out if you can. So she just asked what is the extensive one called the IG L so if you email me I will find out from the girls at the front desk and and I’ll let you know I don’t think I don’t know that. I’m right now and I don’t think Dr. would know that offense either. Okay, um, now in the chat there was lots of questions I’m going to have to go back. Um, do you have an MRI and the neuro quant software at the clinic?

No, you’ve got to get me the neuro quant is quite complicated because you’ve got to, you’ve got to get the MRI company to do specific settings on the MRI to read the neuro quant the neuro con software, but that requires certain settings on the MRI. So you’ve got to buy the software from neuro quant, you’ve got to get your MRI company to be willing to use the settings on the different Siemens devices. And once they change the settings you can read neuro quant but it’s two parts to it. So it took us two years to get neuro quant in Calgary. I tried to get it through healthcare, but they wouldn’t do it. So a private company doesn’t. Because they wouldn’t do it because it requires changing settings and they don’t want to do that.

Okay, Allison just asked where she can find the recipe to the shakes, or recipe for the shake. So Allison, you can send me an email as well. I’m happy to send you Dr. Hoffman’s template, if you can just make sure that you give him credit

for our upcoming book. No, we’ll give it

Yeah, that’s true. We’re doing a cookbook that should be out in a few months. And the recipe will be there’ll be plenty of recipes in there. When working on cell membrane, what daily oral PC dose Do you work patients up to?

It’s a It’s depends on so many things. If you’ve got a very high micelle population, they can’t tolerate much of anything. If you’ve got a robust population, they are often much more able to tolerate higher doses, but they often need assistance with lipase and bile Oxbo. That’s a tadka. And we use a product called Beta plus. And it had Kali cystectomy is that’s another whole puppy sub population of people who can’t tolerate high fats. But it say all those confounding variables are taken out, we always start them slow, like half a teaspoon. And then we work up to you know, I don’t really go more than two tablespoons a day of both of them. The body by a balance we use a lot on food, not in the shake, because it’s pleasant, you know after you’ve cooked it and cook it up. But put it on stir fries and salads. And the PC goes into the shake because some people just eat it off the spoon, but it goes on the shake quite nicely. But I don’t usually use more than two tablespoons. But keep in mind, I tracked labs, I tracked the red cell membrane tests and attract the AGL test. And also there’s another variable there. I’ll think of it in a second. I forget what it was, but there’s another variable to it.

Okay, in addition to body bio products, would you recommend adding an all encompassing Mito booster supplement like mitochondria and RG from designs for health? You can

well, so a lot of the supplements that boost mitochondrial function oh, here’s what I wanted to say before I get back to the question. Our OPC helps strip the cell membrane, or helps repair the cell membrane because it’s got the three phospholipids versatile ever elevate hospitality knows at all. Whereas IVP PC which I use a lot of help strip the DNA of the acts of the toxins. And that’s a general rule. So I do IV password title choline with phosphine or butyrate and glutathione. And I do aro PC and body by a balance for different purposes. There is some crossover, but there is a different therapeutic reason for each of them. Just I just wanted to emphasize that point. And then sorry, what was the question

is so there’s so many questions there. Oh, the other one was on mitochondrial support?

Yes. So much. So using the micronutrients that support the mitochondria, I find is false thinking. You can do it. But you want to sit back and look at that cell and see what state it’s in. Look at the state of the individual look at the state of the food gut brain axis. And you can’t just start stimulating enzyme pathways without first repairing cell membranes and look Looking at the toxicology of cell membranes and the viability of the electron, the voltage of the cell membrane, whether there’s deficient numbers on line. So I don’t go use a lot of mitochondrial traditional support, until I’ve helped repair the cell membrane. improvement in the AGL. And lipid testing, I tend to, I do use carnitine and 210. And nada, I do use them. But if you go use those without preparing the cellular toxicology and the soul structure, it’s a it’s a, it’s a losing battle. You won’t get anywhere.

Yeah, and that’s something that I’ve seen too, which was what really what drew me to membrane medicine because without, I mean, you’re really just throwing things that people do first don’t repair the self.

Find remove as many incoming stresses, and then balance the cell by much and modulating the homeostatic mechanisms, the allostatic load, you know, you’ve got to sort of work this whole system.

But there are specific nutrients like B one, b two and B three will support that front end of the mitochondria and carnitine. And then the electron transport chain is supported by Coenzyme Q 10. NAC. Creatine is helpful.

Nitrogen.

Okay, let’s see here. I think I’ve covered all of them. Is anybody? Did I miss a question? Oh, if someone has recovered from mold toxicity, is it helpful to use the LPC long term? I will say? I will say yes. But now let you answer.

You know, I’ve measured igvault, postmitotic, choline and fllo mean, I’ve never seen levels outside of the range. So people stay on it. We’ve constantly under salt. So as a lipid bilayer is are very much susceptible to oxidative damage. So I think a daily intake of phospholipids is crucial to maintain cellular health.

And then I think it was a question about cosmologists in here too. We do use cosmologists have you? So yeah, we have definitely heard of plasma halogens? Um, regard? Have you heard of plasma ologists with regard to membrane lipids? If so, can you comment on any overlap between plasma telogen deficiency and sirs?

So I’m assuming of Doctor good enough. I’m learning his plasminogen I take them. But as you know, a doctor good enough. He’s a biochemist with a lot of knowledge and where players margins fit in. That’s another whole level of complexity. I’m just starting to get my head around. Justine actually knows a lot more about origins than I do, because she has studied with him recently. But it is definitely appears very exciting. And I think plasma legends will be playing a huge role. In the future, just like peptides came up and exosomes. These things have the, you know, the waves of fashion, but I think plasma origins are going to be a big deal.

Well, and I’ll just quickly comment to that too. So with plasma halogens are a subtype of phospho lipids, so about 20 to 30% of the brain is made up of plasma halogens, so it’s third so they’re made by the ProxySG. They’re endogenous, and you can’t consume anything that’s going to help to support plasma telogen levels. And with SIRs with that chronic inflammatory condition you burn through a lot of those plasma halogens because they’re a very potent antioxidant. So you’re, you’re gonna want to support with plasma halogens likely if you have sirs, the other issue too is with that chronic inflammation you are going to have compromised paroxysmal functioning. So your proxy isms are not going to be making adequate amounts of plasma halogens and then what they are making is getting used up as antioxidants.

Good enough as a test now to measure all of those which we’ve just started to use.

Okay, um What would you recommend to move a patient into dorsal Oh, when we have it an H bot? I don’t know if you talks about H button the lecture by H bot recommended after stabled with mast cell. Do you recommend hyperbaric oxygen?

I think hyperbaric oxygen has a very definite role to play. But I never use it in the front of any protocol. I often use it as a cleanup down the line. Particular In traumatic brain injured patients, so I never use it in the front end, I usually wait one or one one and a half years before I start recommending age parts.

And I think we have all the questions. Let me just go through one more time. If anybody has something like pressing that I did not ask, you can raise your hand. Oh, sorry. Okay, the dorsal are your questions about please see the q&a. Okay. Oh, my gosh, there’s lots.

You don’t want person in the dorsal vagal shutdown response. That’s when they are compromised. The withdrawn they depress the stack. So everything we spoke about today is attempting to shift the dorsal vagal structure into more window of tolerance, self regulation between sympathetic, parasympathetic. And there’s a complexity to it. I did, there was a slide that says what to do. If you go back to that slide, I listed about 20 different therapies vagal tone exercises Somatic Experiencing safe and sound protocols. resi Max, there’s a whole list of them. But if a patient has undergone trauma, and they’re in PTSD type response that requires sophisticated therapeutic encounters, referred to professionals who work with trauma, because that’s very hard to shift if there’s an underlying traumatic etiology to the dorsal vagal shutdown.

Okay, and then we have a few questions about Oh, where did it go? Snowy? You had two questions. One was, okay, how to get patients to tolerate oral PC when they have resistant? dysbiosis?

Chris? You, resistant dysbiosis? I, I just keep working with the dysbiosis until something ships? This that’s a very big discussion. But yes, you’re right. People can’t handle anything coming into the GI tract when it’s severely dysregulated. So you have to go through the whole gut fiber or whatever methodologies you use treats CBOs and levers and CFOs. And there’s a complexity to it. So those people who are in sympathetic dominance with poor vagal tone will have massive dysbiosis. I work around the issue and try and find out what’s what is the problem? Do they have lower last days with low lipase? Are they not making bile? I get gallbladder motility studies. So there’s a lot of complexity to it. It’s difficult to answer that.

And then this question, I laughed when I read this, I shouldn’t I shouldn’t have laughed, but I did. Because I’m excited to hear your answer. The initial part of your discussion, what is the best way to build the patience and love for patients with limbic disorders, especially when you’re seeing many of them and they drain you and your staff tremendously?

This is the million dollar question. How do you stay regulated when your whole world around you is dysregulated? Well, here’s my answer to that. I’m in my I’m in my 60s, I mean 65. So the longer you live, the more resilient you become. So that’s that’s to my advantage. You also learn to know your defenses and as soon as your palms start sweating, you know you’re in trouble and your defenses are up and you’re in a complex. You delegate you delegate low priority items to other people and hopefully you find good people to help you manage the complexity of managing complex patients. And then I find having policies and procedures and systems that hopefully get followed with lots of sort of patient education helps somewhat dampen the chaos get again shoo, which you can never fight, you know, get rid of because any patient any clinic with treating complex patients has a one or two borderlines there At least five or six severely traumatized people with PTSD, myself everywhere you look. And so you will get complexity. And if you love what you do if you just get up every morning enjoying and loving what you do that itself is a buffer against some of the, the stresses that hit you on a daily basis. So there were other things you can do as you can read about in the self help books, but that’s been my experience. It’s just my age has helped me become more resilient, great stuff. Most of the times when you lose a good staff member, chaos ensues and then just loving what you do. If you love in what you do is a high priority. You You can withstand some of the slings and arrows that come your way.

Okay, who do you have run the neuro quant for you? I’m looking to access the test software here in Calgary in Canada.

The only neuro quant in Canada is in Calgary, you have to fly here or you have to go to the neuro quant company and ask them to find the nearest neuro quant in your vicinity. Have you in the US? There is one in Seattle as well I believe so my patients go to Seattle or come to Calgary? I don’t know if there’s anyone close. They may have they may have one in Toronto or Vancouver by now but I much I don’t know that.

Okay, I think we have finished all the questions. Um, let me just double check one more time. There was a comment about oral PVC is worse because it can cause translocation of LPs into the blood and then raise inflammation significantly. I was curious to hear your comment on that because I have never seen that.

I think theoretically that’s true. And I’ve been I haven’t seen I haven’t seen LPs. Well the only test I have for LPS is the Dunwoody one. And I haven’t seen any of the LPS IgG IgM. IGA is getting worse in ever since I’ve run the test, which is the last 10 years. So I can’t vouch for that it probably from an academic perspective, we know how high fat low carb diets increase oxidative damage for LPS, but I haven’t seen it clinically.

Okay, thank you. Thank you all for joining us, right or I’m staying with us right to the end. And thank you again so much for the really really informative, lovely presentation. We’re really grateful that you were able to do this for us today.

Thank you very much. Bye now.

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