Mycotoxin, Mold Related Illness Diagnosis, Treatment

Jill Carnahan, M.D.

Thank you so much for having me. I’m so excited to be here with you and to talk about my favorite topic.

Nafysa Parpia, N.D.

Great, so let’s start by talking about how you would first assess if a patient who enters your clinic has mycotoxin or mold illness. I know that it can be a confusing thing for patients. So how do you begin?

Jill Carnahan, M.D.

You got it, so, if there were one, I always get the question if there’s one test for mold, what is it, and people ask on the blog, and ask on all places, and there’s not one test and I’ll explain how we assess. But before I do, I wanna tell you just a tiny bit of background. We are both traditionally trained. In medical school, we’re just not taught that mold is a systemic multi-symptom, multi-system disease. We’re taught it’s an allergen. And we really, a lot of the stuff we’ve learned in the last decade or two was not part of traditional medical education. And it’s sad, because there’s so many people really suffering from it. Now a lot of this stuff we’re talking about, it’s very science-based, but we’re kind of on the cutting edge of what’s possible with healing and diagnosis and treatment, so things are constantly changing. 

So today you’ll hear this and we’ll give you the very best science that we have, and it might change in a month or two, but the basic principles are the same. So diagnosis and treatment. Basically diagnosis, you’re gonna look for inflammatory signals in the body. What happens with mold is mold, not only as an allergen as we were taught in medical school, but it also causes a systemic cytokine response in the body, and there is a difference with genetics. There’s a portion of the population that has more trouble tagging and identifying these toxins and getting them out of the body. So for that reason, those subset of patients, around 25% of the population, they’re going to have more collateral damage in their body. And it’s not just from the mold, the mycotoxin, the spores, the fragments which are all part of this picture. 

We can think about it as like toxic soup in a water damaged building. And the more data that we’re finding, it’s not just mold, it’s not just the toxins they produce, which are called mycotoxins, but it’s also bacterial, and endotoxins, and other fragments and things that are in the soup that cause an inflammatory reaction in the body of someone who’s susceptible. And I just frame that, because as we do lab testing, there’s no one test, I wish there were. So what I start with in clinical practice is a great history. I ask very specific questions about symptoms. We can talk about that in a few minutes to classify if they have a lot of symptoms that relate. And in order to be diagnosed with a chronic inflammatory response to mold, you have to have multi-system, which means like the brain and maybe the heart, maybe the lungs, maybe the kidneys or bladder, so mold or skin, you have multi-system, and multi-symptom more than one symptom in each category. 

So it actually crosses over into a lot disciplines, because you might have rheumatological arthritis. You might have brain dysfunction, early onset dementia, memory issues, executive cognitive function difficulties, and you might also have a wheezing, trouble breathing, cough, shortness of breath, frequent infections, skin rashes, and I could go on and on, but these things, as you can tell, they’re multi-system, multi-symptom. And that’s where we get into how diverse this is and how difficult to diagnose. So the very first thing, like I said, is a good clinical history. Those of us who do mold-related illness are well-trained to ask good questions. And I would say by the time I’ve talked to a patient, given them plenty of time to tell me their story, I am with about 99% certainty accurate on the diagnosis of mold versus not. 

And then I prove it with the test that I’ll tell you about. Then what we do, what we do visual contrast testing which tests the visual acuity of the retina. These are some of the smallest blood vessels in the body. And the reason this is important is because cytokines that are created by the mold response damage and cause inflammation and leakage to blood vessels. And so we can actually measure that damage with the visual acuity testing. This is scientifically-based. It’s been used since the 1940’s in the Armed Forces to determine if they were susceptible or if they were exposed to biological warfare agents. So it’s not just for mold, it’s for any biological toxin, but if they have a positive history and then they have an abnormal visual contrast test, those two things are free. 

So right now I’ve come to a pretty good conclusion with spending no money of the patients or of my own. And then the next things are testing. So if those are both positive, I usually do proceed with testing. Blood work is important to me, not all doctors do it. I do like to do the chronic inflammatory immune markers. And some of those include the HLA typing for genetics. VEGF which is an inflammatory marker. MMP9 which can relate to blood-brain barrier permeability and lung damage. TGF beta, which is a trigger for immune arm called Th17, which can cause more autoimmunity in the patients. Antidiuretic hormone and osmolality which determines if they’re able to regulate the salt water balance and volume in their hydration status that’s often affected by mold. And then sometimes we’ll test VIP. I don’t use that as much anymore. And there’s other markers like antigliadin antibodies and autoantibodies that may indicate there’s a permeability, a barrier breach in the gut which is also really common. 

One final one that’s very common is MSH which is Melanocyte-stimulating Hormone and this is related to all of the hypothalamic pituitary axis. It’s one of the grand regulators, so if this is off, the hormones can be off, the adrenal function can be off, the thyroid can be off, your hydration can be off with ADH, your oxytocin can be low, so you’re isolated and antisocial. So a lot of things are affected by that. Those are blood labs. Now none of those are specific to mold. So really important to know that just because you have a positive or an elevated TGF beta or an elevated MMP9, that’s not diagnostic for mold. But if you’re a good clinician, you can look at the patterns and see many of those things abnormal in the case of someone with a positive history of exposure. And then the next test that I’ll do is urinary mycotoxins. 

Now this in our world of physicians that have been trained is somewhat controversial. I find it incredibly helpful as long as you know the lab, the technology, and what you’re doing. There’s three labs that do this testing right now. One is Great Plains, one is Realtime Labs, and one is Vibrant and there may be more coming. Right now, those are the three that I know of. I use them all. I do have my favorites which I won’t necessarily mention here, but they all have their advantages and disadvantages. All this is an excretion test of mycotoxins. And that’s important to know, because say you test in the beginning and you’re trying to figure out a cause and you have some excretion of okra toxin or of trichothecenes. 

You know this person has probably been colonized or exposed on some level. And again, I’m talking, you could be have colonization where they actually have internal growth or biofilms in the sinuses, in the gut, or you could just have exposure where there’s no colonization. But when that happens, then the next step is to determine what’s going on with our detox, because you’re measuring excretion. And if you repeat the test in three months or six months, and you’ve just put them on an intensive detox, those levels are probably gonna go up as they should. 

So it’s really critical when you’re working with your doctor to make sure that you know the timing, because just because you go on a detox protocol and those levels get elevated doesn’t mean you’re getting worse. You have to remember it’s excretion. Those are some of the main things. Environmental testing is a whole ‘nother aspect. I’m sure you’ll have experts on the summit talk about that, but I can’t not mention it, because you’ve got to remove yourself from the source if you do have a mold exposure. So working with an environmental expert to measure the environment and either do dust sampling, air sampling, or both is also really critical.

Nafysa Parpia, N.D.

That’s great, thank you, Dr. Jill. We do work in such similar ways. Those are the same tests I run as well. One thing I wanna ask you about is the crossover that you see. So then now you’ve done, that would be like the Shoemaker initial, the Dr. Shoemaker initial panel, you’ve done that. And then you talked a little bit about genes. I’d love to hear you talk more about that. Do you find that patients with mycotoxin illness tend to have other snips, like in their snips in their genes of detoxification or even in cognition? I’d love to hear what you have to say.

Jill Carnahan, M.D.

Oh, love it. Now I could spend two hours on this, right? But I’ll talk about some of the common ones that maybe your listeners have heard about. MTHFR is the popular kid on the block. Most all of us practitioners and patients have heard about this. This is the methylation gene. There’s many, many more. There’s MTR, there’s MTRR, there’s FUT2 genes. And these are all related to B12 and folate metabolism and actually the end product here is glutathione. So the reason it matters is these methylated Bs and the methylated donors will actually contribute in the metabolic pathway of methylation to number one, repair DNA from damage, number two, it also prevents cancer. Number two, create neurotransmitters. 

So all of our neurotransmitters that we need to think, and be happy, and sleepy, and all those good things are created by methylation processes. And then detoxification and immune function are also critical here. So as you can imagine, that’s one reason why this is so popular, because it really encompasses a lot of things we need to do. So one of the popular ones, MTHFR, if you have variations in C677T, or A1298C, these can impair, so instead of being 100% activity of this genetic process, you might be down by 30%, or down by 80%, or 90%. So usually two copies you’re down in the 10 or 20% of activity. 

So what that means is that process for you takes a little bit more effort and definitely requires higher levels of donors. So I don’t treat people based on MTHFR, but what I do is take it into account when I’m giving them a methylated B and I may support more methylated Bs with an MTHR of our person. Now the caveat is if they come in, they’ve just been in a multi-building and their toxic load is over the top of the bucket. They’re spilling out with symptoms. If I put them on five, or 10, or 15 milligrams of methylfolate, oh gosh, beware. They will probably crash and burn like crazy.

Nafysa Parpia, N.D.

Tell me about it, yeah. Happens all the time, yeah.

Jill Carnahan, M.D.

‘Cause what happens is they’ve been under-methylating and it’s actually protective, because when they start to rev up that methylation, they’re gonna massively go into detoxification which is what we want, but if we push it too quickly, I just saw a patient the other day who by another doctor who didn’t really understand giving them 15 milligrams of methylfolate, L-methyfolate, and they crashed. And again, it’s a great thing eventually, but you have to do it in relation to their ability to keep up with that. It’s like, I always think of it as taking an old 1950’s Model T or a pickup truck and racing at a hundred miles an hour around a NASCAR racetrack. It’s gonna shake, and rattle, and roll, and pieces are gonna fall off. And that’s such a good analogy, ’cause you’re pushing something that is not capable of going that speed, so that’s important, MTHFR. 

Another one common is COMT. This one is related to breakdown of estrogens, and norepinephrine, and epinephrine, and some of the adrenaline hormones. The reason this is important is if you have two copies, we call them comp-T positives. I’m one of those, you might be too. And we tend to be driven, and do lots of things, and have lots of energy, but the downside here is if this is impaired, you’re gonna produce a lot of taurine and cystine and you’re gonna produce a lot of sulfur metabolites that can cause pain and inflammation. One of the little tricks here is meladinine can really help that detox pathway. And the other trick is if you give something like quercetin which we love, it’s a poly, is a flavonoid that’s anti-inflammatory, anti-histamine, it could actually inhibit this pathway in the comp-T positive, so you have to be careful of who you’re giving it to. 

The big thing about this is it breaks down estrogens. So for men or women who are in mold, they already have aromatase up-regulated which makes excess estrogens. So women will have endometriosis, fibrocystic breasts, painful, heavy periods, all of these symptoms of estrogen dominance. And men may have man boobs, weight gain around the middle, lack of sex drive, decreased muscle mass. And this is common in mold where that up-regulation takes all the testosterone from men and women and makes it into estrogen. And that’s doubly magnified in a problem when we have a COMT issue. So these are things to be aware of. The other real big ones are GSTP1s and twos, and those are all in relation to glutathione production. 

I think it’s GSTP1 that’s on the mucosal surface of the lungs. I have this one, so it’s particularly problematic for people who breathe in and inhale mold, because, for example, when I was in the worst of my mold, I looked like a smoker with a COPT kind of picture, because those interstitial places in my lungs were inflamed and there wasn’t enough glutathione naturally, because of the gene mutation to actually fix and repair. Now I think they’re back to almost normal, but it took four or five years and I probably still have a low level of lung inflammation that would look like, I’ve never smoked in my life, not even one cigarette, but my lungs would look to a doctor like someone who had been a smoker, because of that lack of glutathione in the lung surface and then the exposure to mold. So those are just a few of the genes, but some of my favorites. Is there any other ones you wanna talk about?

Nafysa Parpia, N.D.

Well, thank you, Dr Jill. I find that piece just so important is how we can we look at the patient truly holistically and where their triggers might be. So on a similar page to that, tell me about other infections that you find. We spoke about crossover of genes. How about crossover of other infections?

Jill Carnahan, M.D.

I love and I knew you and I would think so much alike, ’cause we just flow so easily, because I always talk about functionalists and as I’ve been, I’ve been doing it almost 20 years. It’s not like it’s been a long time like you. And one thing I always think about is if I simplify functional medicine down to the patients that I see, what is the thing all across the board for nearly everyone that comes in my office and it’s always a toxic load and infectious burden at the core. And I say always, there’s probably a few caveats of maybe a weird genetic issue that’s not related, but most of the time, 99% of the time, this is the case. And the reason that’s important to understand is we’re always framing things in that toxic load. 

So mold is part of that, heavy metals are part of that, phthalates, parabens, organophosphates. I could go on, arsenic, cadmium. I could go on and on about the toxic load and that’s continuing to increase in our world unfortunately, just like exponentially, and it used to be when I started practice with functional medicine, someone would come in with a thyroid disorder, we’d fix them. Three months later, they were fine. They didn’t come back, because they were great. Now the complexity and the chronicity of our patients is much greater. And I believe that’s related to our increasing environmental toxic load and stress levels. So toxic loads are one thing. And then your question was what about infectious burden? And these go hand in hand, because what happens is you might have gotten, like me, I grew up in Illinois farmland, and we went hiking in timbers and got tons of tick bites. So you might’ve gotten bit by a tick as a child and those infections, Borrelia, Babesia, Bartonella, et cetera, are lying dormant, because a good immune system is your best defense. 

Not everyone who has Lyme needs treatment. And there’s tons of thousands of people walking around that if we test them all, they would come back positive for Western blot for Lyme, but they’re fine. So then what does, what makes a difference of those who need treatment? And what happens is especially in a moldy environment, most of these molds have a very powerful immunosuppressive effect. They are some of the worst toxins in the universe. Trichothecenes which are from stachybotrys and chaetomium, these are used as chemical warfare agents. They’re being studied for their effects on nefro, toxic to the kidneys, toxic to the brain. Very, very toxic to the immune system. 

Another metabolite called mycophenolic acid is used to create immunosuppressive drugs. Same with gliotoxin, so we know these toxins. This is in the literature, this is nothing new. And when we get exposed to them, I think of it as a limbo bar, the limbo bar drops, and all of a sudden old viruses which we can talk briefly about, old tick-borne infections, they will start to pop up and manifest symptomatically. So your question here is like which came first, what do we do? I like to frame it in the inflammation, the mast cell activation, the stuff that creates this really, really difficult to treat scenario needs to be calmed down a little bit first and addressed. And then next you have to get them out of the mold or the toxic exposure, because those infections are important. But if you start firing guns at the infections, because of the dead and dying debris that it’s created, it’s like shrapnel, you’re actually creating a greater toxic load and they’re already overloaded. Their bucket is spilling over the top, it’s full. So I think you have to kind of go in that order, but most of these patients have underlying infections as well.

Nafysa Parpia, N.D.

Yeah, Dr. Jill, we treat the exact same way. I just love talking with you.

Jill Carnahan, M.D.

I know.

Nafysa Parpia, N.D.

Same language, exactly. So tell me about what you use to calm down the immune system first, you were talking about that. Oftentimes, I’ll use peptides, I’ll use TB4-Frag, BPC-157. I’ll also detox and put them on a big mast cell activation protocol before I’ll even start to treat the infection, before I’ll even start the detox. So calm the immune system down first then I’m gonna start to pre-tox, give them some support to detox. Then bring the toxin load down before I even start to kill the infection. As I’m killing the infection, I’m using the peptides to modulate the immune system and I have a feeling you’re doing the exact same thing. I’d love to hear about how you do this.

Jill Carnahan, M.D.

I love that and you’re so right. I remember an interview we did a while back and I just loved your, how you were talking and really on the cutting edge, ’cause most people know about MCAS, but they’re not using peptides. And as we were talking, you’re just like me using all the tools in our toolbox, ’cause we need them, right? Like we so need them, so I completely agree. And usually what I’m doing is assessing where they’re at and it’s funny, because I love supplements, and nutrition and that, but I’ll often give them things like drink mineral water. It’s so simple, but it alkalinizes the body, or even alkaline water if they have a filter or can buy it, and that tends to be better between meals. Doing Epsom salt baths routinely. 

Doing something like dry brushing, so that they’re getting lymphatic stimulated or lymphatic drainage remedies. I’m a huge fan of infrared sauna, of course. So some of these things are just like lifestyle principles that they’re setting up the foundation, so that they can excrete. And I always talk about with toxins, you need to mobilize the toxins and then excrete them. And I find it easy to mobilize. We can give glutathione, we can do binders, we can do, mobilize easy. Excretion, there’s a limiting factor of our patients and whatever the limiting factor is like their kidneys, or their lungs, or their skin, or their bowels, you cannot push it faster than their excretion. So it’s very common to see practitioners that maybe don’t know any better and are pushing the mobilization of toxins really heavy. 

Just like I mentioned with the MTHFR, if you push too fast, you can mobilize these things, and they have nowhere to go, and that patient gets very sick. They can really crash. So I always am thinking about those two things. So as we’re talking, we’re saying, how can we get excretion ramped up? And I love your word, this is from you, I’ve been now using this and give you credit. It’s the pre-tox, I love the pre-tox, because that’s exactly what we do is that pre-tox and how do we get that mobilization. Now even sauna for a lot of people can be too much. So I might start at a hundred degrees for five minutes, like really tiny little bits and they’re not sweating. That’s an autonomic dysfunction. It’s autonomic issues that have to be addressed as well. So like you said, supporting the peptides are so powerful. 

I love that we have that tool right now. Hopefully we’ll continue to have that accessible. And then the mast cell stabilization, some of my favorite things, and I’d love to hear if you have any others. Quercetin’s standard except for maybe the COMT people. Chinese skullcap, I really, really like. Perilla seed is a good one. Bromelain, nettles, and sometimes I’ll use things as simple as teas, even hydration. Water is the number one anti-histamine and it’s so simple, so if people are dehydrated, because they have a antidiuretic dysfunction, just hydrating them is a big piece of the puzzle. And that can be tricky if they’re drinking and peeing which is common with mold-related illness. Any comments on that or mast cell, ’cause I think that’s actually really important piece of that.

Nafysa Parpia, N.D.

I think that’s a huge piece. So most of the time our patients, their mast cells are on a hair trigger. So anything is just gonna trigger that off. They’re gonna release histamine and 500 other chemicals actually that the mast cells release. So I find that Ketotifen has been really, really helpful. Most of our patients, they have insomnia as well. So the Ketotifen is gonna help put them to sleep. And that’s the one I noticed gives the biggest calming down. Of course, I’ll also give them Allegra, and Singulair, Cromolyn, but from the compounding pharmacy, because oftentimes our patients are gonna react to the fillers and the colors from just the over-the-counter medications. And so when those medications are pure, I’ve seen them really, really work wonders, change people’s lives, yeah.

Jill Carnahan, M.D.

 And it’s not uncommon if you’re listening to this, to need two, three, four, five layer, the layer to purchase is really important. You think, okay, maybe one thing, and these patients, they often need a multi-layered and those drugs are absolutely H1, H2 blockers, mast cell stabilizers. I find I need often all of them plus herbs.

Nafysa Parpia, N.D.

Yes, exactly, exactly. I tried to get ahold of Rupatadine, but it’s not available in America. You let me know if you’ve ever —

Jill Carnahan, M.D.

I will.

Nafysa Parpia, N.D.

But yeah and I’m also finding Thymosin beta-4 or TB4-Frag is helping to calm down that immune response as well especially when given with the BPC-157. And the great thing I’ve noticed and that I’ve also read in the literature is that the combination of that TB4-Frag and BPC-157 also helps with brain inflammation. So I’d love for you to talk a little bit about that, because as we know, the inflammatory cytokines that come about due to mycotoxin illness, it can cross the blood-brain barrier and our patients have a lot of brain fog and brain inflammation, so.

Jill Carnahan, M.D.

Let me pull up, I just sent this to you. I have a monograph on TB4 and so that TB4, and because it’s right here, if you give me one second, it was so relevant, ’cause I know all these things, but I read them and I was like, wow, that’s such a great summary. I’m gonna read real quick for your listeners, because I think it’s so relevant and it remind us both what all it does.

Nafysa Parpia, N.D.

Yeah.

Jill Carnahan, M.D.

So differentiation of endothelial cells which is your blood vessels. So healing there, growth of new blood vessels. Improves collagen depositions, so skin, and hair, and nails, and everything. Decreases scar tissue formation. Quick little story here. I had a, what they thought was a melanoma on my back last year. It turned out not to be, it was benign, but I had a very deep Mohs procedure, right? To remove that which is like a, just a surgical procedure that takes out a lot of tissue. And they said keep the stitches on for 14 days, then come back, and you might still need them longer, ’cause it was deep and on my back. Five days with TB4 and that scar was beautiful.

Nafysa Parpia, N.D.

Great!

Jill Carnahan, M.D.

I took the stitches out myself, because it was 14 days was my follow-up. So I saw benefits after surgery for that faster healing of wounds which is what I just said. Repair of tendons and ligaments, improve flexibility of joints, prevents formation of adhesions in fiber spans, and muscles, tendons, ligaments. Decreases inflammation, increases muscle growth, increases endurance and strength, relaxed muscle spasm, and improved muscle tone, healing of ulcers and lesions. Here’s the fun ones, promotes hair growth. Protects and restores neurons after brain injury. And the last one, protects the neurons from autoimmune inflammation. So this is a pretty powerful thing.

Nafysa Parpia, N.D.

It is, it sure is. And so speaking of brain injury, a lot of our patients have had concussions or traumatic brain injuries, and a lot of them also have craniocervical instability. So then you put those two together on top of muscle activation syndrome and things go haywire. The mast cells, they start to tenderize the brainstem. And so Dr. Jill, I’d love to hear about your experiences with that, with craniocervical instability, mast cell activation syndrome, that company.

Jill Carnahan, M.D.

Oh, I’m so excited.

Nafysa Parpia, N.D.

ES, pods, the whole —

Jill Carnahan, M.D.

Yes, all of it together. Just listened to a colleague of mine do a lecture. He’s a neurosurgeon, but he does functional medicine in this. And he was talking about, there’s a paper if you guys wanna look it up, it’s free online. “Environmental sub-concussion injury external injury and chronic traumatic encephalopathy”. So what that means in layman’s term is bottom line on this revolutionary article, if you have toxin like metals or something that’s affecting your brain or mold and you get a concussion, the effects are worse, and what the neurosurgeon, he works for the Denver Broncos, he treats a lot of athletes professionally. And what he was saying is he really believes the majority of these people who have the long-term concussive symptoms have previously, prior to the concussion, had a molder tax and exposure that predispose them and the concussion by itself with no toxin or inflammation or autoimmunity may not actually create the post-concussive syndrome. That to me is, like you and I understand this, but to me, it’s revolutionary in this world. A conventional neurosurgeon talking about the fact that what he sees as the worst post-concussive outcomes are those with underlying autoimmunity or toxicity. And again, it makes perfect sense, right?

Nafysa Parpia, N.D.

This is revolutionary to hear a surgeon talk about this, because it is what we see every day, in our practice every day and it’s been my hypothesis. Been my hypothesis of our clinic and of you, I’m sure. And so thank you, Dr. Jill.

Jill Carnahan, M.D.

I’ll send you the article.

Nafysa Parpia, N.D.

Yeah, read that. That’s just even more proof to our patients, right? From what we can tell them what is going on here. Yeah and boy, we don’t have too much time left, but if you could tell me a little bit about how you go about treatment. I’d love to hear about your steps in treatment, ’cause I know it’s multifactorial and timing is critical with respect to treatment. So tell me how you treat mycotoxins first and other environmental toxins as you might do that at the same time as mycotoxins. And then when do you bring tick-borne illness treatment?

Jill Carnahan, M.D.

Yes, I love this. It’s so fun to talk to you.

Nafysa Parpia, N.D.

So fun.

Jill Carnahan, M.D.

It is, it really is. So I’m gonna do kind of the very basic, because honestly, the very basics do work. I mean, we often, we know a lot of the things where there, if there’s little tricks or triggers or MCAS to do, but sometimes the basics and people who maybe don’t have access to a doctor, some of these things, ideally you want a functional medicine doctor helping you, but not everybody has access. 

Number one thing that I cannot say enough, is you have to get out of exposure. This is the hardest thing. And I remember when I first started and I realized someone was in a multi-home and I didn’t always have the courage to say, “You need to leave or you need to remediate.” And I will say, I like if they can remediate, but most of the time it doesn’t work, because what happens is it causes, unless you have the perfect sterile situation. Even in that case, there tends to be fragmentation of these dead mold species that actually just go all over the house. And the micron size of these things can go right into the lungs, into the alveoli, and be directly absorbed into the bloodstream. So what I see most of the time, unfortunately, is after remediation, patients get worse and they get stuck. I wish that weren’t the case. It just is a fact that I see.

Nafysa Parpia, N.D.

Jill, thank you for saying this, because I say the same things to my patients and it’s a difficult thing to tell a patient. I think the best thing for you to do is to move. Clean up the house as best as you can, move, get rid of your furniture, buy new clothing. I mean what a difficult thing to tell patients, but to hear you say that you have to say the same thing to your patients, I’m hoping that the patients listening here today that they understand that this is a real thing and we don’t like to have to tell you this.

It’s horrible!

Jill Carnahan, M.D.

Horrible. I remember like a few years, I would just, and I’d be afraid, and now I’m more bold, because I know that their health is more important than any house.

Nafysa Parpia, N.D.

Seriously.

Jill Carnahan, M.D.

Right? It took a lot more and then just experience now I know that I’m right on. I know that I’m not telling them something that’s like questionable. I’m always certain if I tell them that, but.

Nafysa Parpia, N.D.

Exactly.

Jill Carnahan, M.D.

And I wish it weren’t the case. It’s because and that’s why I’m spending five minutes here is because getting out of the exposure, there’s no amount of binders, no amount of MCAS treatment, there’s no peptide. None of those will touch your illness if you’re still in the exposure. You’ll just continue to go merry-go-rounding.

Nafysa Parpia, N.D.

It’s a waste of time and money on treatment and with us trying to treat you if you keep getting exposed.

Jill Carnahan, M.D.

Yes, yes. And then on the other hand, part of the mold induces brain dysfunction, depression, anxiety, mood disorders, OCD. So this can be, it’s a very traumatic thing. And I’m gonna stop right here and say part of the treatment is treating the trauma. You must treat the limbic system and treat the trauma. There’s programs, there’s binaural beats, there’s traumatic somatic therapies. There’s all kinds of things that you can do, but that’s part of getting well too, because whether you are super emotionally healthy and have done all the work, you will not get well if you don’t de-tag that limbic system trauma, because what happens is when you get the mold physiologically exposure again, maybe you go to a hotel or something, your body feels threatened again. 

And even if, again, you’re psychologically healthy, you’ve done the work, you’re not depressed, you’re not anxious, you’re still gonna feel this limbic activation and you’ve got a de-tag that or desensitize your body to that trigger. So that’s part of the healing exposure, yeah, limbic system, training and retraining, and fixing that part. And I used to say that, because what I don’t ever wanna do is make you more paranoid, make my patients more OCD about it. But there’s like a real fine line, because you have to be somewhat careful as you’re getting well. Now I’m five, six years out from my really bad mold exposure. I can go to moldy hotels. I can and I just still poorly take charcoal. I’m fine in an hour, like it’s no big deal long-term. But that took me a lot of work to get to that point and I no longer, like it doesn’t trigger me psychologically or limbic system wise. But again, I’ve done a lot of work around all those things.

Nafysa Parpia, N.D.

It takes so much internal work. Our patients are warriors for their own health.

Jill Carnahan, M.D.

 Yes, they are.

Nafysa Parpia, N.D.

I tell you that they’re so inspirational.

Jill Carnahan, M.D.

They really are. So that’s the foundation and that’s big stuff I didn’t wanna ignore, but the basics are detoxification, detoxification, detoxification. And the things that you want is you wanna raise glutathione. Not everybody will tolerate glutathione. There’s more snips that cause oxidation. So if you can’t tolerate glutathione which is your probably best bet, you can still make glutathione with NAC, with vitamin C, with glycine, with glutamine, with selenium, with lipoic acid. These are all nutrients that I include most of the time. And again, you have to tweak it a little, ’cause not every patient will tolerate all of them. My first few years of mold, I could not take glutathione, so I got well without glutathione. I just got precursors.

Nafysa Parpia, N.D.

Yeah, exactly.

Jill Carnahan, M.D.

So, it worked.

Nafysa Parpia, N.D.

And maybe patients, they’re gonna crash with glutathione, but if I give them those precursors, co-factors of methylation, they can just start to tap on their own methylation system. And then we can bring them into actual, proper, full-on detoxification treatment. Dr. Jill, tell me about order of treatment with respect to infections. Usually I’m gonna treat mold first, and then tick-borne illness, and then viruses. Before that, even parasites often. So there’s a template, but sometimes the template isn’t the right thing. Each patient is different. I’d love to hear about your order of treatment after detoxification.

Jill Carnahan, M.D.

Yes, I totally agree. Yeah and the one thing I didn’t mention, binders are really critical. There’s so many out there. Everything from zeolite, which is great for metals, to clay to charcoal, those tend to be really good with trichothecenes to the prescription Cholestyramine or WelChol and everything in between, and there’s a lot of options nowadays. And then there’s some new humic fulvic acid types of things that are very gentle. So I often combine, because each of these has different charges, and so they will, the more you can combine and patient tolerates it, the more you can get different affinities for different toxins and really clean out the system. So the glutathione, the binders are core, and then order of operations, you have to calm the system enough to treat. So you have to support that, excretion stuff, lymphatic drainage, sweating. And then I always try to calm the MCAS down and then I try to treat the mold first before I treat infections.

Nafysa Parpia, N.D.

Yeah.

Jill Carnahan, M.D.

Always that direction. And yeah, I would agree. Probably parasites fungal layer before Lyme. And then Lyme is usually towards the end. What I found is there’s a percentage of people that don’t need aggressive Lyme treatment once you get all this layer off.

Nafysa Parpia, N.D.

Exactly, yeah. And same with virus, lot of times, they’ll have a high viral load to begin with, but we don’t need to treat that then, because it corrects for itself after we’ve done that border. Well, Dr. Jill, thank you so much. It’s always so much fun to talk with you.

Jill Carnahan, M.D.

I agree.

Nafysa Parpia, N.D.

We treat so similarly. It’s really exciting. Thank you for joining us. Always a pleasure.

Jill Carnahan, M.D.

So fun to be here. And if you, I’ll make sure and give you all those resources in case you wanna share.

Nafysa Parpia, N.D.

Thank you so much.

Jill Carnahan, M.D.

You’re welcome.

Nafysa Parpia, N.D.

Bye for now.