Transcript

Table of Contents
0:00:00 – Introduction

Scott Forsgren

Good morning, good evening everyone. It’s an honor for me to be here today with Dr. Sandeep Gupta to talk about mold illness and the launch of his new course, Mold Illness Made Simple 2. To set the stage for our discussion today, Dr. Gupta and I will talk about mold illness for about the next hour. Then Dr. Gupta will respond to some questions at the end of our discussion.

Dr. Sandeep Gupta is a holistic medical doctor, nutritional and environmental specialist, Ayurvedic consultant and wellness coach. After graduating medical school, Dr. Gupta worked in a range of public and private hospitals, including several years in intensive care. Like many, his own personal journey with chronic illness shifted his focus and he now works to support those with complex chronic illnesses, such as mold illness and Chronic Inflammatory Response Syndrome, or CIRS.

My name is Scott, from BetterHealthGuy.com. I’ve had my own, over 20 year journey, with mold illness and Lyme disease, and I’m very much looking forward to learning today from our discussion. Dr. Gupta talk to us about your personal journey with your own health and how that journey led you to making your work in holistic and environmental medicine your focus and passion today.

Dr. Sandeep Gupta

Thanks so much, Scott. What am I do if it’s okay with you is just very quickly talk about some of the burning questions that are out there in mold illness at the moment, and that people who are suffering from mold illness, or suspect they may be, have to work through in order to try and find answers.

There are quite a few controversies in this field. One of the big ones is what sort of testing should I have done? Should I do the Shoemaker CIRS biomarkers, or should I do the urinary mycotoxin testing or the new serum mycotoxin antibody testing? Is VCS testing useful? Should I have a NeuroQuant? Should I have my nasal swab tested for MARCoNS, or is that a waste of time? Is organic acid test worthwhile? Is transcriptome testing worthwhile.

Secondly, in the area of actually attending to our buildings, how do I find a good mold inspector? How do I clean mold? Is it sufficient to just use fogging and ozone or are more deep methods required? A remediator wants to fog our places is that safe and effective? For treatment, what are the best binders to use? How can I reduce inflammation? Is VIP still used and should antifungals be used?

Lastly, how can I keep a place mold-free? What’s the best air purifier to use? Should I use HEPA or should I use a PCO style filter? Should I have my windows open or shut? How do I find a place that’s mold safe? These are some of the burning questions that are out there and I hope that after this hour today, you’ll be feeling a lot more clear.

Scott Forsgren

So let’s come back to your personal journey and how this became your focus and passion.

Dr. Sandeep Gupta

In 2005, I had an acute and severe health breakdown after taking antibiotics for a gut flu while I was traveling in the United States. I came home and had very severe fatigue and headaches and had no idea how to address it. I started by seeing some of the specialist doctors in the hospital where I was working at the time, however, they really had no answers. That led me into studying the microbiome and to the whole new understanding of how the body is a delicate system, which requires homeostasis. Very luckily I was able to heal myself quite quickly and that led me on a whole journey of seeking answers through integrative medicine.

0:03:49 – What is CIRS and how does inflammation fit in?

Dr. Sandeep Gupta

This condition, CIRS, stands for Chronic Inflammatory Response Syndrome, and this is a condition that was coined by Dr. Ritchie Shoemaker around 2010. What it refers to is a multi-system multi-symptom illness that occurs in genetically predisposed individuals on exposure to biotoxins. Biotoxins are very small particles that we can get exposed to via being in a water damaged building or having a tick bite, or being exposed to contaminated bodies of water.

In a certain percentage of the population, rather than having a proper immune response, what happens is they get a chaotic and inefficient immune response, which then leads to what we call chronic inflammation. Chronic inflammation can be understood as being like a silent fire in the body. It’s something that really affects all of the organ systems of the body and the manifestations of it can include any organ system. We say it’s a multi-system illness, so for instance, if a person said they just have abdominal pain and bloating, well, that’s just one system, that’s not CIRS.

If they say that they’ve just got insomnia and anxiety, again, that’s just one system, so that’s not going to be CIRS either. But on the other hand, if they say they’ve got abdominal pain and bloating and insomnia and anxiety and joint pains and muscle pains and skin rashes and a variety of other symptoms, well, that’s more looking like it because it’s a whole body inflammation process and it affects every organ system there is.

Scott Forsgren

You talked about some of the symptoms that you might see in someone with this multi-system multi-symptom illness. Are there any unique signs and symptoms that might serve as clues that someone should explore mold illness as a potential contributor to their health challenges?

Dr. Sandeep Gupta

One of the simple things I think, Scott, is if you’ve already explored basic functional medicine protocols and you haven’t had success. Let’s say you’ve given it six or 12 months and you’ve done microbiome testing, you’ve taken the probiotics, you’ve done nutritional supplements, et cetera. You simply find that you’re not having the improvement that you expect. That’s often a very strong pointer towards the fact that there’s mold involved.

The second thing is if you’ve got a multi-system multi-symptom illness. It’s much more likely that you’re going to respond to basic functional medicine measures if you have a single system illness. Now, if you have something like I described before with all those myriad of symptoms, it’s much more likely that it’s going to be mold, or it’s going to be CIRS rather.

The third thing would be that if you know that you’ve had a history of exposure to biotoxins. You remember having a tick bite, or you remember that there was a building that you lived in that was particularly leaky or had visible mold or musty odors. Well, that would be also another indicator that biotoxins are something that you’re going to have to look into early in the diagnostic process.

Scott Forsgren

What are your thoughts on symptoms like vibrations or nondermatomal paresthesia? Are those things that maybe are more common in mold illness or CIRS than other conditions?

Dr. Sandeep Gupta

Yes, actually that’s a really good point, Scott, that there are certain symptoms like those ones you mentioned, a vibratory sensation. Some people say static electricity shocks as well is also one that’s fairly specific. Any symptom that tends to get better when you’re away from your home would also tend to be indicative of being a biotoxin related condition.

0:08:02 – Innate and Adaptive immune system / Mold Allergy vs CIRS

Scott Forsgren

Talk to us a bit about the innate versus adaptive immune response and how the response is different under normal, healthy circumstances as compared to those of us that have dealt with chronic inflammatory response syndrome.

Dr. Sandeep Gupta

The innate immune response is a very nonspecific immune response, which really takes place in the first two to three days after exposure to any foreign invader. It’s non-specific and it involves a number of different white blood cells of the body and it involves cytokines. It’s like shooting random bullets around to try and clear any foreign invaders. Then the adaptive immune system is where we get a much more specific and focused immune response. It usually kicks in at around day three or four, and that should lead to a much more effective clearing of any foreign invader.

With CIRS, the whole postulated mechanism is that we are unable to have a proper adaptive immune response, and this is because a process called antigen presentation does not take place effectively. This may well be due to the HLA proteins of the body and variations in the HLA genes. As a result of this, what happens is you get a chronically activated innate immune response. Really that’s what we mean by chronic inflammation, it is a chronically activated innate immune response.

Scott Forsgren

Talk to us about the difference between mold allergy and mold biotoxin illness or CIRS. Can a person have both of these at the same time and is the treatment of mold allergy versus mold biotoxin illness, is it different?

Dr. Sandeep Gupta

Absolutely. The first difference is that mold allergy really involves only one small part of the immune system, and it does relate to the adaptive immune system in that you’re creating types of antibodies called IgE antibodies. Generally speaking, those IgE antibodies then go and trigger mast cells and result in symptoms such as a runny nose and rashes and itch, and some more mild symptoms like that. In some cases it can be more severe and result in something called anaphylaxis.

However, in many cases it’s more mild and it can be a single system illness. CIRS, on the other hand, involves many parts of the immune system and it’s a whole body process. So firstly yes, it is possible to have both, you can have mold allergy and you can have CIRS and the treatment is actually slightly different in that with mold allergy, it’s important to desensitize the person to the toxin or the foreign invader. The American College of Environmental Medicine (ACOEM) has a whole protocol, I believe, for desensitization of mold for those with a mold allergy. The treatment of CIRS is something we’ll get onto later in this webinar.

0:11:01 – Can Lyme cause CIRS without mould? / Microbial soup of WDBs / Importance of HLA

Scott Forsgren

Beautiful. Yeah, I think that distinction is really important for people to understand. Traditionally we think of CIRS as originating from a water-damaged building, however, Lyme disease, and co-infections like Bartonella and Babesia can lead to CIRS and so my question is can CIRS occur with Lyme alone or does mold need to be part of the picture? And in those that you’ve worked with dealing with chronic Lyme disease, how common is it that there is also a mold component?

Dr. Sandeep Gupta

It definitely is possible that tick-borne illness such as Lyme disease can be the only problem going on in CIRS. However, really what we’ve found is that’s quite rare. Because of the ubiquitous nature of water-damaged buildings, it appears that mold tends to get into the picture in almost all cases of chronic Lyme disease. It’s because people with this illness do develop quite a strong sensitivity to biotoxins through the tick bite and through the infections that have invaded their system, and therefore the mold and other microbial toxins that are in most environments, probably more than 50%, all of a sudden started getting in on the act and triggering their innate immune system even more so that they develop even greater inflammation than they would have with just the tick-borne infection alone.

Scott Forsgren

Yeah, I think that’s such an important concept to really understand is for those people that are dealing with chronic Lyme disease, not to miss the exploration into the mold component. I unfortunately didn’t know about mold when I first was diagnosed with chronic Lyme disease and probably could have accelerated my recovery had I understood that earlier. I think that’s a real example of where a course like what you’re creating here will really help people to understand that connection.

Many people think of mold illness as mold and mycotoxins, but in reality, there’s this whole soup of toxins, inflammagens of microbes, even in water-damaged buildings, many of which we’re still learning about how to approach treatment and so on. Talk to us about the range of things that we might encounter when we’re in a water-damaged building beyond simply mold and mycotoxins and how those might also play a role in the development of CIRS.

Dr. Sandeep Gupta

Absolutely. When a building is exposed to water into the substance of the building for 48 hours or longer, it becomes what’s known as a water-damaged building. Now, that dampness and that water that gets into the substance of the building attracts a whole host of microbes. As you say, it’s not just mold, it’s also microbial VOC’s (mVOCs), it’s also bacteria, it’s also parasites. Some recent research has also suggested mycoplasma and chlamydia may be in on the act. There’s a whole microbial soup. There’s also something called Actinomycetes, which Dr. Shoemaker and his group believe is very, very significant. So you’re right, it is a whole microbial soup. Often when we talk about mold, we forget that there are many, many other organisms involved, and it’s important to keep that in mind.

Scott Forsgren

Beautiful. The HLA-DR genes have been discussed for many years as predisposing one to the development of CIRS. What’s the latest on HLA-DR and that genetic component, both in terms of serving as a predictor of the potential for the development of illness, but then also as a predictor for a response to treatment.

Dr. Sandeep Gupta

It’s a very interesting area of research and I hope that more research takes place in the area of HLA haplotypes and CIRS. However, on a practical level, we’ve found that really these, what were known as the CIRS positive haplotypes, are so common in the general population that there’s really no diagnostic benefit in doing them because they just don’t seem to differentiate between cases of CIRS and normal controls.

0:15:07 – Mold Sabbatical / Self-testing of Home / Air Filters

Scott Forsgren

We know that the source or ongoing exposure must be addressed either removing the toxin from the patient’s environment or moving the patient from the toxic environment. Talk to us about the benefits of a mold sabbatical, both in terms of exploring the potential impact of the environment on our health, but then also as a longer term treatment option.

Dr. Sandeep Gupta

The mold sabbatical is where you take some dedicated time off from the building that you’re being exposed to on an everyday basis. A very common way of doing this is to go tent camping for around about two weeks, or even longer. The big advantage of this is that you get a clear break from whatever building that you were in, and all of a sudden, what can happen is that your sensitivity of your body in being able to notice subtle symptoms on exposure to water-damaged buildings, is restored.

The concept is kind of like that if you have a button that’s always pressed all the time, then you’re not going to notice a subtle difference in someone pressing the button stronger or weaker, because that button’s already pressed all the time. I think that same concept really applies to food allergens, such as gluten. If you’re eating gluten all the time, and then you go and eat one more slice of bread, well, you’re not going to notice a difference because your gluten button is already pressed. It’s only when you eliminate gluten for probably four weeks or longer, that all of a sudden, when you then have that slice of whole meal bread, you’ll be astounded at how strong the inflammatory responses to that.

That was something I experienced myself on my healing journey, was going off gluten and dairy. Just to take a quick side-track: when I was working in intensive care, the nurses in that unit, often nurses know a lot more than the doctors in the hospital about holistic methods, they would say to me, you know, “Sandeep, I’ve noticed that you’ve got blocked sinuses, have you considered going off gluten and dairy?” I actually said, “That’s rubbish, that’s nonsense.” But I’d said, “Okay, I’ll do it anyway, just to prove you wrong.”

And exactly what I just said, happened. I went off the gluten for four weeks and then I had a slice of multi-grain bread and I felt like I was choking all of a sudden, I couldn’t believe it. I couldn’t believe the impact of the inflammation from that toxic insult. To me, the mold sabbatical is very similar to that concept, it allows you to have the button switched off for a little while and, you know, while you’re doing that is that there’s a whole host of things you may care to do. Some people may care to start doing limbic retraining programs and so on.

Often what you’ll find is that there is some subtle, but definite improvement. Then when you’re re-exposed to your building, the key thing is to really take note of the symptoms that come up in response to that exposure. Often this can be more definitive in terms of how that building is affecting your health, than any type of environmental tests such as air testing or ERMI.

Scott Forsgren

Yeah, I think that’s really important. I think we will only ever be as healthy internally as the environment around us, right? If we’re constantly every day being exposed to our kryptonite, we will never again regain our superhero status. It’s really, really important that we look at our environment and what we can do to improve it and really optimize our road to optimal health.

Let’s talk about testing. What are some of the better self testing methods that could serve as maybe a starting point for someone that’s just beginning to explore this journey? Then, when should I consider an indoor environmental professional, or IEP? When I’m thinking about IEPs, how important is it to find someone that understands CIRS? Then, where might I find those types of resources?

Dr. Sandeep Gupta

Okay. It’s a very multi-pronged question, but that’s okay, I’ll try and take it bit by bit.

In terms of self-testing methods, there are a number of different options, and the first one is actually not to do any professional test, but really just to tune into your senses more carefully. When you walk around the house, take particular care to notice, is there any visible mold at all, and are there any musty odors? Now, having said that, not having visible mold or musty odors doesn’t exclude the possibility that you have mold. However, if you do notice those things, that’s going to be a very strong indicator in and of itself.

The next thing is to really just ask yourself, have there been any water intrusion events in that home, in any area? If there have been, really go closer and just see how you feel in those areas and if there are any subtle signs of water damage. One subtle sign that’s distinct from the ones I’ve already mentioned, is that sometimes you’ll notice bubbling of the walls or the paint job. Sometimes you’ll notice some subtle staining. Sometimes if you have ducted AC or HVAC, you’ll notice that there is some subtle signs of mold starting to appear on the HVAC. All of these things are a really good first step, is just to make sure you’re really tuning in to all the subtle signs, because in many cases, if you really pay attention, you will be able to notice the subtle signs.

Now, moving on from there, the next option can be to do some mold testing plates and one advantage of that is that you can, you know, they’re generally quite inexpensive and you can put them in various rooms of your house. If you see mold growing there, that’s a very, very strong visual motivator and a very, very strong confirmation to most people’s mind that they have a mold problem in their house. I think that can be useful, however again, the thing to know is if the mold plates are negative, that doesn’t exclude it. That’s probably quite a common theme in CIRS.

Then the next thing to consider after that, would be doing an ERMI test. So ERMI stands for Environmental Relative Moldiness Index, it’s a type of DNA testing and it’s collected via a Swiffer cloth, and there are various labs who perform this testing, including Mycometrics in New Jersey. What you do is you collect the Swiffer cloth, you collect dust from the house, and often that’s from places like the tops of cupboards and the tops of white goods. You’ve got to make sure that there’s a certain amount of dust on that Swiffer cloth, and then you send it to the laboratory for analysis.

When it comes back, you’ll see there’s a whole host of DNA fragments of mold that get tested for. It includes a number of different Aspirgillus species, it looks for Stachybotrys, it looks for Chaetomium, it looks for Wallemia, et cetera. Now, if you notice that there are elevated numbers, Dr. Shoemaker used to say any ERMI above two, is something that you need to look into further. At that point, you may care to then consult an indoor environmental professional. I can’t really emphasize enough the importance of having a good indoor environmental professional.

Now, whether they’d be in more the building biologist mold, pardon the pun, or the industrial hygienist, there are a range of different shapes and sizes of IEP. The key is to make sure they understand CIRS as a condition, and that they understand the importance of getting to the source of water damage in a building and not just addressing it at a superficial level. Those kinds of IEPs are actually few. They’re actually only a minority of the IEPs that are out there. Unfortunately, the majority at this point are more concerned with dealing with it at a cosmetic level. If you’re wanting to look for an IEP, there is a list of IEPs at the website for ISEAI, which is the International Society of Environmentally Acquired Illness. The website for that is iseai.org. If you go to the Get Help page, there’s a list of IEPs.

I believe that these IEPs have been vetted by the board of ISEAI and they are IEPs who are familiar with CIRS and familiar with addressing water damage at a deep causative levels. You can be pretty confident if you get an IEP from this list, that they are the type of IEP that you’re looking for. There’s a couple of them that I’ll make mention of who are very, very experienced in the United States and a very much worth consulting. That includes Mike Schrantz, Larry Schwartz and Greg Weatherman.

0:24:22 – Virtual IEP / IEP and Remediator Separation / Air Purifiers

Scott Forsgren

I think that website that you just mentioned, it’s also a good resource if people are listening and they don’t yet have a practitioner that can help guide them down this path. There’s a list of practitioners there as well, that are part of this ISEAI organization. In one of our previous conversations, you made the comment that finding a good IEP is as important as finding a good doctor. Tell us a little bit more about that statement.

Dr. Sandeep Gupta

I’ll stand by that statement because the thing is, if even if you have a good doctor and you get the correct diagnosis and you get the correct medications, if you don’t have a well qualified IEP or indoor environmental professional, then what’s going to happen is your house is not going to be properly addressed in terms of the water damage. If you were to ask me, what’s the most important step of all in the treatment of CIRS due to water-damaged buildings, it is the removal from exposure to water-damaged buildings. If you don’t get a well-qualified IEPs, you’re not going to probably get removed from exposure and therefore anything the doctor does, even if they’re the best mold doctor around, nothing’s going to be particularly effective because you’ve got a leaky boat and we’re trying to pail out all the water from that boat, but that boat’s still leaking. You’ve got to make sure that the leak in the boat has been sealed and then all your efforts in paling out the water and repainting the boat are likely to be much more effective.

Scott Forsgren

Yeah, I definitely agree with that. I know historically I’ve heard people say with the Shoemaker protocol that I believe was 11 steps that after you get through step one, which is removal from the source of the exposure, that you’re more than halfway there. It really is a big part of the puzzle to make sure that we’re not having this ongoing exposure. When we talk about IEPs and the fact that there are limited numbers of IEPs that really understand CIRS, maybe there isn’t one physically in your geography, virtual consultations is something that’s been emerging over the last couple of years. How might a virtual consultation with an IEP help someone determine their path forward?

Dr. Sandeep Gupta

I think virtual consultations can be very, very useful and there’s different kind of protocols you could say, or different progressions, of how you can use it. One option is as we said before, you actually do some self-testing and then you go do a virtual consult with an IEP. The other way of doing it is you do the virtual consult with the IEP first and then discuss with him or her what sort of sampling you could do as a self-testing methodology.

One of the things you can do, firstly, the thing that you can discuss with them is their approach, what approach do they take to inspecting and remediating buildings? How do they identify whether a building is water damaged or not? Often if you’ve got a laptop or a good quality iPad or something like that, you can actually take them around your house and give them a little bit of a tour of the house so that they get an idea of what the structure of your house is. They can start to think of what the possible water damage issues would be and can start thinking of what the best sampling methodologies might be.

Scott Forsgren

Yeah. Another scenario that I know you’ve mentioned as well that I think could be helpful is if you have somebody in your area, they can use that virtual IEP as kind of a mentor to then guide the local IEP that maybe doesn’t have the full knowledge of understanding CIRS as a condition, can really use that virtual person as a mentor to help figure out your unique personal situation. I think that’s a very interesting option that really has just started to come up in the past couple of years and certainly presents some new opportunities for people.

Dr. Sandeep Gupta

The main thing I would think there is that there needs to be a level of open-mindedness on the part of the local IEP. If they’re very, very set in their ways, that’s probably not going to be as successful. The key is even if they don’t have the full knowledge, they have to be willing to open their mind and expand their knowledge base.

Scott Forsgren

Absolutely agree. If somebody arrives at the place where they need to explore remediation, how important is it that the inspector and the remediator there are different people, different companies?

Dr. Sandeep Gupta

It’s definitely the gold standard. When the IEP or the inspector and the remediator are separate people, it avoids any type of conflict of interest going on. Sometimes conflicts of interest can be subtle as well. I think that’s the ideal way to go. Let’s say you’re consulting with an IEP, an experienced IEP like Michael or Larry by virtual means. Often what will happen, let’s say they decide to do ERMI and some air testing and so on. If there is shown to be a problem, often what you need to do to identify the source of a problem will be using moisture mapping. Perhaps what might happen in your case is a local IEP may be able to do the moisture mapping.

Let’s say that they identified that the kitchen has been the problem and that there’s been a leak in the kitchen. Once a full evaluation has been done, generally, what an IEP will do is write up what’s known as a scope of work for a remediator. They will try to contract the correct person, the best person in the area to carry out those works. Very rarely the only person available — I guess this could happen in small towns — is that same local IEP who did the testing. I’m not saying that that can never happen or that’s never appropriate, but I think one should start from the point of view that if possible it’s better to have a separate inspector and remediator.

Scott Forsgren

When we then think about correcting the environment, how important is it that there’s an actual removal of the source of the exposure, whatever material was water damaged, does that need to be physically taken out or extracted from that environment? Then where this conversation kind of goes from there is: can we avoid that and use ozone or fogging or diffuse essential oils and completely bypass the need for something that might be more invasive or more costly?

Dr. Sandeep Gupta

It’s a great question and the answer is it’s of utmost importance. You have to get to the source of exposure. The analogy, which, which Dr. Neil Nathan gave last year in Denver, which I’m shamelessly using all the time now is that if you have a patient with some kind of bowel tumor, and you’ve got a surgeon come along and say, “Oh, you’ve got a bowel tumor, but that’s okay. We’ll go in and we’ll patch things up on the surface and we’ll make sure that your skin looks really nice. And we might do some liposuction while we’re at it. However, we won’t bother going in and actually removing the tumor.” How confident would you feel in that surgeon’s approach? It’s an extreme example, but I think it makes the point very well.

If you have someone who wants to remediate the home, but not actually remove the water-damaged building materials, essentially you have not got to the source of the problem. Even if you’ve temporarily mitigated the problem those water-damaged materials are still going to be off-gassing microbial toxins into the environment. When you talk about fogging or ozone or essential oils, yes, in some cases they may temporarily reduce the mold count, particularly in the air. They may not actually reduce it on an ERMI test because what happens is often the mold will then just go and settle into the dust.

Sometimes the ERMI test can increase because you’re actually settling more dust and the ERMI will pick up non-living organisms as well. ERMI will often show that it hasn’t been totally dealt with while air samples will improve after you do fogging and ozone in most cases. However, with time, the contaminated building materials will again off-gas and the problem will be back. It’s really at best a symptomatic approach. I understand in some cases people just can’t afford to do remediation at the current time. It’s possible in some cases that that temporary use of ozone or fogging could be part of a temporary strategy. Other things would be to use air filters; do you use good quality air filters just to keep that environment as good as it can be up until proper remediation is able to take place.

Scott Forsgren

We’re going to come back to the air filter conversation, but I wanted to drill in a little more on this idea of non-living particles. I think a lot of times we’re thinking about killing the mold in the environment through some of these things that we just talked about, whether it’s ozone or essential oils and so on. If we think about these non-living particles, can they be contributors to the ongoing CIRS condition? How do we kind of think about addressing those non-living particles?

Dr. Sandeep Gupta

The non-living particles are just as important. The research so far points to the idea that non-viable particles of mold may be just as damaging for a CIRS patient as living particles. Really the only way of addressing these particles is by removing contaminated building materials and the use of air filters. You’re really not going to get anywhere with them through the use of things like fogging and ozone and essential oils.

Scott Forsgren

Let’s talk just briefly then about air filtration devices. These continue to evolve, there’s new tools emerging. Some of them are strictly filters. Some of them include PCO purification, sanitization using different types of light. What are the filters that you’re finding most clinically helpful with your patients? Can I simply get a good air filter and then bypass some of this remediation?

Dr. Sandeep Gupta

There’s two main types of air filters. HEPA stands for High Efficiency Particulate Air, and PCO stands for Photocatalytic oxidation. They’re two totally different methodologies. HEPA essentially is using filters of various types to try and block the actual particles from getting through. They filter everything above a certain particle size which is around 0.03 microns, if I’m not mistaken. Then PCO filters on the other hand, are really using UV light or other similar technologies to oxidize particles and break them right down. There’s no limit to the size of particles which PCO filters can get to. Sorry, it [HEPA] is actually 0.3 microns, not 0.03.

The downside of PCO filters is that you can get some by-products building up, some oxidative by-products, and therefore our experience and recommendation is to use an air filter that has a combination of both. One example is the Air Oasis iAdaptAir. As far as I understand that there are various other models on the market. I haven’t really tried them. There also a particular air scrubber that’s been produced by Air Oasis which is a larger unit called the iAdaptAir scrubber, which has both a HEPA and a PCO filter. That’s what I personally use in my bedroom. However, in some cases, using just a HEPA device can be useful too. One brand that I’ve used quite a lot of is the InnovaAir [Australian brand].

0:36:38 – Mold Colonization, OAT / Urinary Mycotoxins

Scott Forsgren

There is some debate about the potential for mold colonization in the body after exposure to water-damaged building organisms. How is colonization different from infection? What is the potential for internal primarily sinus and gastrointestinal colonization of these organisms? Then can that lead to internal production of mycotoxins even when maybe we’ve now fixed our environment or moved to another environment. Can we essentially have a mycotoxin producing factory in the body?

Dr. Sandeep Gupta

Mold colonization is more where we just have a very localized presence of a certain organism. Infection is where we actually start to get invasion of that organism into surrounding tissues and into the body in general. Really it’s infection where we generally start to get a range of different symptoms. Mold infection is definitely something that exists. It’s been well-described in the medical literature. There’s something called rhinosinus fungal infection which has been well-described. It’s known that in with rhinosinusitis, which is infection of the nasal passages and the sinuses, there’s a very great proportion of these patients who test positive for fungus on their specimens. Therefore it’s likely that fungus is part of the etiology in many cases of rhinosinusitis and also in many cases of gut infections.

There’s also fungus that may show up on various different types of sampling, whether that be on the GI-MAP type of PCR testing or whether that be on various types of culture testing. It can be Candida albicans and various species of Candida in certain cases, which is more of a yeast than a mold. Then there’s also mold infection or colonization in the lungs. It’s well known that there’s a condition called pulmonary aspergillosis where you have the aspergillus species of mold [usually A. fumigatus] colonizing the lungs. It can be very severe in some cases. So it most definitely exists.

Probably the gold standard is to do an actual sputum sample of the lungs or to do an actual sinus washing of the sinus passages and do special culturing for fungus. However, it’s actually very difficult to pick up fungus on culture. Therefore, other methodologies such as the organic acid test are being used more and more commonly. On the first page of the organic acids test, there’s a range of different markers there. The aspergillus markers are often elevated I find in cases where people have significant sinus congestion on a chronic basis. I do think that really means that antifungals of some type, whether they be herbal or whether they be pharmaceutical, should be considered as part of the treatment program.

Scott Forsgren

You’re referring to OAT from The Great Plains Laboratory and things like markers 2, 4, 5 and 9 for example, correct?

Dr. Sandeep Gupta

Yes, exactly. Thanks for being more specific on that. It’s more what we call the furans. The furans are basically a range of different markers which become elevated in the presence of Aspergillus and other mold species.

Scott Forsgren

The original MIMS 1 course goes into great detail about the CIRS blood markers, how to interpret them. All of that material is part of the MIMS 2 course, but expanded. I want to talk a little bit about some of the new testing concepts that have been introduced in the MIMS 2 course. Specifically the urinary mycotoxin testing. There is some debate on the usefulness of urinary mycotoxin testing, the possibility of positive or high levels being normal excretion, potentially from exposure to various food sources that might be contaminated with mold or mold toxins. Talk to us about your perspective in terms of the value of urine mycotoxin testing.

Dr. Sandeep Gupta

I do have actually a slide here that may help to answer this question. So I’m just going to pop that up quickly and just share this idea and really just tracking backwards for a moment. If we just go back to the idea on how water-damaged building exposure causes illness, you can get water damage in a bathroom due to poor waterproofing which causes microbial growth in the bathroom or the rest of the house. And as we talked about before, one of the ways of inspecting a home is through a do it yourself test or a full IEP inspection, which may indicate water damage or amplified mold growth. So that’s often one of the first places to go in terms of testing. And I’ve talked about the fact that one of the key diagnostic things first is to ask yourself if you have a multi-system, multi-symptom illness.

Now, if you don’t have a multisystem, multi-symptom illness, you may still have problems with mold. I’m not saying that you don’t, it’s just that it’s unlikely to be the classic illness of CIRS. Then when we get into testing, we have what we call direct testing. Direct testing really means we’re actually testing the thing that we worry about directly. Therefore the urinary or nasal mycotoxin testing can be done through three laboratories. It’s Great Plains Laboratories, Vibrant Labs and also Real Time Laboratories. Real Time Laboratories, by the way, are the ones who also do a nasal mycotoxin test which is another test that you can do if you’ve got chronic sinus congestion. This testing really shows up a range of different mycotoxins in the urine, other different methodologies. There are some authors such as Dr. Neil Nathan have been advocates of provoking the test using a glutathione and also saunas and so on. That may be more likely to show up various mycotoxins in the urine. I believe he’s only recommending that now for Real Time Laboratories.

Scott Forsgren

That’s correct, yeah.

Dr. Sandeep Gupta

If you do this test, you’re only going to be seeing those mycotoxins in the urine which you are excreting. Firstly, a negative test doesn’t exclude the possibility that you’ve got mold in the tissues. It simply shows that you’re not excreting mold right at the moment. One of the things I will say is I don’t recommend the use of urinary mycotoxin testing to establish whether there has been mold exposure or not. I think for a practitioner, you really should be taking that from the history. Generally speaking, you can tease that out in a history reasonably easy by asking about whether there have been water leaks and whether there have been musty smells and whether there have been buildings that a patient has been exposed to in which they didn’t feel so well.

Once you’ve established all of that, in my view, the role of urinary mycotoxin testing is firstly to see how well the patient is excreting mycotoxins. Secondly, to see which exact pattern of mycotoxins is being encountered in that patient so that you can tailor the toxin binders to the mycotoxins that are showing up. Also in the new precision detoxification of mycotoxins, which has been developed by Dr. Neil Nathan and Emily Givler and Beth O’Hara, they’ve also described which detoxification pathways are involved for different mycotoxins. Therefore you can decide which exact detoxification support you may want to choose. The thing to know is that it’s going to be almost all cases are going to show ochratoxin A we’ve found so far. Particularly if you’re using the Great Plains testing and therefore using either cholestyramine or welchol or charcoal is going to be indicated in most cases.

However, if you then also see some of the rare mycotoxins such as aflatoxin and zearalenone and so on, that often indicates that you’re going to need to use a alternative binder such as bentonite clay. I think it suggests that urinary mycotoxin testing has shown that the use of just cholestyramine and Welchol on its own is probably insufficient for the long-term treatment of CIRS. So it can be very useful for that. Then as I said, you can decide on which kind of detoxification support you may want to choose. If you’ve got ochratoxin A, we know that involves the glutathionation and glucuronidation and amino acid conjugation pathways. Therefore you can support the patient through the use of either glutathione precursors, such as NAC or glutathione itself. Then using glucuronidation support such as calcium-D-glucarate supplements can be very helpful. Then using amino acids support such as glycine can be very helpful. That’s also going to greatly help with the detoxification of glyphosate.

So I know that was a long answer to that part, but really it’s definitely got a role. However, I think it’s important not to just use it as a rote. Sometimes in functional medicine, I think the tendency can be just to jump and do a raft of tests. I think it’s very important to do a very thorough history. Then to know what specifically you’re trying to get out of the test. For the urinary mycotoxin testing, I think those are the key things.

Scott Forsgren

Yeah. I think to your point, if you’re doing urine mycotoxin testing and subsequently doing another one four to six months later and it goes up, that’s not necessarily a bad thing, right? It could be that you weren’t detoxifying or excreting previously, now your body’s better able to excrete things. There is some skilled interpretation of these tests that needs to occur. I personally have found them very helpful in my own journey, but that’s with someone who really understands the potential that a worse result is not necessarily bad news. To your point, sometimes you could have a false negative early on if you haven’t provoked or haven’t supported the detoxification and drainage pathways appropriately.

Dr. Sandeep Gupta

Yeah, that’s right. I think it’s important not to just use it in a very simplistic way where you say, see mold equals bad, no mold equals good. It’s probably a lot more complicated than that.

0:47:25 – Treatment – Natural vs Pharmaceutical Binders, VIP / Testing – Blood Biomarkers, Urinary Mycotoxins, Serum Mycotoxin Antibodies

Scott Forsgren

My next question, I think you really covered in some of that response, but in general or more broadly, can the natural binders be helpful in moving a patient forward or is it important that there is a pharmaceutical binder as part of a protocol like cholestyramine and Welchol for example.

Dr. Sandeep Gupta

I think current experience has shown the natural binders most certainly have a role. For some patients, that’s the only thing there’ll be able to tolerate. I have most definitely seen people move forward with natural binders only. I do think that cholestyramine and Welchol overall are stronger. I think they do have a role, particularly in the case of people who are still being exposed. I find it’s more difficult to probably be able to mitigate that situation through natural binders. However, I think generally speaking, they’re better to use shorter term, and in the long-term I think it’s a better thing to use natural binders.

Scott Forsgren

Beautiful. Yeah. That’s a great answer. Let’s talk about a little bit about VIP or vasoactive intestinal polypeptide that’s often been perceived as the end goal or the holy grail of treating CIRS. Where does VIP fit into a CIRS treatment protocol or CIRS discussion today? Is it something that people must do to regain their health?

Dr. Sandeep Gupta

Vasoactive intestinal polypeptide is a type of neuropeptide which often becomes lowered in CIRS. There’s a number of symptoms that’s associated with that. However, the key is that when have low VIP and also MSH, which is another neuropeptide which is often low in CIRS, you tend to not be able to control the inflammation in your body. In the Shoemaker protocol, the cherry on the top of the pyramid was VIP nasal spray treatment. I know that for a period of time people were very impatiently waiting to get to the step of VIP and putting a lot of their hopes in VIP, as basically returning integrity to their inflammatory pathways. Generally speaking in the Shoemaker protocol, there’s a whole bunch of prerequisites that need to happen before you can get onto VIP nasal spray treatment.

That includes having a house that had an ERMI less than two or in the more recent testing methodologies having a HERTSMI-2 less than 11. Then also having a nasal swab which is clear from macrons and then having a normal VCS test, and then also having a normal lipase. In some versions of the protocol, Dr. Shoemaker also recommend that people have a stress echo and have a look at their pulmonary artery pressures, but that’s something that’s probably a little bit peripheral. So generally speaking, it does take CIRS patients quite a long time to get clear of a contaminated environment. As we said, that’s actually the most important thing, not VIP. The most important thing is getting clear of a contaminated environment. Once you’ve done that, generally speaking, all the natural binders and herbal or pharmaceutical antifungals and anti-inflammatory treatments all tend to work much, much better.

VIP really fits in the category of anti-inflammatory treatments in my view. I’ve found that certain patients will have a very, very good and sustained response to VIP and others won’t have any response whatsoever. I think it just comes down to individual physiology. It’s definitely not something people must do. I don’t think people should pin all their hopes on VIP. It’s just one possible option. For whatever reason you’re not able to take it or it’s not available in your area — I think at one stage the availability with the FDA was being challenged, luckily that seems to have been fought off for the moment — it doesn’t have to be done. If in your case through discussion with your practitioner it’s decided that VIP should be trialled, then it may turn out to be something that’s quite useful in your case. However, there have also been many other cases in which people have recovered totally without the use of VIP.

Scott Forsgren

You mentioned Dr. Shoemaker several times. I think it’s a good opportunity to honor him for his contribution to this whole space. I know we both appreciate him and I know my own health would not be what it is today without the ideas and concepts that he’s put out into the field. So, thank you to Dr. Shoemaker. At a high level, what do you recommend for the average mold patient in terms of testing and treatment? Is there a basic approach or strategy that’s emerged from all of the work that you’ve done?

Dr. Sandeep Gupta

This is leading on further from the question on urinary mycotoxins, and it might just pop up that same slide again to try and illustrate this even better. When we talked about direct testing or we talked about the urinary and nasal mycotoxin testing, but in some cases fungal stool testing can also be done and also nasal fungal and bacterial culture. These are really to help answer the question of, is there fungal colonization rather taking place in the body? I think that’s an important one to answer. The other thing as we’ve already alluded to is the organic acid test. In terms of what testing you should do, I think one of the big questions to first ask is, does your insurance policy cover tests such as the Quest and LabCorp biomarkers for TGF-beta and C4a and MSH and so on, if your insurance policy covers it and your practitioner’s an MD or DO or someone else who’s able to charge on insurance, to me that’s a little bit of a no-brainer because it basically gives you important information, it’s useful information, and it doesn’t cost anything out of the pocket.

I think that’s a pretty simple decision point there. Now, the next thing after that, generally the next test I believe to be the most important is the organic acid test. The organic acid test really gives a broad range of information. It tells you whether you may have fungal colonization, it tells you whether you may have bacterial or Clostridium contamination. One thing we haven’t talked about that’s very important is oxalates and the presence of increased oxalates. Oxalates can really be considered to be a secondary mycotoxin. I learned all about oxalates from Emily Givler last year in Denver, and it really opened my eyes. Since then I’ve been looking at them with a lot of interest. I do believe they’re very important and overlooked often in mold illness.

That’s another thing you can look at on the organic acid test. Often you find there are a range of nutritional deficiencies that are taking place, particularly if someone’s got fungal colonization and an excess of oxalates. So the organic acid test can be very, very useful. As I said, the urinary mycotoxin testing is also quite useful. We’re now using the serum mycotoxin antibody test which is being offered by MyMycolab. It appears that the most beneficial use of this particular test is in determining whether there’s current exposure going on, particularly in those who have had their home tested and there’s nothing coming up. It can be a way of testing whether they could be getting exposed somewhere else.

Let’s say, it’s in the gym that they go to every week or it’s in their car. Sometimes they can be these incidental mold exposures which are ruining the whole show. Sometimes the clue to that could be in doing a, MyMycolab test. It’s still something that we’re quite new to utilizing, but I believe that may well be its role. The next thing that we look at and particularly in legal cases is a NeuroQuant. NeuroQuant is a type of volumetric analysis of a brain MRI and it’s offered by CorTechs laboratories in San Diego. However, you can have it done with a range of different imaging companies around the world who have set up their software correctly so that they can send the images from a brain MRI to CorTechs laboratories. They give you a range of different reports which includes what’s called, a age-related atrophy report and a general morphometry report and a triage brain atrophy report.

Based on those reports, you can get an idea of which parts of your brain have become shrunken or enlarged due to inflammation. That can really be a very strong motivational tool for recovery. It can also be an important pointer towards the fact that limbic system dysfunction is taking place and one needs to do limbic system retraining programs. I’ll take a moment to speak about those and what they are, but basically limbic retraining programs are systems where you regularly work on different practices to calm down this part of the brain, which some people refer to as the reptile brain or the animal brain. It’s really got to do with very primal anxiety responses that get triggered by biotoxin exposure and also just by the whole trauma of the CIRS event. The NeuroQuant will often show swelling in areas of the limbic system, such as the thalamus, hippocampus and amygdala.

0:57:27 – Limbic retraining / Basic Treatment Approaches / The CIRS Journey

That can be a strong pointer that one needs to do limbic system retraining. The most well-known programs for limbic system retraining are what’s known as DNRS or dynamic neural retraining system, which is being developed by Annie Hopper. Secondly, The Gupta Program, which is my namesake, Dr. Ashok Gupta in the UK. He’s a great guy, and he also refers to it as the amygdala and insula retraining system. I believe Annie Hopper system is more delivered either by face-to-face or by DVDs, and the Gupta program is mainly online. Both of them have a cost of somewhere between $300 to $500. I’ve found that it’s a very, very worthwhile investment.

Scott Forsgren

Let’s see, I think you had one slide here as well on the basic approach to treatment. Maybe we can talk about that for a brief moment before we move on to a couple of other questions.

Dr. Sandeep Gupta

As we’ve already talked about treatment to a large degree, and I’m just going to, again, emphasize the fact that removal from water damaged exposures is very, very important. If you’re not sure you’re getting exposed, one thing you can do for free is to do a mold sabbatical. As we said, the mold sabbatical will often tell you once you then re-expose yourself to the building, it’ll often tell you whether you are reacting to your particular home. Therefore will tell you whether more efforts need to be put in to remediating or relocating. That’s number one. I think that’s the most important as we’ve already said. The second thing is toxin binders, and we’ve already talked about the fact that cholestyramine and Welchol are probably the most strong binders, but we’ve now got other natural binders such as charcoal, bentonite clay, zeolite, chitosan and the list goes on and on.

There’s also a range of different toxin binders mixes. There’s one called Tox-Ease Bind, for instance, which is from Beyond Balance. There’s Ultra Binder, which is from Quicksilver and there’s a range of other ones. I think the key is, that you need to be on at least two different toxin binders, but in many cases, having three different toxin binders is a good idea. Because you’re then going to have a broad net in terms of the different mycotoxins that you’re able to capture. This is a really important step. I’ll also add to this that detoxification support is very, very useful. If you’re using toxin binders you need to make sure there’s enough bile being secreted by your liver and gallbladder. One thing that can help that is the use of cholagogue herbs or coffee enemas.

If you’re doing coffee enemas regularly, that’s going to greatly help with the excretion of bile. Then the use of supplements like I discussed before with things like calcium D-glucarate and glutathione and glycine may also greatly enhance the detoxification capacities of your liver. Then moving on to step three, is MARCoNS or fungal colonization. We’re really taking a much more broad view of the nasal biome now, and not just thinking of MARCoNS as the ultimate enemy, and really just thinking of disruption of the nasal microbiome on the whole. It may well be that for some people, MARCoNS is a significant factor in their dysbiosis, and in other people it may be more fungal, the type of dysbiosis. Therefore, using natural agents has become much more the go-to and using colloidal silver and or EDTA, or even antifungal medication such as Nystatin or amphotericin nasal sprays has been used.

Then also using nasal probiotics, once you’ve done the killing, appears to be a very holistic way of doing things. The more recent way of looking at this issue is that MARCoNS may not need to be eradicated totally. It just needs to be addressed to some degree, and it’s possible it may not be able to be eradicated totally. We just really focus on bringing balance back into the nasal biome. Then in the gastrointestinal tract, really the protocol is very similar. We use herbs, we use antifungal medications when needed. We really emphasize the importance of a low sugar and low carb diet. For some people, ketogenic is very useful. Then the use of prebiotics and probiotics ideally guided by a microbiome test. All of those things together can lead to a very good outcome on gastrointestinal level.

Lastly, we have inflammation correction. We want to try and reduce neuroinflammation particularly, and that’s using things like fish oil or other types of Omega-3 oils, low amylase and anti-inflammatory diet, resveratrol and curcumin are very important. Limbic system and vagus nerve support, one thing I didn’t mention about them, is they actually reduce inflammation in the system. Therefore, I believe that they are a very, very important part of the treatment protocol for most people. Then we have increasing neurogenesis via the use of VIP. There’s also a nasal spray called Synapsin, which contains a NAD precursor called nicotinamide riboside, lifestyle factors such as exercise, vitamin D and sun, lithium, lion’s mane, Bacopa, the list is endless actually. The other really important thing I’ll add in here is that mast cell activation [MCAS] should be addressed if present.

Scott Forsgren

If that seems overwhelming, that is the beauty of this course, the MIMS-2 course, is really breaking it down, trying to simplify these concepts. This is a big overview of all of the different steps that one could go through. There’s a tremendous amount of information in the course that really goes much deeper. I want to actually, as we start wrapping up and jumping more into the Q&A from listeners, I want to ask you a more philosophical question, and maybe you can stop your screen share there so we can get into this one. So, what is the role of illness? And when we go through something like chronic Lyme disease or CIRS or mold illness, is there meaning in our suffering? Does it lead to personal growth or evolution at some level? Would you personally change your own illness journey if you could?

Dr. Sandeep Gupta

That’s a great question. I remember going through mold illness myself in 2014, and it felt like my whole world had come to an end. It seemed like the expenses were never ending. It looked like recovery was almost impossible because just getting away from mold was so physically difficult. I remember at the time thinking that finding meaning through that journey was going to be hard. Even just being able to get back into a lifestyle which I enjoyed was going to be difficult. However, through that whole journey, well, for me personally, I’ve learned about CIRS, mold illness, Lyme disease, and other illnesses and it’s absolutely transformed my personal world.

I’ve seen that for many other mold illness patients, despite how difficult it is at the time, I’ve found that they can get through this process and find meaning on the other side. Often I’ve found that there’s a lot of personal growth that takes place. And that’s been the case for me too. If you were to ask me personally, would I take away, if someone could press the rewind button and just delete my mold illness journey from my life journey, would I want to do that? I would actually say no at this point. I would say, no, leave it in. It’s given me so many wonderful benefits and given me so much growth. I hope that’s encouraging for those to hear who may be right in the midst of it right now.

I know it may not feel positive right at the moment, that it may feel extremely overwhelming and disheartening. However, hang in there and try and see if you can find some clarity from this call and from whichever course you may want to do. Once you can find clarity and once you can get a degree of confidence in a treatment protocol, then try to get and work your way through that. Slowly you’ll find that you should be able to recover and get through to a whole different sense of meaning on the other side of life. I really wish people the best who are suffering from this illness.

Scott Forsgren

I, 100% agree with you in terms of there are gifts that happen from this journey. I also would not go back if I had that option. I want to ask you, kind of end here before we jump into the other Q&A piece, with giving people some hope, these conditions, mold illness, CIRS can feel so overwhelming. They can feel hopeless. I personally feel like there’s more hope now than ever that the field is really evolving, that I’m seeing community of doctors and practitioners fully working well together. What are some of the things you can share to provide people that are in the midst of this journey with some real hope?

Dr. Sandeep Gupta

What I’ve seen in my management of thousands of patients with these conditions, is that almost every month there are new treatment options coming out. There’s really an amazing community worldwide. Just the other day I heard of a new treatment, or just yesterday, I heard of a treatment called Lyme N, I’d never heard of, and various other different innovations which are coming up all the time. I think this does provide hope in that we can think that there’s a group of people all around the world who are trying to break down this area and make it easier. One really important innovation in this field has been the use of disulfiram, I want to mention very quickly, and I feel that gives a lot of hope for tick-borne illness patients, in that, previously where many people were on herbs or antibiotics almost seemingly endlessly, all of a sudden we’ve got a tool which seems to be able to be used often for somewhere from 9 to 12 months or so.

In many cases you’re able to stop that medication and be able to maintain remission. Somehow disulfiram appears to be taking away the conditions from the human body, which seem to promote the presence of tick-borne illness. I feel very hopeful now that that solution has been brought in. I think there’s a range of other solutions in the area of mold illness. I think the whole group of mold doctors around the world, and I want to give a shout out to Dr. Mary Ackerly, Dr. Jill Carnahan and Dr. Lauren Tessier and various other physicians around the world who are really working to make this protocol and this area of illness easier for patients and making it easier to recover. I do think it’s now easier to recover than ever before now that we’ve got a more broad view of mold illness and we have all these tools available to us that we didn’t in the past. So, there’s most certainly hope, a lot of hope for people, and I hope you can take that in and feel it.

Scott Forsgren

Yeah. It’s actually interesting in the context of this discussion that disulfiram is also antifungal. I’ve often wondered how much of its benefit is simply Borrelia, Bartonella, the Babesia. Maybe not Bartonella so much, but that arena versus is it also having some effect on fungal colonization? I think there’s a lot to be learned about it, that definitely a lot of things, as you pointed out, the speed at which new tools and new insights and new understandings are happening is really the fastest that I’ve seen in my 23 years of journeying through this experience.

Question & Answer

1:09:52 – FAQs from Facebook groups (Caleb Rudd)

Let’s spend some time on questions. I know that you and your team have spent a lot of time connecting people through the various forums and talking with people there. I want to hear about what are some of the common questions, common threads that you’re seeing when your teams interacting with people in the online communities?

Dr. Sandeep Gupta

Okay, well, I’d like to invite Caleb Rudd to come on at this moment. He’s the technical director of our Lotus Institute of Holistic Health and has been a major driving force behind the development of Mold Illness Made Simple. So, welcome, Caleb. Would you like to address this question?

Caleb Rudd

Hello everyone. First I just want to thank Dr. Gupta for asking me to work on the Mold Illness Made Simple back in 2015 when it started out just as an eBook. So, it certainly has come a long way since then. I think with every new test, especially, there are a lot of questions and confusion in the mold community. Since the first version we’ve had two urine mycotoxin testing, one serum mycotoxin antibody testing, plus the GENIE test. There are no black and white answers. Everyone has to weigh up the usefulness and cost of each test with their practitioner and choose accordingly.

Environmentally people are struggling with testing again, do you do it yourself ERMI or mold plate, or do you get a professional to do it? Spore traps or surface testing? Also, the basics of remediation, what is porous and needs to be thrown out and what can be cleaned and kept? I think people will often need a professional to guide them through both the medical and built environment side. In the course we just try to show people the viewpoints, the science, and people can choose what resonates with them.

1:11:47 – Not Making headway with treatment

Scott Forsgren

Beautiful. Excellent. Thanks, Caleb, for sharing those insights. All right. So, let’s jump into some questions from listeners. First question is, “Started consulting with doctors in 2017, not making any headway with mold treatment. What are some of the things that I might be missing if I’m still in too much mold? Could this make me unable to tolerate binders well? What about viruses or reactivation of retroviruses? Is there a higher-up issue that needs to be tackled before mold?”

Dr. Sandeep Gupta

Okay. Well, obviously this is a bit difficult to answer given that I haven’t seen any of your lab tests or gone through your history or anything, but the first thing to think about if you want to address mold as a possibility is could you be living or working or driving in mold. It’s important to address not only your home environment, but also thinking about your work environment, assuming that you’re working somewhere separate from the home. I know many people aren’t right at the moment. Also your motor vehicle.

If you have a hidden source of mold, that’s most definitely going to be a block to responding and to improving, and it also could mean that you don’t tolerate binders well. That’s quite right. It was also taught by Dr. Shoemaker that one common subtype of patient which don’t tolerate binders well and get something called intensification is those who have tick-borne infections. I think it’s very important that you look into tick-borne infections, especially if you’ve had a tick bite. The other thing to know here is not all people who have tick-borne illnesses remember a tick bite, and sometimes they can have got those infections from another source. Generally speaking, I think it’s important to cast the net broadly and to look for that.

Then, as you say, absolutely, viruses and retroviruses are something you can most definitely look into. Parasites are something to look into. Heavy metals, and then microbiome disruption, and pyroluria. These are all things we cover in the final lesson of the course, Bonus Module: Lesson Four. We go into quite a lot of detail. It’s also important to just exclude general autoimmune diseases. Whether that be things like Hashimoto’s thyroiditis or lupus or rheumatoid arthritis, et cetera, all of those should be excluded by your physician before we go and just focus in on CIRS.

Also, connective tissue disorders, particularly one called Ehlers-Danlos syndrome is a really important one to exclude. The other last thing I’ll say is if you’re not tolerating binders well, that may point towards the fact that you could have mast cell activation going on. I would definitely be looking at mast cell activation as a possibility as well. I hope that helps.

1:14:45 – Normal C4a ruling out MCAS

Scott Forsgren

I think to your earlier point, sometimes in people that are highly sensitive to many things, the limbic system and vagus nerve focus can be really helpful to expand the toolbox of things that you then as the practitioner can use in helping them move forward on a more physiologic perspective. So, great response there. Question about, “I’ve heard Dr. Shoemaker say that C4a in range means that mast cells are not at the root cause.” I’ve not heard that, but they’re asking if you have any insights about the connection between C4a level and the potential for mast cell activation.

Dr. Sandeep Gupta

I know that mast cells can most certainly secrete C4a, so I would say it’s less likely if the C4a is in range, but I can’t see how it can exclude mast cell activation. What Dr. Raj Patel and his team [and Scott] have found is that MMP-9 is probably the more accurate marker out of the LabCorp and Quest panels. There’s also another range of different tests you can do, including serum tryptase, Chromogranin A, urinary methylhistidine, et cetera. Or you can also do a serum histamine and serum heparin. There are a range of different tests. Normal C4A would even put in question whether CIRS is present, but really, you need to look at all of the different tests holistically with a qualified practitioner and then come up with a diagnosis. It’s quite tricky in many cases.

1:16:14 – CDC has outdated mold information

Scott Forsgren

The question is, “Why does the CDC have outdated information that is incorrect around toxic mold exposure when hundreds of peer reviewed studies have been proven?” Maybe I can just generalize that to ask, why does it take so long for mainstream sources, medicine, regulatory agencies, why does it take so long for them to start grasping on to these newer tools and solutions that are available?

Dr. Sandeep Gupta

That’s a really good question. The answer I’ve come up with is, what appears to happen in conventional medical circles is that information generally streams down from the older professors. Often the CDC for example, would get their information from one group such as the American Academy of Allergy and Immunologists. This group of allergy and immunologists have a certain view on mold, which is, how should I say, which is somewhat antiquated. What those professors generally believe and consider to be the consensus is still generally what goes. There seems to be a reluctance in some cases for these experts to start taking on new information such as the studies that are published by Dr. Shoemaker or other experts in this field.

One of the reasons is also, they generally like to only take information which has come from the mainstream journals such as the New England Journal Of Medicine, The Lancet and JAMA and so on. In general it’s quite difficult for this information on mold to get published in those mainstream journals because there just isn’t the same money power to be able to do meta-analyses and randomized controlled trials, and therefore the types of studies which get published in these journals are generally very difficult to produce

1:18:15 – Timing of antibiotics in Lyme with Mold

Scott Forsgren

The next question says, “Regarding the intersection of Lyme disease and CIRS, can you speak to details about the medications or interventions, how would they be prioritized, and is there an ideal ratio of Lyme antibiotics to cholestyramine?” Let me just rephrase this maybe and say, in someone that’s dealing with chronic Lyme disease, should mold illness be explored and treated prior to getting into Lyme and co-infections? What are your thoughts on the order there?

Dr. Sandeep Gupta

Yeah, I generally feel that it’s best to address mold first, but there’s no absolute rule actually. I have found in some cases that starting off with Lyme antibiotics, especially, I think that’s the way to go if you’ve got an acute tick-borne infection, that’s very different. In an acute tick-borne infections, you want to not delay at all, and you want to just directly get onto antibiotics. Actually that’s the only situation these days that I will use antibiotics in general. For chronic cases of tick-borne illness I will generally use herbal approaches and ozone together. Generally speaking, I intersect them in with the treatment for CIRS. I feel that it’s best to get onto binders first. There’s no ideal ratio, as far as I know it, but if you do know it, let me know because I’m always looking for these ideal ratios.

Often starting with binders would be great. Then, bring in the herbs and the ozone on top of that. There’s no need to stop the binders, generally speaking. Then, other treatments, like VIP, can also co-exist with the use of whatever tick-borne infection treatment you want, but generally speaking, herbal treatments and VIP also go together well. Many of the other treatments we’ve talked about, whether they be antifungal, herbal or pharmaceutical, they can also coexist with the Lyme treatment.

It’s also important to mention that if you’ve got a significant amount of mold toxicity and particularly a significant amount of fungal colonization, you really have to consider are antibiotics going to be a good way to go, because they’re going to tend to increase the amount of fungus in the system by taking away beneficial bacteria from the microbiome. So, generally speaking, if there’s a degree of fungus to the picture, which there usually is in my opinion, I would tend to go more towards the herbs rather than the antibiotics.

The exception would be if you’ve got someone in a wheelchair or paralyzed or MS or whatever, in those cases I still do think that intravenous antibiotics can have a part to play. So, there’s no absolute answer. It depends on the details of the case, and that’s why having a very well-qualified practitioner is so important.

1:21:14 – Patricia Kane Protocol & Phosphatidylcholine

Scott Forsgren

Any thoughts or insights from your clinical experience on the potential role of the PK [Patricia Kane] protocol or the use of Phosphatidylcholine in the treatment of CIRS?

Dr. Sandeep Gupta

I think there’s a lot to suggest that mitochondrial membranes and cell membranes in general, in the body, get damaged through exposure to biotoxins. As part of the whole recovery process, using certain supplements such as Phosphatidylcholine and some of the other supplements which are used on that process, I think also NAD is used to a certain degree, and butyrate, and I think that they can be very useful complimentary treatments, shall we say. Dr. Andy Heyman actually uses that first up to just try and create a degree of stability of the cell membranes in the body before he starts things like cholestyramine, because it’s more likely that those medications are going to be tolerated once mitochondrial membranes have been stabilized to a certain degree. So, I think it can be very useful.

1:22:20 – Mold Illness Made Simple 2

Scott Forsgren

Beautiful. Let’s touch a bit more on the MIMS-2 course. We really just touched the tip of the iceberg. I’ve gone through all of the slides you’ve put together. I know there’s so much amazing content there. Tell us a bit more about the course. I know there’s also a community that you’ve put together so that participants can continue to dialogue. Then, maybe give us your vision for how you see people using the course. Is it something they can watch and then go self-treat? Is it something where they should still have the guidance of a knowledgeable doctor or practitioner to guide their treatment? How do you position this course?

Dr. Sandeep Gupta

Okay, great. Well, let’s go ahead and share the slides again and go through this quickly. So, MIMS 2 or Mold Illness Made Simple 2 is really a labor of love. It’s being produced over around about three and a half years, and really, there’s now 17 hours of lectures which include animated slides. There are nine modules, eight basic modules and one bonus module, which include 30 lessons all up. It’s something that can be completed at your own pace. There’s no pressure to complete it by a certain time, because we really want people to not feel pressured but just to feel that they can do it according to their own energy levels and according to their own cognitive abilities, because we know many people with CIRS are not feeling like their concentration abilities and their ability to assimilate information is as good as it could be.

What we’ve really emphasized is making the information as simple as it possibly can be. So, Part 1 of the course is on the condition of CIRS and also other forms of mold illness. We talk about fungal colonization, we talk about mold allergy, and we also talk about mycotoxicosis from food stuffs. All of these appear to be important. We go through all of the different theory points on CIRS; we explain very minutely what is inflammation and how do biotoxins trigger inflammation in patients with CIRS. I hope that helps people to really be able to understand what the illness is in very simple terms and how they can get onto a treatment protocol.

In Part 1 of the course we cover an introduction to inflammation and CIRS. Secondly, other causes of CIRS besides water damaged-buildings, so that includes tick-borne illness, and it includes ciguatera, et cetera. Then, in Module 3 we talk about screening for CIRS, in Module 4 we talk about diagnosing CIRS, and in Module 5 we talk about CIRS treatment.

In Part 2 of the course we talk about water-damaged buildings specifically because they are so important. Module 6 covers mold, water damage and building testing. In Module 7 we talk about the basics of remediation. In Module 8 we talk about finding and maintaining a healthy home. Then, we have a bonus module which covers using biomarkers to determine water damaged buildings. This is more for interest rather than anything else, particularly for anyone living outside the United States. It’s where, for instance, you can go and do a mold sabbatical and have your blood drawn for C4a and other biomarkers. Then, when going back into a water-damaged building, you can then redraw those biomarkers and see whether there’s a significant rise, which also tends to confirm the idea that that building is contributing or not contributing to your health problems.

In Lesson 2 of the bonus module we talk about psycho-emotional stress and trauma, limbic system retraining and vagus nerve methodologies. I would say that possibly this is the most important lesson of the whole course. It’s actually one hour and 20 minutes. We talk a lot about why the limbic system gets affected in CIRS, and we talk about what all the different trauma that can occur in CIRS is. Some of the trauma in CIRS is simply not being understood or validated. This all has a very great effect on the system. We talk about why limbic system retraining can be so useful, and also vagus nerve stimulation methodologies.

In Lesson 3 we talk about the similarities between CIRS and COVID-19. And those who are listening probably know that severe COVID-19 is in fact an inflammatory illness with a cytokine storm. We talk about this illness specifically, and we talk about why we don’t believe that CIRS patients are at greater risk of COVID-19, but there is a protocol there that you can follow in terms of preventative supplements and so on.

Then, lastly, we talk about other causes of multi-symptom illness, and that includes SIBO, it includes heavy metals, it includes pyroluria and parasites and dental problems, because we really, as we said before, you want to make sure that you’re casting your net widely in terms of what you’re looking at in order to recover from chronic illness. We want people to have as many clues as possible. So, these are what some of the slides look at. On the bottom left-hand side of this slide you can see one slide relating to the serial biomarker test and the version by Dr. Raj Patel. Then, on the top right of the slide you can see there is one regarding building materials and a decision matrix on what to do for non-porous, semi-porous and porous building materials.

I feel just the section on dealing with water-damaged buildings, if you only take that part of the course, I believe that the cost of the course is warranted just for that alone, because making mistakes in that whole domain can be very costly and frustrating. If you can get the right information to start with, for instance, getting a proper IEP and making sure you dispose of any porous materials, et cetera, then you’ve basically got the right information there and you’re going to do the right things that are going to promote your recovery and not make silly mistakes that people like me make in their recovery from mold illness by not getting rid of all of their possessions when they move house.

It’s a huge amount of information in this course, and you don’t have to do it in a linear fashion. You can go and do the bonus module first, if you like, and then go through the different modules in various different orders. There is a quiz, which is optional, at the end of each module, and for those who complete all the quizzes, you get a completion certificate. We really want people to be able to access this material and make best use of it.

In closing, I want to say that that the main intention behind this course is to provide clarity and hope. I hope this webinar today has helped you to attain more clarity and hope. And it’s my utmost wish that people with this illness can find the solutions they’re looking for and move towards recovery. We’ve got more webinars and blog posts coming soon. So, please subscribe to our website, www.moldillnessmadesimple.com, and also to Scott’s, www.thebetterhealthguy.com. I want to say a big thank you to Scott for performing¬† this launch and being such a great interviewer.

Scott Forsgren

This has been a highly informative discussion, Dr. Gupta. I personally appreciate all that you do to help those of us that are really impacted by these conditions. I know your heart and how hard you work to help those of us that are struggling with mold illness and related conditions. So, just want to thank you for sharing with all of us today. Thank you to everyone that’s attending. Best of health, and take good care everyone.