Genomics: Your Key To Inflammation And Detox Response

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

I’m so glad to be here with you, Ann. Thanks for having me.

Ann Shippy, MD

You’ve been at this for a while. I remember when you first started this company, and, oh my gosh, you’ve been on such a mission to something that stands apart from all the other genomics testing that’s out there. It’s been a great tool for me to be able to use with my patients and myself. We can talk about that a little bit too. I know this is a new field for some of the audience, and I wanted to start by defining some of the important terminologies that we’ll be using. Maybe even just start with genomics.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Genomics is the study of small changes in an individual’s DNA that, by themselves, are not disease-causing. But when combined with environmental exposures, differences in nutrition, and other factors, even the interactions between different gene variances, or SNPs, as we call them, can have a very significant effect on somebody’s health and well-being. Whether you’re talking about physical health, mental health, or cognition, genomics gives us insights into things like what kind of inflammation people might have. What kind of detox pathways are working better or less well? When you’re talking about brain health, things like what neurotransmitter or transporter, or even, again, what nutrients someone may need more or less of? It’s a tool that allows you to personalize your care down to what we call an N or the number of people in the study of one. It’s different than genetics. When you talk about a genetic disease, you’re talking about a big mistake in your DNA. That’s a mutation, and if you have this mutation, you’re going to get this disease: Tay-Sachs and cystic fibrosis. If you’ve got two copies of those gene variants, you get those diseases; genomics isn’t like that. You have made lots of little changes. Kind of like typos or slight changes in a recipe.

Ann Shippy, MD

It may have been a survival mechanism at some point. It might have been malaria or other environmental challenges that ended up being a survival benefit. That’s what I like to tell my patients and it’s not necessarily a bad thing. Certainly, in some circumstances, it’s great to have these genes. I know I have some that are a double-edged sword. Sometimes they’re great for fighting off illnesses and those kinds of things. Other times they get me in a little trouble.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Absolutely. Having more inflammation can be good. If you’re fighting an infection, it can be bad if you’re getting an overzealous response to mold.

Ann Shippy, MD

There’s this term floating around called precision medicine. I think it’s important for people to know that that’s an option. If you wanted to find that term, that would be great.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Yes. Previously, and still to a large extent, when people go to medical school, practitioner school, or even a naturopathic school, they’re given algorithms and different ways of approaching Here’s the way to approach depression: Kind of a classic way in allopathic medicine is, okay, you’re going to start with a serotonin medicine. Here’s a way of approaching high blood pressure: Start with this. If this doesn’t work, do that. The end of one medicine, or precision medicine, is to wait a second. Let’s take a step back and look at what we can find out about this person so we can make our treatments much more specific to what’s going on for them. If they truly have a problem not making enough serotonin and not recycling enough serotonin, then serotonin medicine or natural things that raise serotonin might be good. But what if their mood problems relate more to not making enough norepinephrine, too much inflammation, or different growth factors or nutrients? What precision medicine is about: let’s try to find out much more about the person. Instead of having global ways of approaching things, treat each person as an individual, which of course makes a lot of sense because we have the ability.

Ann Shippy, MD

Yes. It’s really fun.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

It is. It’s much more fun.

Ann Shippy, MD

This is really what my body needs or this is what my patient’s body needs. How about epigenetics? Do you have a good definition of epigenetics?

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Absolutely. Epigenetics. It was first described well before we sequenced the human genome, and it’s the word to mean on top of genetics. It has to do with things in your environment as well as things you take into your body. Like nutrients, you can modify your genetics. We know that plastics are big epigenome modifiers and change a bunch of gene expressions. That’s why we took BPA out of a lot of canned foods and said, Don’t drink from water bottles that have BPA in them. But what we do in terms of exercise can be an epigenetic modification, meaning it can change how our DNA is expressed or modulated. It’s just saying to use diet, lifestyle, and environment to modify or modulate DNA.

Ann Shippy, MD

Even take. Yes, taking certain supplements and other things helped to modulate, too. What I want people to take away from our talk today is that, yes, you might have gotten some genes that may make you more predisposed to environmental medicine or illness, but there are things that they can do to even help those genetics and genomics.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Yes. You and I are both on the same page with that. That’s what we do in our practices: “Okay, your DNA is not your destiny, but if we understand it, we can address it.” You don’t have to look at anything pathogenic or disease-causing to improve outcomes. You just look at all these little pieces of the puzzle and say, “I can get you well.” You mentioned that medicine’s more fun when you do personalized medicine or precision medicine. I agree. But I think the reason is because we get people well, and they feel better.

Ann Shippy, MD

Getting to the root cause, I mean, really looking at this as part of understanding the root cause of the illness so that then you get people well, rather than validating the symptoms wrong.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

I agree.

Ann Shippy, MD

Let’s dig in. The most important thing for people with mild and chronic illnesses is to know some of their genomics that they can look at to better understand why they got into this situation in the first place and what they can do to start to remedy that.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

I think that the first thing that they understand about genomics and chronic illness is that there are a couple of different things. The Mycotoxins. Just in terms of a definition, there wasn’t this Mycotoxins summit, but Mycotoxins are kind of like the bullets shot out of the gut. The mold toxins that cross into the body can interact with genes, turn on and off genes, and even turn on and off mitochondria. When you’re talking about mycotoxins and genomics, you’re talking about how we respond to the insult and the whole cascade of events that the mycotoxins create. Some enzymes are coded by genes; genes, of course, are kind of our blueprint for ourselves and are needed to remove mycotoxins such as glutathione transferases and these efflux transporters. Those are important in how you respond to mold efflux transporters. When you’re talking about genes, they start with A’s and ABC’s, like ABCC1 and ABCC2. So, ABCC1 and ABCC2, for example, relate to being able to kind of go, “Wait a second, I’ve got to kind of kick this out, this particular mycotoxin out of my gut or out of my brain.” Aflatoxin, you can’t kick it out if you don’t have a good working ABCC1 in your brain; you’ve got more brain fog.

Ann Shippy, MD

That’s a direct injury down right where it is because the toxins are just more likely to build up in the different tissues.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

You’re going to have a bigger issue with it if you’re kind of bad, and some people say I’m a bad detoxer; I’m a poor detoxer. My question to them would be, “Why? Is it because of the glutathione? Again, we’re using a lot of big terms. I’m going to kind of make analogies. Glutathione is the true quicker, picker, upper, taking a boundary, but your body is that paper towel; it picks up stuff so you can carry it out. You can carry it out through your urine, through your sweat, and your gut. If you have problems with that, that’s one way that we would fix it or work on it in your glutathione systems. There’s also a way of conjugating different toxins so you can eliminate them that the liver helps with. Then again, there’s this bouncer gene. Those are all important for detox. Now, part of it is: What are your genomics? Part of it is realizing that different toxins will upregulate different CYPs. Some of those liver enzymes help remove toxins. That’s why it’s so hard to fight mold-related illnesses because the mold can make it so that you’re a worse detoxer than normal. Mold can also affect something called the Nrf2 pathway, the Nrf2P, which, as far as I remember, means that Nrf balls are fluffy and good. Nrf is good, and keeping it is good, and you want to have a good active Nrf because that’s anti-oxidant; that’s protection against your mitochondria getting damaged. Well, mold can already turn down your Nrf2 pathway, but if you’re genetically bad, about 2% of the population is really bad at making Nrf2. If you’re already genetically bad at that, then you’re going to have excessive oxidative stress. Why do we care about these different things? Because it’s going to give us ideas. There are hundreds of supplements and nutrients that we could prescribe or take, and we want to be able to figure out what’s going to help you as a particular patient. Those are just a few of the pathways.

Ann Shippy, MD

What I love about what you’ve done with the database that you’ve created with Intellxx is that you tie those particular opportunities to each polymorphism so that it is very actionable. It’s very clear to me now what I can do to keep myself out of trouble and try to help those genes work better.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

There are some things that everybody who’s exposed to mold would benefit from since we know that mold, for example, turns off Nrf2. We know that sulforaphane, which is some three-day-old broccoli sprouts, turns it on. That is a great intervention. If you don’t have access to your genomics, you can kind of get started on your general detox with mold. I started treating mold in the days before we knew a lot about it. One of the hardest things was dealing with the brain fog. Once I learned about Nrf2 and the role of sulforaphane, I didn’t have to use any of that. Let’s try intranasal VIP and all these different things for brain fog, because just getting back those Nrf2-dependent antioxidant and detox pathways and kind of giving them a relatively high dose of sulforaphane, you need to use a good quality sulforaphane that has myrosinase or moringa in it. Moringa is another anti-inflammatory that helps activate the precursor, the raw product behind sulforaphane. But then it was like, okay, now I just had to deal with everything else, like the inflammation in the pots. But the brain fog went away quickly. If you’re only going to do one supplement for mold, I don’t know what your favorite is, but one of my favorite supplements is to use a sulforaphane supplement.

Ann Shippy, MD

Now I need to go back and make sure that it has myrosinase in it. Do you have a good way of talking with brands? Is there a brand that you like?

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

I like to use brands that have data in the study. I generally will use AB McCall or AB McCall Professional, the reason being that three-day broccoli sprouts are where we get this product called Glucoraphanin from, but it has to be activated by your stomach. About 25% of people don’t have enough enzymes in their stomachs to activate them. When you package it with the myrosinase or the moringa, you’re going to make sure that even for those 25% of the people, they get good activation. But the real thing is, if it’s not properly made, you’re not going to have success. However, they have done studies on autism, schizophrenia, and cognition. That makes me feel comfortable that this product ends up with good outcomes, that this product is properly made, and that it crosses the blood-brain barrier because I think that’s the really important thing.

Ann Shippy, MD

Admirable too. Just as a side note, the supplement companies put the money into the research because it’s not like drug companies, where they can easily put a patent on it and make a lot of money from it. It’s a huge commitment for the supplement companies to do this.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Absolutely. It’s hard to patent three-day-old broccoli sprouts, but you can grow Brussels sprouts. You can take mason jars; people can look online; and you can take canning jars and mason jars. You buy the seeds, and you grow them with a little bit of moisture, like a wet paper towel. Three days after they sprout, you throw them in your salad, and you do it again. That will help those genes. But there’s another piece of genetics that, when you’re ready, we should talk about because of the genetics of not just what the mold does to your body and how that interacts with your genetics, but it’s the downstream genetics. For the patients, how are their mitochondria, their inflammatory pathways, and some of their nutrients? Do you want to talk about some of that?

Ann Shippy, MD

I would love to because this is one of the biggest things that I see, especially with neurological issues where there’s been mitochondrial damage that I measure through a lab and that we send the blood to germinate to get the best measurements for that. This is such an important topic for people to heal because when the mitochondria are damaged, it’s hard to get that momentum for the body to do that repair. Yes, dig in.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Okay. I thought I would give an example of two of my favorite mold patients and some of how their key SNPs were different. Their histories sound almost the same, but their solutions differ. So, Judy presented with mold exposure, tons of brain fog, and low energy, and Noreen presented with memory issues when she was near mold. Again, low energy, but more of a post type for people that don’t know; it is when you get low blood pressure and kind of tachycardia and weakness. There were similar histories. They both have significant things in their genomes. But with Judy, when we looked at her genomics, they both have significant things in their genomics. But for Judy, she way overdid TNF alpha. TNF alpha is anything that is like putting an alpha under it. Interleukin-1 alpha is TNF-alpha. It usually is a pretty important pathway if it was named with the alpha kind of think alpha male alpha dog and she’s in the 3.8% of the population that exaggerates, she kind of overturns on that TNF alpha gene. Addressing that with things like lion’s mane mushrooms and magnesium, three was important. But she also had something called CNR1, which is your endocannabinoid pathway. These are lots of big words, but think about it: people know that CBD is a cannabinoid, so endocannabinoids are these receptors in the brain where CBD works, but they also regulate microglial inflammation, which is brain-type inflammation of the garbage collectors. If you’re getting mold in your brain or mycotoxins and you have problems where your microglia are overactivated, that’s important. That kind of particular endocannabinoid is an inflammatory response.

Ann Shippy, MD

Let’s pause this for just a second. Yes, this is important. I think so. I think a lot of people don’t realize that they make endocannabinoids in their bodies, and they think it’s just this plant that’s grown that people make into a supplement or smoke. It does end up being a really important pathway in the body that we often overlook in medicine. What did you do to help her with that?

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

There are a couple of things you can do, diet-wise. Chocolate is good for the endocannabinoid pathways.

Ann Shippy, MD

I know that you’re prescribing chocolate. Maybe that’s why some of them love chocolate so much.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Chocolate and olive oil are some of the best foods. But there’s something called Palmitoylethanolamide that can help to address those inflammatory pathways and kind of activate them. It works well. One of the things about genomics is that you would never be able to evaluate someone’s endocannabinoid pathways from blood because the endocannabinoid receptors are only in the brain, the spinal cord, spinal fluid, and the gut. You could draw the blood, but you can’t measure it unless you’re looking at genetics. That’s helpful. But for her, we gave her a PEA because it also has some other anti-inflammatory effects.

Ann Shippy, MD

I have gotten much more of an appreciation for that supplement in the last couple of years.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Yes, it’s kind of one of those under-spoken or under-discussed supplements. But again, it works on some very specific pathways that maybe only 6% of people have. It’s really powerful. If you’re in that 6%, it might not help everybody, but it did help her. Another one of fun ones that was helpful for me to find out about her was that she didn’t recycle vitamin C well. We have these glutamyl transferases that are kind of the quicker picker uppers, but there are also glutathione works that help antioxidants. Vitamin C is an antioxidant. Glutathione, GSTO1, and GSTO2 work with vitamin C, and if you don’t have those working well, you can’t recycle your vitamin C once it gets oxidized back to an antioxidant. What does that mean? It’s kind of like, if you have a towel and you can’t reuse it, you would have to have a whole big stack of towels. You need more vitamin C throughout the day because humans don’t make their vitamin C; we only get it through diet.

That’s important because vitamin C is one of the cofactors for some of the detox pathways for mold. That kind of thing was important. Then it was also found that she was particularly sensitive to gluten, which can make the brain fog worse, and that she had seven times the risk of celiac. Then finally, she had a gene variant that made it so that her mitochondria got damaged more easily. That outer membrane wasn’t as healthy. For her, it was really important for her to have mitochondrial support. There are a lot of different products that are designed for anti-lipid factors, ATP fuel, KPAX, and things like that. But you wanted one that had mitochondrial lipid factors in it. For those, probably the best study is ATP 360, which has mitochondrial membrane support. Again, what does every mold patient need? Not necessarily. Does every mold patient need vitamin C? No, not necessarily. Does everyone need a lion’s mane? No. But for her, those were kind of the basics of her plan now.

Noreen was the one who was kind of like she was. I first met her when she knew that her house was moldy and that she would sometimes have to lie down when she came into the exam room because she was so lightheaded. She wasn’t really tired, but she would stand to sit with you longer. Her blood pressure would drop. This was interesting because a huge factor for her was pathways related to her mast cells. Do you want to explain what mast cells are to our listeners?

Ann Shippy, MD

Yes. Why don’t you go ahead and explain? You’re doing such a great job.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

I just don’t know if everyone is listening to me.

Ann Shippy, MD

No, no, you’re excellent. I appreciate how you’re putting these pieces together. I’m enjoying listening to your analogies of things because you just have a great way of explaining the information and tying it together. I’m curious how you describe them.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Well, thank you. Feel free to jump in on any of these apps. Mast cells are your allergic pathway, and some people, even if they’re trying to fight an infection, mold, or whatever they’re trying to fight, kind of switch over and start making too much of the allergic pathway. Well, it releases histamine. Think about how antihistamines can make you sleepy, but too much histamine can make you wired, but it can also make your blood vessels more relaxed, and kind of like some people get a bad allergic reaction. They get all red and flushed. Well, if all of your blood vessels start to relax, your blood pressure can drop. It is one of the contributing factors for people who have this type of blood pressure dysregulation. When we have someone like that, the mold is going to trigger it and make it worse if they’re already hypersensitive to that allergic pathway. One of the ones she had was called interleukin 4 and the interleukin 4 receptor. There are many contributing factors. But how do you address it? Well, you can if you don’t want to just give antihistamines. That’s like trying to wrangle the cats after you’ve let the expression come out of the bag; that’s much harder than just keeping the cats from leaving the bag.

Ann Shippy, MD

I love your analogy so much. It’s just so vivid and crazy.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

I’m going to use some of them. I hope that’s okay. I think it’s just over the years. I like to get things to help people remember them, but we gave her tons of quercetin, so you might give someone one capsule of quercetin. She’s on like six capsules of Quercetin a day because Quercetin is a very potent mast cell stabilizer. But it took a lot. We also gave her some gladiolus, and then we used some of the prescription drugs, like Montelukast. She also did not have all the mitochondrial issues, but she had huge inflammatory issues. It was different. It wasn’t TNF Alpha. She had more interleukin one alpha and interleukin one beta, and those two can interact. Sulforaphane can help with that. But curcumin helps to coat the question a little bit. But the other thing that was part of what made her so prone to low blood pressure was some of her nitric oxide pathways. addressing the fact that she wasn’t properly regulating her ability to make nitric oxide, which opens up blood vessels. Part of what made her feel weak was that she was in this really fun one. She was in the top 1% of the population that had this specific gene variant in a gene called ENTPD1. It doesn’t matter what it stands for, but think about ATP and AMP; they’re all kind of related to adenosine monophosphate.

Ann Shippy, MD

Go ahead. Ready to make the energy to do the work that the cells need to do.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

This particular SNPs is associated with being able to store that extra energy in your muscles. If you can’t store it, people studied it in people who are trying to run that have these SNPs, and they like to take ribose before they exercise because it kind of gives them some ability to have a little bit of stored energy. She had it all, and then she also had something called.

Ann Shippy, MD

Seeing some of these implications of her genetics is probably her whole life. She probably didn’t like going to the gym too much or exercising.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

She was not. Yes. You do, kind of, and sometimes I’ll ask someone, Do you get tired with exercise and go? I dig deeper, and they’re like, well, what kind of exercise do you do? Well, I walk well. How far do you walk? They walk a mile. The whole thing is, they’ve learned since they were children not to do that track, not to play softball, or not to play tennis because they don’t have that muscle reserve. They might instead do something like get into music or art, but it gives them the ability to exercise once we understand that. Those genes can also affect whether people tolerate statins. It’s not all about CoQ10, although she also had problems recycling her CoQ10 and her Vitamin E. The reason I wanted to give the comparison is that there are a lot of different pathways, and it’s not going to be found with one or two genes or one or two variants. We can talk about the difference between a gene and a variant. But you have to create a map for the person and go, “What are the things that they have that make them unique that relate to this disease state that are in gene variants that we know are clinically significant? “You can’t just look at a list of gene variants and go, “Oh, well, it’s a variant, so it must matter.” That’s not how it works.

Ann Shippy, MD

Back to the nitric oxide. In addition to giving her the ribose, what did you do to help her?

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Her dysregulation. It depends on which way the dysregulation occurs. If the dysregulation is that you are expanding too much, then you’re going to do that, which would be one thing. But for her, it was that the lining of the blood vessels wouldn’t relax when they were supposed to. That created more brain fog because she wasn’t getting enough blood to her brain. We gave pycnogenol because that will make the endothelial lining of the blood vessels produce more nitric oxide and relax hyperbaric, which is phenomenal for that. Since we’re here dysregulation, It depends on which way the dysregulation occurs. If the dysregulation is that you are expanding too much, then you’re going to do that, which would be one thing. But for her, it was that the lining of the blood vessels wouldn’t relax when they were supposed to. That created more brain fog because she wasn’t getting enough blood to her brain. We gave pycnogenol because that will make the endothelial lining of the blood vessels produce more nitric oxide and relax hyperbaric, which is phenomenal for that. Since we’re mostly adults here, one of the things that not having enough endothelial NOS3 and endothelial nitric oxide creates is that there’s another really important blood vessel that has to be able to fill and relax in men, and that can affect their function as that relates to libido.

If you use Pycnogenol L-arginine in this particular gene in a man that she had two copies of, which is 12.9%, it has been associated with a dramatic, like a five-fold or 400-fold increased risk of erectile dysfunction, and addressing it with Pycnogenol along with amino acids like arginine or citrulline can solve that problem over 90% of the time within a few months. These are really important genes. Mostly adults here, one of the things that not having enough endothelial, NOS3, and endothelial nitric oxide creates is that there’s another really important blood vessel that has to be able to fill and relax in men, and that can affect their function as that relates to libido. If you use Pycnogenol L-arginine in this particular gene in a man that she had two copies of, which is 12.9%, it has been associated with a dramatic five-fold or 400 times, increased risk of erectile dysfunction, and addressing it with Pycnogenol along with amino acids like arginine or citrulline can solve that problem over 90% of the time within a few months. These are really important genes.

Ann Shippy, MD

Yes. I’m sure that there are people in the audience right now who are like, Oh my gosh, I want to do that test. They may not have access right now. Those are just such great stories. With all of these supplements and things that you’ve talked about for solutions, I don’t see any harm in trying some of them. If the people listening hear some relevance to what they’re experiencing, you can do some trial and error, but it’s much more direct if you know your genomics and have something that works silently.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

I think again because I want to be helpful to people who get that if someone wants to do genomics, they can go to Intellxx DNA, which is two Ls and two Xs. Intellxx DNA is that common; they can find a physician or a provider near them that’s trained. But in getting started, I would start with the ones that we know mold is going to affect. We know because the mold itself is going to affect those mitochondria. Use mitochondrial support if you’re feeling fatigued. The ones that some of them have more of are inside the mitochondria; some have more of the mitochondrial membrane that you can support and then use, and things that push the detox are the sulforaphane you can use. Some people benefit from glutathione. The problem with glutathione is that it’s not very well absorbed. You have to use a liposomal, a nasal prescription, or a sublingual. But also NAC. NAC is a really good one to talk about because NAC, which stands for N-acetyl cysteine, will help you make more glutathione. There’s always what’s called a rate-limiting step in chemistry, and that’s like the slowest thing. In bread baking, your rate-limiting step is baking powder or baking soda. You’re not going to get the bread to rise if you don’t have it.

It’s only a small amount, but it’s not usually something you have huge amounts around. Cysteine is the most important thing that we tend not to have as much of in our body for making glutathione. So NAC helps with that. But as a gene regulator, not epigenetics, it also helps you produce more to affect some of the inflammatory and some of the other pathways. It can affect what Sulforaphane does as well; Sulforaphane turns on and off some genes. I would say that those are kind of the big three. Vitamin C is good to make sure you have enough of because it’s part of the mold detox pathways, and after that, you’re right. If you’re having a lot of mast cell symptoms, like tending to flush, you can guess, and you can go, “Wow, I think I have a lot of histamine-type mast cell symptoms. Maybe I’m going to try adding quercetin. You should know that quercetin is a little bit of a blood thinner. If you go too high, be careful that you’re not getting bruises or anything.

Ann Shippy, MD

Beautiful. I love that. Another area that I find super helpful with my patients is looking at their methylation genomics. Let’s spend a little time on that too, because I know that’s an important part of what you do.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

So in MTHFR methylation genomics, people think of that as kind of one of the ultimate epigenetic regulators, just because the ability to put a methyl group on something will turn off different genes. That’s part of it. But it’s also really interesting because the methylation pathway, which relates to homocysteine levels and all these other different factors that relate to making SAME, feeds into our ability to make our brain chemicals, serotonin, norepinephrine, and dopamine. Those do important things like serotonin. It makes you feel happy when you’re holding a puppy. Norepinephrine is energy, motivation, and concentration, and dopamine is pleasure. Kind of more like the kind of pleasure you get when you’re achieving something, like when you win a video game. If you don’t have a good ability to turn the folic acid from your food into methylfolate, you’re not going to make your brain chemicals either. But it also feeds into whether you are going to be able to turn off other important genes and help with gene regulation. There are other parts of the methylation cycle. One, for example, part is a gene called CGL; it’s right below that homocysteine gets converted by CBS to cystathionine.

Well, why do we care about that gene? Well, if you can’t convert your homocysteine into cysteine, then you’re going to need that NAC because you’re not going to have any of the cysteine ultimately needed to make your glutathione. Some genes related to ADHD are involved in that methylation cycle because they can affect your ability to kind of repair your DNA and have other enzymes, and that can affect concentration and your ability to make something called methionine, which again is key as the kind of beginning step for turning on a bunch of enzymes like CompTIA. It’s the true methylator. The methylation cycle is pretty popular. I think that MTHFR got kind of a bad rap as one of those dirty genes, and I don’t think that I would label it as a dirty gene as much as it’s an important gene, but it’s still just one piece of the puzzle, and it’s not that big of a deal for people with one copy of it; 47% of the population has one copy, but with two copies, it does become a big deal. Then you go: why has it gotten associated with depression, and why has it become a bigger deal? I think it’s because we started putting folic acid in our breakfast cereals and our food supply, and so people who weren’t good at turning folic acid into methylfolate became even worse at getting methylfolate in their brains because the folic acid kind of gummed up the transport pathways to let them get into the brain. You are already low. That makes sense.

Ann Shippy, MD

Yes, that makes a lot of sense. It does show the natural consequences of some of the decisions that were made in our food industry causing more harm than good sometimes.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Yes. Unintended consequences are a big factor in the world.

Ann Shippy, MD

What I love about this, methylation pathway is that it’s so great to look at the genetics and be able to measure in the lab so many different aspects of the pathway to get a feel for where it’s getting challenged and not fully flowing. I think of it as a series of cogwheels that are all working together and passing things along, and it does make such a difference to get it flowing smoothly and how well the body can repair.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Ann. It’s important also because, again, some of the pathways, if you have problems with them, like MTHFR methylfolate, are going to be an important supplement, but depending on where in the MTHFR genes, like which variants, some people know the numbers, like C6770, that one is right in the riboflavin binding site. If you have that one methylfolate, riboflavin can help, and for some of the other ones, you only need methylfolate. But then other genes are B12 and B6-dependent and are in that methylation cycle. You could just take everything, but the problem is that other ones respond better to fulimic acid compared to methylfolate. You can take a kind of shot-in-the-dark approach, and you will get some benefit. Some good products have a little bit of this and a little bit of that. There’s a methylation supplement called EndLighten that has some good studies, and depression kind of puts a little fulimic, a little methylfolate, B12, and B6; there’s one called neuro-nutrients that would support that. Also, ads like precursors for serotonin and some saffron. There are good combination supplements, and you can just take a shot in the dark. But sometimes, if you’re having some chronic illness or you’re having severe problems with your health, the more information you’re going to get, the tighter your protocol can be. If you’re having cognitive decline, the mold may have kind of brought it out. But you want to understand the components of it because the mold is just kind of making you realize that you have some gene variants that can be problematic later on. I didn’t talk about that with Judy and Noreen, but Judy had a variant that gave her 3.4 times the risk of Alzheimer’s. Then Noreen had a different one that affected her. Judy’s was that APOE4 with the mitochondrial stuff. Noreen had a different one that was microglial but also had almost four times the risk. They’re getting their brain fog early because the mold is causing all this inflammation. You want to understand it because that can be not only your ticket to helping you heal from the mold—of course, getting out of the mold is important—but also to come up with a plan to keep your brain healthy for years and years and decades to come. That’s super important.

Ann Shippy, MD

That’s another thing that I love about your work because a lot of people are checking those APOE genes like that. It’s part of the Boston Heart, and in so many places, they’re doing it. But then people are just left with the fear that they’re going to get the disease. Share a little bit more about your thought process on that and how this approach can really put people at normal risk, or maybe even less, by taking these actions. Because I think about it, they’re actions that you can take that probably reduce your risk.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Absolutely. APOE4 is thought of as the Alzheimer’s gene, and that particular variant is found in about 22% of the population. First of all, it only explains 40 to 60% of people. Only 40 to 60% of people who get Alzheimer’s have that gene. There’s a lot more to it. But you can have APOE4 with genes that lower your risk or ones that increase your risk. By addressing the whole picture, you can improve your cognition. I always say that APOE4 is either too much information or not enough. The reason is that if that’s all, it’s just going to be a fear tactic. But when you have it combined with these different things that can either cut your risk in half or increase it even further and how you can address those different particular risk factors that you have or those variants that have been associated with problems with cognition, then it becomes empowering. That’s what we’re trying to do at IntellxxDNA: give patients and clinicians a map of empowerment. Dr. Dale Bredesen, whom a lot of people in the cognition space are very aware of, uses our genomics as part of his research. There’s a publication that was in the Journal of Alzheimer’s last year, and again, if you read it, they’ll talk about using genomics to help add further specificity to their decision-making.

That’s our genomics. It’s also being used in other memory studies and a very large study that Dr. Bredesen and his colleagues are doing now. It’s the same thing. It doesn’t matter whether it’s a child with autism, a young adult with anxiety, or a senior who’s starting to know that their memory is going. Brain science is hard without genomics because of the blood-brain barrier. You can check things in the blood, but we purposely have differential tissue expression, and what that means is that if you turned on 25,000 genes in every cell in your body, you would be a mess of chaos. We have different things going on in our brains and our blood, and we have to keep them separate. When you do a blood draw, you’re only doing a blood biopsy. What would it take to get information about the brain? The easiest, and this is not easy, would be a spinal tap. At least you get the fluid from the brain. But it takes a tissue—a brain tissue biopsy. Well, that is clear. We don’t want to do that. We don’t do that. Know some things you can get from the blood because they cross the blood-brain barrier and kind of seep into the blood. But even for something like TNF Alpha, the levels could be 40 times higher in the brain than they are in the blood. Genomics is helpful with lots of chronic diseases, but particularly anything in brain science.

Ann Shippy, MD

We’re in an autism epidemic. When they were comparing the 2018 to 2020 numbers just a couple of months ago, it took a couple of years to get a couple of years behind. It seems to me like that’s as big of a news story as the pandemic that we just went through. I think it’s like one in ten boys now is somewhere on the spectrum. We know for sure that autism has a moldy influence. I know that you’re working with some practitioners in the autism space to dial in how to help these kids reverse their autism symptoms, not just Band-Aid things, but help them recover, and I’m so excited about that. If you want to just spend a minute on that, that would be great.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Yes. We now have practitioners trained in over 30 states, plus we have people doing telemedicine, and we have a couple of publications in the autism world. I would say that one of the reasons that I’m not yet ready to retire and that I keep going is partly our autism work. That has been the most fulfilling for myself and my co-founder because children’s brains are very plastic. When you have a child, a lot of children with autism start out developing neurotypical behaviors, and then around two or three, they start to regress. When you have a child that is especially in that category of autism, which is the largest group of people with autism, if you can figure out what’s going on, some of the same things we talked about are the detox pathways, the inflammatory pathways, the mast cell pathways, and the nutrient pathways. But then there’s also, for all of these disease states, very specific pathways—specific ones for Alzheimer’s, specific ones for autism. If you can figure out that some of them are mitochondrial, some of them have to do with how the brain scaffolds. Think about scaffolding on the outside of buildings when the brain is being developed. It has scaffolding issues.

If a child has scaffolding issues and one of the things that scaffolding needs is because you’re having problems where you don’t have enough of that scaffolding, protein one, called SHA-3, is zinc. Well, then you can give them much more, and you go. Well, why has autism skyrocketed? Well, it’s a mixture. Nutrients: people used to eat things like organ meats and liver that were high in zinc, but now they don’t. People have lower zinc, lower omega-3s, and different nutrients in our soil. The bread conditioners that are being used affect the ability of other nutrients to be active. But also, the addition of the pesticide glyphosate, which is rounded up and sprayed on their crops, causes an autoimmune disease that triggers more inflammation because it makes the gut leakier. All these factors, and so the autism work, are no different than what we’ve been talking about, just a different set of genes. You take a map, and you just slowly start addressing it. What can we do for gut inflammation and detox, but also for specific genes associated with neurodevelopmental issues? We’re getting outstanding results. There are a couple of papers on the web page, but there’s a lot of work ongoing, including a couple of studies.

Ann Shippy, MD

That just makes my heart so happy.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

We just trained a group of pediatricians last weekend, and they were sharing their own stories. The cool thing is they were saying they’re now using this on all the kids in their practice. It’s even the kid who’s, as my co-founder said, just being a butthead. It turns out that when you address their genomics four weeks later, they can be completely pleasant. The child is having some mild oppositional defiant issues, anxiety, or depression. A lot of times it can be fixed by understanding what nutrients they need, more of which neurotransmitters they don’t make well enough, and with no prescription medications. It’s not just about autism; I think it’s that we wish that our children and we came with instruction manuals. But our genomics is our instruction manual.

Ann Shippy, MD

That’s why I’ve been such an early adopter of genomics. I began doing genomic testing almost 20 years ago. Every time a new company came out, I would try it out on myself to see how applicable it was going to be for my patients. Some of the early things were super helpful, especially around some of the methylation genes, the glutathione genes, and that kind of thing. But when I did my Intellxx test, I was like, Oh my gosh, this is like a library. That explains why I’ve had autoimmune disorders and neurological impacts from mold, celiac disease, and all the other things, and it’s made me feel so empowered to know what the priorities are in the supplement protocol and lifestyle protocol. Personal thanks to you. But then I also just saw it. Thank you for really helping my patients.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Thank you. That’s what we’re seeing. We just built this because it was a tool that was needed. People like you and me get the patients that are in the medical mysteries because if they were easy and the kind of protocol fixed them, they wouldn’t be going to somebody who has integrative or functional medicine training, and we’re also very empowering because when you find out, okay, the reason that you had a bigger inflammatory reaction and that you got brain fog after this infection is because you are in the 4% of the population that over makes this basically chemokine enzyme, an inflammatory enzyme that destroys tissue. And so we need to bring that kind of brain inflammation down. It not only helps them get well, but it also gives them a different understanding of themselves. I had one patient; she’s almost 70 now, and she came to me for some issues like migraines and depression. We’ve untangled them all, and she’s doing great. But she had a lot of different gene variants that related to her depression, some with her gut that related to migraines, and all these things. 

She told me that when she was a child, she was constantly told to just get over it. She understood that she couldn’t make enough serotonin, she couldn’t make enough norepinephrine, she made too much cortisol, and she couldn’t recycle it, just like in the perfect storm. She used to hate Christmas because winter was that bad. That was partially because she had some genes where the seasonal affective disorder would have been more of an issue. She’s like, Not only have you given me back the ability to celebrate Christmas and enjoy it with my children and grandchildren, but I now can go back and forgive myself and go, “Gosh, I didn’t do anything. I wasn’t being a bad kid because I was depressed. It was because I didn’t understand what I needed to keep myself healthy.” I think that was very empowering to be able to do that.

Ann Shippy, MD

That’s a beautiful story, and that leads into all kinds of other conversations that we’re having in the summit around trauma, our inner voice, and those kinds of things that play an important role in healing. One last question, and that is rescue. When you get mold exposure, I think you have some thoughts on how to get yourself back to a baseline.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Yes. The first thing that you and I probably spend more time than we would ever have imagined that we spent is getting out of the environmental exposures. I mean, sometimes it takes a long time to convince somebody to get out of your home, and if it’s moldy and that’s super important, if you’re at the point where emotionally you can’t kind of do it right, then go and find a friend to stay with for a couple of weeks, go to an Airbnb, go on vacation if you feel better, and that’s giving you important affirmation. Getting out of exposure is important. Doing what you can with food and lifestyle is important. Sauna helps with detox, so sweating is good for detox, and then start with those basics. I can’t give medical advice to anyone but my patient.

But I can tell you that in studies in general for using something like sulforaphane, like in what the AMA calls studies of children and young adults, they went up to full-size people because they were looking at boys that were 18 years old. They took one of the pills the AMA calls for per 30 pounds of body weight. That gives you an idea. But so you’re not going to take one pill or something, and you’re going to be fine with mold. Talk to your doctor, particularly someone trained in integrative or functional medicine, and look at what you can do. First, start pushing those pathways that we know. That’s why I said that. Nrf2, the detox pathways, sulforaphane, glutathione producers, and mitochondrial things start with that, and then you’ll have to either get genomics or experiment because there are so many diversions. Do you need more of the mast cell? Do you need more TNF-alpha? Do you need more of the IO1 Alpha? Do you need more choline for brain repair? There are some people who, if you’re getting a lot of neuropathy symptoms within weeks, talk for hours. Some people do much better with neuropathy using high-dose B12 and fulimic acids. But again, it would be great if you could have somebody trained in this area. For any physicians listening or anyone who wants to be trained, please reach out. We’d be happy to train you. We have a mentoring program. If you have a patient you want to get started on, we will give you our training and mentoring program with your first patient because we want you to do well. It’s more about helping more people. I think that we just need more people, and you’ll find it even if you are just kind of beginning your integrative or functional medicine journey. We can help you with genomics because it’s going to give you a map. I think that’s the thing: if you’re interested in this field as a health care provider or a patient, this is where we need to move medicine because it’s just the best tool.

Ann Shippy, MD

It’s one of the best tools for getting at the root cause and then finding solutions to help the body heal and stay healthy.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Yes, but I’m just saying we need to move medicine, in a broader sense, to not thinking about a disease state, mold-related illness, depression, anxiety, or cognitive decline, but thinking about, “Okay, why is this person reacting to mold and their husband is not? “That is where personalized medicine can help—understanding why one person reacts and the other doesn’t and how to get that person well.

Ann Shippy, MD

Beautiful. Well said. Amen.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Thank you.

Ann Shippy, MD

That’s I think that’s a great place to wrap up. But I want to make sure that people are clear on where to find you.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

The hardest part is the spelling. But it came from an intelligent approach to DNA. It’s intellxxdna.com. The two X’s are because myself and my co-founder are both women.

Ann Shippy, MD

I do know that piece.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

That’s why we thought about calling it two dumb Chick’s DNA. But I didn’t like that name. 

Ann Shippy, MD

Just the way you brought your vision to life and the number of people who are benefiting from all this hard work that you’ve been doing to make genomics highly actionable—it’s such a gift. Thank you so much for really making this come to life.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

Well, you’re very welcome. It has been the most satisfying part of my career to be able to use the site to merge the science knowledge, medicine knowledge, genetics knowledge, and all these other things that were part of my life and my training and bring them together to make something that people across the country and the world can use. It’s been my pleasure.

Ann Shippy, MD

I  think it gives a lot of hope.

Sharon Hausman-Cohen, MD, FAAFP, ABIHM

I think. Sam, thanks for having me.

Ann Shippy, MD

Thanks for being with me.