Revitalize Your Health: Combat Chronic Illness Now

Neil Nathan, MD

Thanks for having me. My pleasure.

Dale Bredesen, MD

Maybe let’s start. You’ve got a book coming out that is very relevant to what we’re talking about today, which is How Do We Reverse Alzheimer’s Disease. How Do We Improve People’s Symptoms? We’ve got a paper now coming out that shows Sustained Reversals For Over 10 Years in some people. Again, when you’re addressing what’s causing the problem, you can expect long-term improvements. very excited about that. But if you’ve got a copy of the book, please hold it up. Let’s take a quick look at this.

Neil Nathan, MD

Here it is. I’m very excited about it. This is, The Sensitive Patient Healing Guide, and over 20 guest authors joined me in writing this book. It’s to help patients who have gotten mold toxicity, Lyme disease, Bartonella, and many other conditions. Over time, their nervous system becomes affected, specifically the limbic system, the vagal nerve system, and mast cell activation. That trifecta will often make people sensitive to light, sound, chemicals, food, EMF, touch, and pretty much everything. As many of those patients have been told, oh, it’s in your head, You can say that’s sensitive, but that’s impossible. I’ve tried to champion those patients over the years, and I’m excited that we now know enough about neurology and biochemistry so that we understand why it’s happening, and that tells us how we can help them. I’m very excited about this.

Dale Bredesen, MD

This is interesting because you could argue that someone who is APOE4 positive is essentially hypersensitive. They’re developing Alzheimer’s from the same things that are affecting others who are not developing Alzheimer’s. I’ve been thinking of this conceptually and biochemically as something where what we think of as Alzheimer’s is a network of sufficiency. It’s driven by too little support, blood flow, oxygenation, and mitochondrial function. As you had said before, we started here with too much inflammation. You’re asking too much of this system. It is a network insufficiency. They respond that you downsize the network; you start with the 500 trillion synapses and work down from there. Unfortunately, those who are APOE4 positive have a hyper-response, more inflammation for a given insult. They are now downsizing earlier, which is unfortunately leading to Alzheimer’s disease. We want to reduce the drag, reduce the inflammation, reduce the toxicity, reduce the stress, and improve the energetics, neurotransmitters, and neurotrophins. 

This is huge; what you’re working on is a huge part of that. There’s a very interesting Netflix documentary now that’s highly relevant for your new book. It’s called Afflicted. They have, for example, one of the patients, and they follow these patients over time. One of them is very sensitive to EMF. People, again, as you said, look and say, Come on, this has got to be a fact. Her father-in-law said, You got to toughen up, like, well, wait a minute, it’s not that simple. Another one is highly sensitive to mold species, as an example, and I think, he was the mold species sensitive when he was told, you just got to toughen up. These people have. Then, when they finally find it, they go from doctor to doctor to doctor, who just has virtually no help. Finally find some that can start to make these people better, where so many people have doubted their disease and said, What are you doing? You’re trying to live in the desert. You’re trying to get away from mold. You’re trying to get away from EMFs. One woman goes to a place where they bar EMFs because of a local radio telescope. She’s better. She notices the difference. There are others there who’ve come for the same reason and said, We’re doing so much better. Maybe since I think there is some relevance here. Tell us a little bit about the biology of being sensitive to, for example, EMFs.

Neil Nathan, MD

Well, sensitivity to anything is regulated and controlled in the brain by two major systems: the limbic system and what we call the vagal nerve system, which consists of the vagus nerve or the cranial nerves that are connected to it. Now there are two different parts of the brain, but they work synergistically, very hand-in-glove, to monitor the body for safety. It’s all about safety. They’re out there scrutinizing the stimuli that you are exposed to. Yes, from a safety perspective. If they don’t think you’re safe, they’re going to shut you down, not to hurt you but to protect you. The way they shut you down may not be pleasant, but that’s not their job. The job is hey, this thing that you’re getting exposed to, be it EMF, or some smell, some chemical, light, or sound, I don’t know if that’s safe for you, and I’m not going to let you do it. It’s a protective mechanism. It’s kind of gone off the rails. What we have to do then, and this is, by the way, not psychological, is neurological. Many of our patients have been told, This is in your head; you’re making this up. It’s how come I’m in the same room with you and I’m not feeling it? That’s because you don’t have the same triggers that are affecting me; it’s very real. Here’s the good news. It’s treatable in the same way that we can influence all of those patients with Alzheimer’s because we can look for the inflammatory causes and treat them, and a whole lot of our patients can get better to the point of being well.

Dale Bredesen, MD

That’s very interesting. Talk if you could a little bit about what the difference is between what’s being delivered by the vagal side and what’s being delivered by the limbic side.

Neil Nathan, MD

That’s a good question. The limbic system’s primary job is to monitor stimuli that have to do with sensation and emotion. The symptoms that would tell you that your limbic system is being affected or any sensitivity of any kind, light, sound, touch, chemical, food, EMF, all of that is limbic. The emotional side is important because anyone who has not been particularly anxious but now is depressed, feels hopeless or despair, or even has OCD behaviors or has depersonalized or demoralized, all of that is limbic, and all of that can be triggered by mold toxicity. Lyme, Bartonella. There are some other important causes as well, but those are the big issues. 

On the vagal side that has more to do with the autonomic nervous system because the vagus is a primary component of the parasympathetic nervous system, the sympathetic and the parasympathetic being the two branches of the autonomic nervous system that regulate the trouble breathing, the heart rate, digestion, all of the major parts of the body. Someone who has a vagal issue might, for example, have constipation or intestinal issues because the vagus regulates intestinal motility, and the vagus also regulates heartbeat. If you have tachycardia, that could be vagal, or a POTS that could be vagal, or temperature dysregulation. All of that is quite common in our patients with mold and Lyme disease. Often, people will go to specialists who have POTS clinics where they can go and get elaborate testing, You have POTS, but most of them don’t realize that there are actual triggers for it that affect the vagus. That’s one of my messages, which is that it’s all well and good to put a label on it, but it’s important to back up from that label and go, Yes, but what’s triggering that? That’s where the real help can come for patients.

Dale Bredesen, MD

Very interesting. The other thing that jumps out at me is, now one of them, the vagal, of course, has more information suggesting gut-related changes in the microbiome; even prions can move up the vagus, and you end up in the brainstem, which is where you see Parkinson’s. Interestingly, you see locus coeruleus in the early stage of Alzheimer’s disease, where you’re losing all that Norepinephrinegic projection to the cortex. You see, so of these very passive people, when you ask them a question, they turn to their partners all the time. You’ve got the vagal side, which is more related to the G.I. As we’re hearing more about the microbiome and movement of prions and things that are vagal to GI to brain connections and GI to brain stem connections, On the other hand, you’ve got a system with a limbic system that you’re associating more with the nasal input. Interestingly, the neuropathologist told us years ago that whatever you guys find out about Alzheimer’s, it’s going to have something to do with the nose, because it’s the Rhine and Cephalon; it’s the so-called nose brain that tends to be affected. That’s the distribution. Is there a sense that some of these things that are attacking and affecting these two are more on the ingestion side and one is more on the inhalation side? Or is that not the case?

Neil Nathan, MD

Well, one of the things that a lot of people don’t know about mold toxicity, for example, Yes. Is it true that once you’ve been in a moldy environment, not so much food ingestion is possible, but once you’re in a moldy environment, you’re taking in mold spores? Compressors—you’re swallowing them. You’ve got a reservoir of mold that grows and colonizes in our sinus and gut areas. A lot of people think, Well, I used to live in a moldy environment, but I’m out now. I don’t feel any better. I’m out of that moldy environment. Yes, but you’re carrying that moldy environment with you. An important part of treatment is recognizing that you’ll not only have to get the mold out of your body, but you’ll also have to get the mold that’s growing in you out of your sinus and gut areas. There is a connection.

Dale Bredesen, MD

You bring up a good point because this is an area and this is a difficult field. I have to say nothing. When I was training in neurology, it was ever suggested that mycotoxins were going to be the important players that they are or tickborne illnesses and things like that. Yet they’ve turned out to be major players in cognitive decline. Now, of course, as you well know, you are, a leader in this field, there is the idea that this kind of Shoemaker approach is chronic inflammatory response syndrome. You don’t need to use antifungals, and if you measure something in the urine, it’s probably coming from your gut. Then there’s what I would call the Dr. Nathan approach, which is, yes, you do want to use some antifungals, and yes, you do want to check the urine for mycotoxins. For those of us who listen to you as a teacher, I guess the question is, do you get better outcomes when you include antifungals and address that part of the illness?

Neil Nathan, MD

But I would say, yes, Dr. Shoemaker, who I worked with for many years before deciding that we had different views on the matter. I think it kind of boils down to the fact that, for reasons known to him, he’s never embraced urine mycotoxin testing. He always thought that it was related to food, which most of us don’t believe is the case, and he’s never included it in an otherwise scientific way he has evaluated, for a series of chronic inflammatory response syndrome. Because of that, I think he’s missed how to do this whole process more comprehensively. His objection to antifungals is partly theoretical because of a single line in a single paper that was published that suggested that if you take antifungals regularly, it will do some harm to your body. I’ve read the paper, I’ve looked at that line, and I’ve run that past hundreds of my colleagues. None of us think that occurs. Generally, antifungal medication is quite benign. There is very rarely any resistance to it. My big problem is that, outcome-wise, if you don’t get rid of the colonized mold in your sinuses, you’re not going to get better. 

My different way of looking at treating it is that having tried his method for many years, I found, and by the way, I did not invent this method. It was created by a whole team of us, including particularly Dr. Joe Brewer, an infectious disease specialist in Kansas City. Shows were profoundly influenced by our way of looking at them. His papers, published about 12 years ago, began to get us thinking, There is colonization here, and if we don’t treat it, that might explain the people we haven’t helped. Again, based on my experiences, having treated probably hundreds of people, I have tried Dr. Shoemaker’s method and have not gotten well. Is it true that when we got them on the correct binders when we treated them with antifungals, they recovered completely? That’s my bias. I know Ritchie well enough that if he were standing next to me, he would have a compelling argument for why I was completely wrong.

Dale Bredesen, MD

Yes, and one of the things I’ve found throughout the years is dealing with the top experts. Sometimes they have two different approaches, and they’re both different, and they both have reasons for why they are saying what they do. Each one of them.

Neil Nathan, MD

Yes. Mine is practical, Dale. I’ve, as Ritchie has, taught those concepts to hundreds of physicians, and they have shared that they have so many people getting well that they have not been able to help before. I know there’s at least something in what I propose or teach that works, and I’m completely open to learning how to do it better. Because that’s the bottom line.

Dale Bredesen, MD

Yes. That’s what we all want. I have to say, it has been so exciting for me since the very first patient with Alzheimer’s reported her improvement back in 2012. It’s been so exciting to see people who had no hope and are now improving. We have many of them now, and a number of them, of course, have consulted with you and have been helped by what you do. We come back to the conceptual model. This came from the test tube, and if you look at the actual signaling of the amyloid precursor protein, it is this change in network sufficiency that’s mostly brought about by three groups. It’s an energy reduction, an increase in inflammation, and, as you’ve indicated, an increase in toxin exposure. Some toxins that you’re now having to deal with are adding to this. Of course, these things can interact with each other.

Neil Nathan, MD

Everything you’re saying would fit beautifully into Bob Naviaux’s concept of Cell Danger Responses to stress, toxins, and infection all have a choreographed role on the cells in the body to shut down the mitochondria to deal with that stress or toxin infection. That energetic void that you’re talking about is a natural consequence of all the things that can trigger that cell danger response.

Dale Bredesen, MD

It’s a great point. The other thing we found is that there are these modes. It’s very much like what you were just talking about. Your limbic system and your vagal system are telling you you’ve got to go to a different mode. You’re not going to be normal. I’m protecting you by shutting things down. What we’re finding is that the same thing plays out at the molecular level with the APP, amyloid precursor protein. It’s a beautiful switch, and it, by the way, has a preonic loop. It either goes to one side or goes to the other side by having positive feedback. But what’s interesting is that one side is connection. It’s making synapses; it’s keeping synapses. When things are bad, it switches to protection. You go from connection mode to protection mode. The protection mode is where you make the amyloid because it sequesters and kills microbes. It also binds to metals. It is; as you said earlier, it’s not trying to hurt you. It’s trying to help you. It’s trying to save you in this case from various insults that are happening. You can trace the molecular pathways beautifully. When you activate NF-Kappa B, it enters the nucleus and affects hundreds of genes. Two of the genes where you increase the production are beta and gamma-secretase, which make more amyloid. 

Alexei V. Korennykh, who is my colleague and works with me, and he’s an Interact OMICS expert, has pointed out that beta is part of the memory component of the innate immune system. It’s very much what you said when you set it high: because of stress, because of APOE4, because of saturated fats, because of inflammation, then you’re going to be making more amyloid. You are hyper-responding to try to protect yourself because you’re at risk of being exposed to insults. On the other hand, when you can relax it with some extra virgin olive oil and fewer Bartonella and Babesia and things like that or your APOE4 negative, you’ve got it, the set point itself is lower so that you’re not so much dealing with this hyper-response that occurs on the inflammatory side of Alzheimer’s of course, on the adaptive side, it’s the basis of MS. We see these same sorts of cellular responses time and time again. as you say, very much like Professor Naviaux’s work, interesting. Let me ask you about some specifics. You mentioned in your wonderful book on Toxins that Bartonella was a common one that you see with people who are chemosensitive. Sensitive to various things. What is Bartonella doing? I’m assuming that when you say this, you’re talking about Bartonella, who is presumably coming. Is this mostly from tick bites, or is this from other things?

Neil Nathan, MD

Well, we tend to think of it more as coming from tick bites, but it can also come from fleas, cat scratches, cat bites, viruses, and mosquitoes. You don’t have to get it from a tick. Many people think of Bartonella as being intimately connected to Lyme, but you could have Bartonella without having Lyme.

Dale Bredesen, MD

What are the typical things you are seeing, and do you have a sense of why it’s so good at producing? Is it because it is interacting with the vagal system or the limbic system? As you were talking about before, what is it about Bartonella that seems to give you these interesting symptoms?

Neil Nathan, MD

Like many infectious agents and viruses, they intentionally—we’re going to call it intentionality here—inflame us so that our immune system runs around putting out fires. It doesn’t get around to recognizing the Bartonella to deal with it directly. It’s one of them.

Dale Bredesen, MD

Evolutionary intention.

Neil Nathan, MD

It’s been around longer than we have. It has mechanisms for protecting itself, so this is about inflammation. You might, for example, find that mold toxicity, Bartonella, and Lyme disease have very similar symptoms in patients. You can go. Why would a toxin have the same symptoms as an infectious agent? Yet the answer is that they both create a reaction in our immune systems, a cytokine reaction, so that the cytokine patterns that we see are extremely similar so that toxins can do the same things as infection agents because they’re similarly inflaming us, and depending on our biochemistry and genetics, it affects whichever organ systems are weakest. We’re off to the races.

Dale Bredesen, MD

Interesting. Let’s talk about some actionable items here. One of them would be cholestyramine as a binder. A lot of people say it’s very aggressive and can make some people sick. Of course, some of the preparations tend to have some glucose or at least some carbs in them that make it difficult for people to stay in ketosis or to get into ketosis. What do you like about binders? Again, I know in your book you have specific ones for specific pathogens. Do you try in general to avoid cholestyramine, or do you use it frequently?

Neil Nathan, MD

It’s about the patient, I work with a lot of sensitive patients because I’ve kind of gravitated into a specialty area where physicians send me their more sensitive patients because they’re having difficulty figuring out how to approach them. For sensitive patients, I find they can only tolerate tiny amounts of cholestyramine, or not at all because, A, is strong, and B, has more side effects than some of the other things we use as binders. I tend to use low doses of Welchol, which is a pharmaceutical cousin of cholestyramine. Because most of my patients can tolerate it better, it has a very similar effect, and it doesn’t overwhelm our patients. But again, as you point out, and I have this listed in my book, Toxic, all of the mycotoxins that we can measure in the urine, tell us how to treat them. In other words, we know that cholestyramine or Welchol is an excellent binder, particularly for ochratoxin or zearalenone. But it’s not a particularly good binder for some of the other toxins. It’s not a standalone. Yes, we give this to everyone, and that’s all you need. If you have, for example, trichothecenes or aflatoxin, which are very common toxins in the body, things like charcoal, clay, and chlorella are excellent binders for them. If you had gliotoxins or zearalenone, the best binding agents would be bentonite clay and good yeast saccharomyces boulardii. There is a way of understanding once we measure the toxins in your urine. Once I know what’s in your body, I know with some precision exactly what I can give you to pull that out of your system.

Dale Bredesen, MD

Fantastic. Yes. So critical. Then, when would you like to use intranasal antifungals?

Neil Nathan, MD

Again, I don’t do that for everybody. Some patients, if they’re lucky, have only been exposed to mold briefly and are sick from it. The mold may not colonized, If it hasn’t been colonized, there is no reason to give out antifungals. If you simply give them the binders that will pull this out of your body, provided they’re no longer in a moldy environment, I want to emphasize that, and then that’s all they need. But if, for example, they have persistent symptoms of runny nose and sinusitis and recurrent infections and difficulty with stuffiness in this area, or, you name it, the GI effect, particularly gas, distension, bloating, diarrhea, constipation, and abdominal cramping, then we’d probably look at giving them some oral antifungals as well.

Dale Bredesen, MD

Then how many of these people are you seeing? As you pointed out, there are a lot of people with chemical sensitivities and a lot of people with chronic illnesses. How many of these people have brain fog or frank cognitive decline?

Neil Nathan, MD

Almost all of them. If they don’t, I’m going to question my diagnosis because brain fog or cognitive impairment is almost universal in our patients with mold, Lyme disease, and Bartonella. The universal things are fatigue and cognitive impairment for almost everybody.

Dale Bredesen, MD

What are you seeing when you treat them? Do you see improvements in their cognition?

Neil Nathan, MD

I would say that the vast majority and I have successfully treated over 40,000 people with mold toxicity. The vast majority are well when they’re done. Now, if they have early cognitive decline, if they’re working towards Alzheimer’s disease, the sooner we treat them, the more likely it is we can reverse that. The longer it goes on untreated, the longer it just kind of sets in, and it’s harder to reverse.

Dale Bredesen, MD

Yes. I think that one of the huge changes now is the availability for the first time of good blood tests that can tell you where you stand. Things like P-Tau 217 and, to a lesser extent, GFAP and NAFL, which now allow you to get blood tests rather than having to do spinal taps, will be able to tell us, Hey, first of all, for example, did your latest Bartonella patient, even though they had some modest changes, be headed for Alzheimer’s? Again, Alzheimer’s is not something special. It is something where you’ve got that you’ve got something that’s changing that support of your brain. You’re starting to go down that pathway. Now, you may never get a diagnosis. Typically, a diagnosis is 20 years down the road, but you’ll be able to see whether these Bartonella patients, Babesia patients, and Mycotoxins patients have increased in their phospho-tau. 

One of the studies that was fascinating to me a few years ago was where rodents were given Candida just to see how long they could exclude this from their blood-brain barrier. The thought was, would it be a month? Would it be two months? The answer was about 5 minutes. The Candida got access to the brain, boom. They’re quite good at that. As they pointed out, the immediate response looked very much like the earliest changes in Alzheimer’s pathology. Yes, you’ve got something; you’ve got an insult; you’ve got a response. This is early on now with your innate immune response, and you’re trying to sequester it and kill it. As you’ll be able to see, are these people headed in that direction? I think it’s going to be fascinating to see. At the same time, we can also follow the Alzheimer’s patients as you’re dealing with them, as people are now improving their status. That is interesting. Are you seeing a lot of Long COVID with cognitive decline as well?

Neil Nathan, MD

I would add to your excitement about some of the newer tests that are coming down the pike. I’m excited about the fact that some of the tests that were developed for Long COVID, will probably be relevant for this patient population because they’re a much more elaborate evaluation of the cytokine response than we’ve ever had access to before commercially. For example, Bruce Patterson’s testing for Long COVID through the Radiance Lab lights up a whole bunch of cytokines that point toward Long COVID. But he’s also discovered, surprisingly, that Long COVID, which some people are calling Long COVID, is unmasking mold toxicity, and Lyme disease. You can see in his cytokine panels that there’s a different panel of cytokines for Lyme than there has been for a Long COVID. Hasn’t quite looked at it from mold toxicity in the air, but is working on it. We are developing tools, and I think applying this to our patients will help us pinpoint just what this patient with early Alzheimer’s needs to work on. Is it Long COVID that can trigger it? Once again, another inflammatory response that the body’s not controlling is mold and Lyme combinations. That will help us to be more precise in our treatment as we go. I just want to add to this discussion that anyone listening to it might take home the message that everything we’re talking about today is potentially treatable. That’s my most important takeaway message: we’re talking about a lot of things, and they’re treatable.

Dale Bredesen, MD

Yes. Now I know that you consulted on the patient recently who has some leg pain as a severe consequence, and it has what’s called posterior cortical atrophy and is doing well. Where do you see a lot of it, and is Bartonella something that is a cause? I have to say I hadn’t heard of Bartonella as being an important cause of leg pain. Is this something that you see a lot?

Neil Nathan, MD

I’ve seen it with mold toxicity.

Dale Bredesen, MD

Interesting.

Neil Nathan, MD

I’d almost say that if you have a patient with all kinds of symptoms and weird pains, think mold, think Lyme, and think Bartonella because it can just affect the body in all kinds of ways that we didn’t realize. Visual disturbances of every type—mold, Lyme, Bartonella—people with floaters with snow in their eyes, with all kinds of things that ophthalmologists say, That’s fairly rare. I don’t normally see that when you treat that, these things tend to go away.

Dale Bredesen, MD

Very interesting. Could you talk for a minute a little bit about Babesia, another co-infection? As you pointed out, Bartonella is not just a co-infection with Lyme, but Babesia is the most common co-infection with Lyme disease. Certainly, we’ve had patients who’ve treated their Lyme in the past, but now they’re having a decline again. It turns out, they had Babesia, which was untreated. What sorts of things have you seen with Babesia?

Neil Nathan, MD

That’s the history of Lyme disease. First, there was Lyme. We treated that some people got well, and then we found Babesia, and then we found Bartonella. Then we found it goes on. I know that there are more things than there that we haven’t figured out yet, but we know enough that we can help a whole lot of folks. With Babesia, it can again present with fatigue and cognitive impairment as a primary symptom, but it tends to cause three other things: what’s called air hunger, where you feel like you just can’t take a deep breath, and frontal-frontal head pressure, which patients keep reassuring me is not a headache. It’s head pressure here and night sweats. Those three things are more characteristic of Babesia. But there’s such an overlap that I can get all three with mold toxicity. It’s by symptoms alone. It’s hard to tease these things apart. The good news is that our testing is getting better. We have better tests now than we have ever had for Lyme, Bartonella, and Babesia so we can begin to more quickly jump to Yes, I know what you have, and I know how to treat you.

Dale Bredesen, MD

Great point. This is an important, actionable item for all of us. As you said, someone comes in, they’re having, let’s say, cognitive decline, they’re having brain fog, and it’s getting worse. They’re saying, okay, you’re thinking it could be mold, it could be Lyme, it could be other things. What are the best tests that you like? What do you like best for mold? What do you like best? Babesia for Borrelia, etc.? Did you go through those?

Neil Nathan, MD

Yes, I’ll even back it up one step further, which is that from my clinical perspective of the people with cognitive impairment that I’ve helped over the years, the four most common treatable things that I’ve come across, in addition to mold and things in the Lyme world that we’ve been talking about, are heavy metal toxicity, particularly mercury and lead, and for women, hormonal deficiencies, particularly estrogen. I just want to add that there are a couple of particularly helpful things. When we treat those things, we see remarkable improvements in some patients in getting their cognitive impairment resolved. 

To answer your question more specifically on the mold side of things, very simply, a urine mycotoxins test. Several labs are doing it. Having looked at tens of thousands of these tests over the years, I think that the real-time test has been the most consistent, reproducible, and accurate of the tests if that’s not possible. Other tests from Mosaic Lab, which is a rename of Great Plains and Vibrant Health, are okay tests. No matter what test you use, If it comes up positive, that’s actionable. That’s something we can treat on the Lyme, Bartonella front. I think that the IGeneX laboratory has been the leader throughout the labs. Things like an Immunoblot for Lyme and Bartonella are extremely accurate. FISH tests for Babesia and Bartonella are accurate and pretty much brand new is the new is ECPCR testing from IGeneX, in which we can now culture Lyme, Bartonella, and Babesia and enhance that culture using enhancing tests and know if it is actively in you. The reason that is so important is that it tells us that yes, that organism is growing in your body. All the other tests that we’ve had for so long are immunological tests; they tell us, have we seen this organism? Have we reacted to that organism? But it doesn’t tell us—is it still there? Did we fix it? Is it gone? Is it still active? The new ECPCR test will tell us. Yes, that’s in you right now.

Dale Bredesen, MD

Now, is the PCR going to pick up all these different species? As Dr. Horowitz has pointed out, you’re not looking at just Borrelia burgdorferi anymore. You’ve got all these different species that you’ve got to consider.

Neil Nathan, MD

Supposedly, it will pick up most. Again, it’s so new that I’m excited about it. I want to. I’m the type of guy who needs to be shown something. Let’s just see how it translates to patients. But I will say that the Lyme test is a remake of a test that used to be done 10 years ago by a laboratory called Advanced Laboratories, which grew it out. They didn’t do a PCR enhancement, but they grew the Lyme out. It was, at the time, the most accurate test we’ve ever had. I’m excited that they’ve improved that test and expanded it to Bartonella and Babesia, and you’re right; there are so many species of Babesia and Bartonella and Lyme that we can measure more of them. We’re still not able to measure all of them.

Dale Bredesen, MD

Yes. Is it your sense that these are ultimately going to turn out to be part of the microbiome? Or are these still infections coming from exogenous sources?

Neil Nathan, MD

These are infections coming. I don’t think it’s part of our microbiome. It’s too toxic. These are uniquely toxic agents that have multiple ways of evading our immune system and surveillance, making it hard for us to treat them now where we’re staying, maybe one step ahead of the organism as it evolves. But at this point, we still have the tools to treat it successfully in most patients.

Dale Bredesen, MD

Yes. A fascinating paper recently showed you that you go back a little over a century and go through all the things that syphilis does to your brain. Of course, all that I learned all those years ago about Gomez, about neurosyphilis, and Tabes Dorsalis has all these sorts of things that we rarely see. Now, you just go through the same thing. Now you’re looking at things where Borrelia is taking the place and causing many of the same pathophysiological looks in the brain. Here is yet another thing you have to be concerned about, and that is the neurosyphilis of the 21st century. 

Neil Nathan, MD

It is. It begs the question, Dale: why have we all become more familiar with epidemics of these things? Lyme is an epidemic, and mold toxicity is an epidemic. Autism is an epidemic. There are so many conditions that revolve around inflammation, and Alzheimer’s is an epidemic. Why now? Why, in the history of humankind, are we having it? I would submit to you that it’s because our immune systems aren’t as robust as they used to be. They’ve been weakened powerfully by, I would suggest, some of the exposures and toxicity of the planet as we’re creating it. There are tens of thousands of chemicals in our environment that weren’t here 50 years ago. The EMF exposure we have now. This didn’t occur 50 years ago to anything but the most minor, and I think we’ve been blowing it off. Yes, so what? I think it’s time for us to stop blowing that off and to take a serious look at what kind of world we are creating in which we are all so prone to an inflammatory process.

Dale Bredesen, MD

Great point. Along those lines, what do you do for your patients to optimize their immune systems?

Neil Nathan, MD

But first, I want to get rid of what’s trashing their immune system, which is that I have a broken record. Mold and Lyme are the biggies, but that’s heavy metal toxicity. But then there’s also their diet. Are they eating organic, meaning clean air and water to drink, and are they exposed to what kind of strain is on their liver by the life that they’re living and what they’re doing to it? Are they getting enough sleep? Are they getting exercise to any adequate degree? Those are the basics that everybody can have, but in the fairly stressful world that we live in, I would say the majority of people that I’ve treated over the years don’t feel like they’ve been able to do that. Many know they should. But, that’s great, Neil. But I’ve got kids to take care of. I have family responsibilities. I have a job to hold down. When exactly am I going to exercise or find the time to eat properly, and blah blah blah? However, if you don’t, you’re setting yourself at risk of being pretty miserable as you get older.

Dale Bredesen, MD

Along those lines, how often do you use low-dose naltrexone? Some people swear by this. see how it is impacting your immune responses. For some people, of course, much better in terms of just allowing their thyroid to improve. How much, is this a common thing you’re using with these diseases or not?

Neil Nathan, MD

I’m not as big a proponent of LDN as other people are. I’ve probably given it to a couple of thousand people, and it’s helped a few. But not to the extent that some of my colleagues are absolutely in love with LDN and give it to everybody, and it has several different uses. One is that there is some evidence that it will help reverse autoimmune conditions. I have used it for that with some success, but a lot of people are using it for their inflamed patients, be it Lyme, mold, or whatever is inflaming them, COVID, and I haven’t seen it do much to make me jump up and down, and I think it’s the greatest thing since sliced bread. Just my take on it.

Dale Bredesen, MD

Have you used Resolvene, and did you find that it helped in terms of reducing inflammation?

Neil Nathan, MD

It’s not enough to have an opinion that I would voice publicly; I just don’t have as much experience with Resolvenes.

Dale Bredesen, MD

When you’re going after, let’s say you’re going after a tickborne illness, let’s say Bartonella. Do you take antibiotics or do you favor more of a natural medicine sort of approach, or what has given you the best results?

Neil Nathan, MD

Well, my naturopathic friends often feel that they can get good results with botanicals. I’ve tried that, and I have had very few successes in that realm. I have found that as Lyme disease has evolved, which it has, we’ve had to go to stronger and stronger antibiotics to get any results at all. I have found that antibiotics are essential in the treatment of Lyme and Bartonella, and I’m a huge fan of Dr. Horowitz. That’s on the program. I’ve had quite a few patients over the years who could function much better if they were on antibiotics, but if they went off antibiotics, they just crashed. It’s not something I ever wanted to do, but if I didn’t keep them on antibiotics, they just couldn’t function. His program has enabled many of those patients to be done with that. I think Rich is honored by something, and I’m a huge fan of what he’s been researching and studying these last few years.

Dale Bredesen, MD

Do you use the pulses, and do you use the double doses that he’s recommended?

Neil Nathan, MD

I have followed his protocols; however, I work with unusually sensitive patients. Usually sensitive patients sometimes respond surprisingly well to small doses. I typically start them on very tiny doses of his protocol and then only work up as they can tolerate it. Many of them will respond to lower doses and don’t need to go to extremes. Again, I come at it from a different perspective.

Dale Bredesen, MD

Exactly. Different patient populations. What do you do for those people in terms of making sure that their gut microbiome stays robust?

Neil Nathan, MD

There are lots of different kinds of probiotics of every type. I think a single probiotic isn’t as likely to replenish the microbiome as multiple ones. I would usually ask people to take different kinds of probiotics to give their gut a chance to not react. I will say, having given lots of antibiotics to lots of people for years, which was never my intent when I started medicine, that wasn’t the idea that was necessary to help these people with Lyme, Bartonella, and Babesia.

Dale Bredesen, MD

Yes.

Neil Nathan, MD

If you take plenty of probiotics, it is rare for you to mess up your gut biome. Most of these patients can do it reasonably comfortably without being messed up. I will confess that there are a few who did get messed up by taking antibiotics, but the vast majority can take antibiotics comfortably and well. When they’re done, their gut is still functioning well. I think the fear that the antibiotics will mess things up doesn’t apply to most people.

Dale Bredesen, MD

Yes, it is fantastic to know. Dr. Neil. Nathan, I could talk and discuss these things with you for hours, but I want to be cognizant of the time. I appreciate your input, as always. I love the fact that you are so focused on the best outcomes. This is what we need for all the patients. I appreciate that, and I thank you so much. I’m going to stop the recording here. Again, I am grateful for your time.