Rethinking Treatment of Environmental and Mold Toxicity

Episode Intro:

Welcome to Dr. Ruscio Radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player for weekly updates. Visit drruscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now, let’s head to the show.

DrMichaelRuscio:

Hey everyone. Welcome back to another episode of Dr. Ruscio Radio. This is Dr. Ruscio. Today, let’s jump into a number of updates from the research, a case study and walk through an assortment of insightful bits from our Future of Functional Medicine Review. We’ll go over a case study where there was resolution of Psoriatic Arthritis pain in a month. Really importantly regarding this case study, there were other findings – namely with metals and mold – that could have led us down a rabbit hole. However, even though those were positive, the symptoms were largely resolved via gut care. So, another good evidence point for why we place so much emphasis on the gut first. It seems to have the highest probability of resolving symptoms. When we look at that in juxtaposition to the fact that a fair amount of functional medicine testing is still being worked out in terms of its validity and utility, then we want to make sure to start where we’re going to have the highest return on time and energy invested — hence, the gut. We’ll also go into a review on how mycotoxin – or just mold exposure – can manifest as a wide array of symptoms, a few studies on inflammatory bowel disease treatments, and clarity on Blastocystis hominis and how often that causes symptoms.

Case Study: Psoriatic Arthritis Resolution

DrMR:

The case study here comes from the June, 2021 Future of Functional Medicine Review. The case study is entitled ‘The resolution of Psoriatic Arthritis pain in one month.’ The patient’s name was Caroline and she was a 72 year old female with a history of radiation-induced hypothyroidism. She was Graves’ before she saw us. Hopefully we could have helped prevent that because we have a pretty good track record with Graves”, although I can’t say we have a super high volume. In any case, she had radioactive ablation of the thyroid so she became hypothyroid. She also had Psoriatic Arthritis plus atopic dermatitis, some constipation, some skin rashes and some obvious joint swelling with the arthritis, fatigue and insomnia. She had been on Synthroid for the hypothyroidism. She wasn’t too crazy about it so she was currently off of it. Her labs actually found her to be subclinical hypothyroid. So, she was maintaining normal levels of thyroid hormone. What you saw was from January to March. So this is a fairly insightful finding — her TSH went from 8.9 to 12.5; her free T4 was right on the edge of becoming low at 0.8 and then 0.9. When you go over that 10 with TSH, that’s really when most of the consensus shows that even if the free T4 hasn’t gone over that cusp into truly low, once you traverse past 10 with TSH, that’s something to use thyroid hormone for.

DrMR:

Her concerns were poor gut health, immune dysregulation, potentially histamine intolerance and nutrient deficiencies. She was wondering if there were any environmental contaminant or toxin that was driving this. As we start wading into this case study, there are a number of things clinically that we’re thinking about — dietary changes, initial supplements, are the thyroid medications required or not and how do you get started with this individual. The treating clinician here was Dr. Robert Abbott. In this case, we issued a urinary heavy metal screen, a correspondent LabCorp heavy metal screen, a thyroid screen, an optional GI map stool test and an optional RealTime Labs mycotoxin test.

DrMR:

We started her off on a treatment program of the autoimmune paleo diet – remember, that’s like paleo, but also cuts out eggs, nuts, seeds and nightshade vegetables – triple probiotic therapy, gut rebuild nutrients and a 2 to 4 day Elemental Heal reset. We also recommended that she follow up with her PCP for Synthroid. When we followed up with her a number of weeks later, her joint pain, fatigue and rashes had markedly improved. Her itching was better and her sleep was also better – as the itching was sometimes interfering with her sleep. She had started on Armour instead of the Synthroid she was using prior.

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DrMR:

So, we see almost all of her symptoms improving from autoimmune paleo, triple probiotic therapy, gut rebuilding nutrients, and an Elemental Heal reset – plus getting her on the thyroid, which she almost for certain needed. This is where it’s much less debatable. Like we said, with the TSH going from 8.9 and over the course of three months, jumping up to 12; with that free T4, right on the borderline of positive negative. For the clinicians in our audience, if you wanted to suss out to get a more accurate picture on that free T4, there is that liquid chromatography with mass spectrometry methodology that you could use. That may give you a more accurate read.

DrMR:

In any case, we’re off to a great start. When we looked at the re-testing, her thyroid had normalized on the Armour. She had elevated blood and urine-led elevated ochratoxin and alpha toxin. At her follow up, the results of her GI map were pending. We did have her start on a low dose binding protocol of charcoal, chlorella, bentonite and some modified citrus pectin. A follow up was recommended with an inspector for any source of lead and mold in the home and to continue her diet and GI supports.

DrMR:

Some of the main takeaways to pull from this — Even though Caroline had a toxic load based upon her lab findings, we did not need to immediately address those things in order to make a very significant improvement in her symptoms. You could even argue that if we had jumped right to treatment of metals and mold, we would likely have missed the opportunity to get to what seemed to be the primary driver of her symptoms – which were diet, GI and thyroid. Remember that treating the gut first will address a lot of symptoms. We could even argue that over time as her gut became healthier, she may be better able to process toxins. Just a few notes there on why we need to have a structure, plan or model through which to sequence the various therapeutics that we use. For example, if someone had started with a lot of testing and then decided to treat the tests, they could have treated gut and toxins at the same time. That’s where you lose that signal of what really moves the needle symptomatically; why I think an algorithm or hierarchy is so valuable. It helps you prioritize, execute and learn from patient response. If you’re going through the do-it-yourself protocols on your own, it helps you learn from your response and not have that murkied up by the fact that many things are being supported at the same time.

Neurocognitive Symptoms & Mold

DrMR:

Continuing on… Joe Mather did an excellent review on water damage, building syndrome and mold in the June, 2021 FFMR. There’s a lot here to unpack, but the high level would be to appreciate that neurocognitive symptoms clearly can be attributed to mold exposure and may even affect not only brain fog, but also IQ. This is actually one of the symptoms I have noticed when I’d been exposed to mold. I’ve had that “wonderful” experience. I noticed it’s a bit harder for me to focus and I also sleep poorly.

DrMR:

So that’s one important item to understand. Infection and colonization can occur and mold may even cause immunosuppression, thus allowing fungal infections to occur – another important insight. An important point here is that sequestering or binding agents have an affinity for the toxins, but it’s kind of this loose affinity. An analogy you may be able to use is this – You have this dry sponge, you put it in the sink to soak up some water and then you’re going to take the sponge to wring it out over the toilet. There’s going to be some water dripping as you move the wet sponge over to the toilet to wring it out. This may be why – if the binder dose is too high/too aggressive – you’ll see a provocation or eliciting of symptoms. You will have a lot of that water you dump into the toilet with the sponge. But, some of that drip-off will essentially be that you bind some, some falls off, is liberated into the body and thus the exacerbation of symptoms. That’s one other point to keep in mind. We don’t necessarily want to aim for the most aggressive, but personalize the protocol to the individual.

DrMR:

There’s a great summary section that breaks this down. Point 1: Become aware of the patient’s environment. Could there be water damage or some type of exposure in the home? This is where we really feel having an IEP (Indoor Environmental Professional) to lead that charge is the way to go. They’re really the doctor of the house, so to speak. I think it’s difficult for a functional medicine clinician to gain mastery of all the different ways of assessing homes. It really is a different field of education and study. That’s why we want to be careful not to falsely conclude someone has mold in their home because they did one of those hardware store agar plates – or maybe an ERMI – and they don’t have the appropriate context or interpretation. You have to be very careful to have someone who can interpret – just like a stool test. If you don’t have the right interpretation, it can be very easy to think you have a problem when you don’t. This is quite important because going through remediation can be expensive and stressful. So, become aware of the patient’s environment and definitely get a qualified IEP to lead that assessment.

DrMR:

Point 2: Have the appropriate clinical suspicion of mold or heavy metals in a setting of neurocognitive, auto immune and allergic symptoms. Be on the lookout when you see those symptoms, especially when they have been non-responsive to other therapeutics.

DrMR:

This ties into Point 3: Implement diet and lifestyle treatments followed by GI treatments before starting binders. This will improve the tolerability of the follow up binding therapy. It’ll also help give you a sense for “Is this person seeing the typical kind of response that you see from diet, lifestyle and gut therapies – or are they not?” To the degree to which they are not responding normally, that builds the case that mold, mycotoxins or metals may be present.

DrMR:

Point 4: Utilize a simplified binder approach. It doesn’t have to be overly technical. That’s another important point. This is akin to – What are the best herbal microbials for SIBO? Or what are the best probiotics for SIBO? Some recommend very elaborate and detailed dosing protocols; some will make very detailed and elaborate detox re-binding protocols where there are two or three agents for each mycotoxin elevated on the urinalysis. This can be expensive and it can be arduous. It seems that’s generally not the way things need to be treated. Usually, the most effective and most accurate version is more simplified. As another parallel GI analogy, multiple different antibiotics have been shown to be effective for SIBO. You can counter argue that perhaps the side effect profile of Rifaximin is better due to its localized nature. That’s an argument for sure, but it doesn’t take away from the fact that we’re talking about what antibiotics can remedy SIBO. There are a number that have been shown to be effective.

Inflammatory Bowel Disease

DrMR:

Coming over to a few different studies from the FFMR Plus, there was a review for diet in supporting inflammatory bowel disease, diet and dietary supplements. This is interesting. Within one week of 5 grams per day of immunoglobulins, one study found a 50% improvement in inflammatory bowel disease. This was corroborated by five other similar studies. Another evidence point was that Mesalazine works better when given with curcumin. There’s also some evidence showing that essential fatty acids like omega-3’s, vitamin D, phosphatidylcholine, and nettle can all be helpful for inflammatory bowel disease.

Blastocystis hominis

DrMR:

Another relevant study was looking at Blastocystis hominis in 900 patients who were admitted to a hospital in Iran. 8% of these individuals were infected or colonized by Blastocystis hominis, but there were only gut symptoms reported in 61%. I shouldn’t say only – that’s over 50%. At some point, we will go through a more comprehensive review of Blastocystis hominis. We have the data and I’ll do a podcast run through on it. We’ll also do a write up in the FFMR for providers so they have it at their reference for when a patient comes back with positive Blastocystis hominis. I can give them an accurate and responsible overview on what this means. What this study partially eludes to and the more robust research review finds, is that there is a signal. In this case, 61% of patients had symptoms. Those who have Blastocystis hominis may have gut symptoms, but it’s a weaker signal and we should not be telling patients that this is a parasite and that everyone has to eradicate this. I think that’s incredibly important to keep in mind.

DrMR:

There’s this old school naturopathic sentiment that if you have H. pylori, or if you have Blastocystis hominis, you have to test the entire house, aggressively treat everyone and get rid of it. That doesn’t seem to be the rule. In fact, it seems to be more of a normal resident for most people. There is a signal, it can be problematic and treatment can be helpful. However, how we communicate this is very important – especially in those with IBS. We know individuals with IBS have a higher predilection towards anxiety. So, now you have an individual who leans in the anxious direction and you’re telling them they have a parasite.

DrMR:

That’s a strong statement to say. I think it’s better to describe Blastocystis hominis as an organism that is in this gray zone – where it’s a normal commensal for some and can also be problematic for others. All these things really add up in terms of the emotional and financial service or disservice you may be doing to a patient. When you understand this, at least the way I interpret it, we don’t have to serially re-test to make sure Blastocystis hominis is “eradicated.” It’s a finding. We can use someone’s symptoms to dictate, “Okay. We found that on your initial test, we’ve done some initial GI supports and your symptoms are now gone.” We don’t necessarily need to re-test because Blastocystis hominis isn’t like an amoeba that’s always pathogenic that we need to see through to clearance. The psychological piece and the cost really do add up in terms of your care model – in how much we hit that mark of giving patients accurate advice, not creating any kind of neuroticism, not over-treating and not wasting anyone’s money.

Dr Ruscio Resources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of the fact that we deliver cost-effective, simple, but highly efficacious functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who have been unable to improve their health – even after seeing numerous doctors – to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health supportive supplements. Health coaching. We now offer health coaching – so if you’ve read the book, listened to a podcast like this one, or are reading about a product and you need some help with how to use it or integrate it with diet, we now offer health coaching to help you along your way. Finally, if you’re a clinician, there is our clinician’s newsletter – The Future of Functional Medicine Review. I’m very proud to say that we’ve now had doctors who’ve read that newsletter find challenging cases in their practices, apply what we teach in the newsletter and be able to help those patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/resources. Alright – back to the show.

Episode Wrap-Up

DrMR:

So, that’s pretty much what I wanted to go through from The Future of Functional Medicine Review. I hope this all ties together. We have this gut first approach. Why we have that gut first approach is because we’re fairly attentively evaluating what lines of therapy are the most helpful. That has led us to a GI first model. Even in the paradigm of a GI first model, we’re still carrying forward that self-critical nature. Blastocystis hominis is an organism you find in the GI, but we’re still going to be self-critical and amend what I think we were all taught, which was Blastocystis hominis is almost synonymous with a parasite. We’re revising that over time.

DrMR:

I think the primary driving principle is being self-critical to make sure we’re always whittling the inefficiencies out of our clinical model. That may be both big picture – where we position GI interventions – but, also micro picture. How do we navigate the nuances of something like a stool test finding Blastocystis hominis positive?

DrMR:

As a reminder, the FFMR – The Future of Functional Medicine Review – is our clinical newsletter, but really building up as a database. As an example, we’ll have our position statement on Blastocystis hominis listed there. We have our thyroid algorithm listed there. We have our overview on traditional antigen stool testing vs PCR stool testing listed there. We’re progressively building this out. We’re also adding reviews of different topics there to make this not only an informational and valuable newsletter with case studies and research study reviews, but also reviews on certain topics. As in this case, a provider or a lay person, can toggle over to a topic like – What’s a thyroid algorithm? How should my provider be working with me regarding the application of thyroid medications if I’m hypothyroid? How should we be interpreting and potentially moving on the finding of Blastocystis hominis?

DrMR:

Remember that for the month of October, we are doing a promotional window to make it easy for you. If you sign up any time during October, you will have 30 days of all access. I really hope you check it out, give it a read and see if it’s something that is beneficial for you. If so, I hope you will join us. This is one of the main vehicles through which we’re trying to have a constant stream of data; that gives providers and patients something to rally around regarding this new paradigm in functional medicine we are trying to pioneer. I hope that was helpful. We will talk to you next time. All right – bye bye.

Outro:

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