Uncover The Link Between Mold, Hypercoagulability & Biofilms

Kelly McCann, MD

Hi. Thank you for inviting me. 

Ann Shippy, MD

So excited about this conversation. We got to talk a few days ago and compare some notes and came up with this topic. And I think it’s going to be one of the most important ones of the summit. I was reflecting back about doing this with you. I remember seven or eight years ago you were giving a presentation, I think it was at the American Academy of Environmental Medicine Meeting. You did one of the best lectures I’ve ever heard, and I’ve heard a lot on specifically the way that you did your research to pull together really valid information and then make it so that people could understand it because it was like there were a lot of people in the audience who really didn’t know much about Phosphatidylcholine and then brought it to a clinical level and then made it where we could take action on it. You’re such a rock star and how you think about medicine and applying these new territories to really help patients I just love you so much.

Kelly McCann, MD

Oh, thank you. Thanks. I really appreciate you, too. Thank you for the opportunity to speak and share some of the things that I’ve been excited about so far, though.

Ann Shippy, MD

Yeah, and we’re both we both had our run-through with mold. If you want to just tell a little bit about your background and anything else that you want the audience to know about before we dive in so that they can really know who they’re talking to.

Kelly McCann, MD

Okay. Big picture. I, too, am a mold survivor. In the bedroom there that I grew up in high school was in the basement in upstate New York. I know it was moldy. We had a decommitted for a running 24-seven, so definitely mold exposure there. Fortunately, I didn’t really have any major illnesses. It was just kind of allergies that affected me at that point. Fast forward in my first job out of residency, I was in Oregon, in Western Oregon, and my office was a flat roof building and I’m sure there was mold there. I started to develop fatigue and depression. Felt like fibromyalgia at the time, didn’t know what was happening at all, but managed to move on from that job and do something else recovered and then probably got exposed to mold several other times and then big mold exposure a number of years ago now. I remember talking to you the day that my movers were coming. I was 16 and you’re saying, Kelly, you got to get rid of everything. You’ve got to put stuff in storage. That’s what I did. I got rid of nearly everything. I put many of my belongings in storage, hoping that I could try and salvage them.

Just threw out a ton, moved into a new home. I had to strip down from the clothes that I had used to move, threw them outside, took a shower, and put on brand new clothes that I had picked up at Ross or Target or something like that. I started rebuilding my life from scratch. I had literally nothing and it turned out that all the things that I had put in storage I tried to salvage a year later and it was impossible. I was symptomatic trying to bring those things into the new house. Actually, my husband was too. We have the same symptoms. We were both twitchy when we were exposed to mold and threw them out again. Even last year I had another mold exposure. I feel you folks, I understand. One of the things that I learned is not only to how to deal with stuff but also how to help get people better. Somehow I managed to work through all of those mold exposures and keep my brain and my wits about me, mostly thanks to Phosphatidylcholine, which is just a game changer. Magic. For those of you who don’t know about it, it is the building block of cell membranes and so any mycotoxins, any toxins in general that might be impacting your cellular health, impacting your mitochondrial health because mitochondria are made with lots of cell membranes. Lots of membranes. The mycotoxins, the toxins can be mobilized out of the membranes and you can heal. With my little plug for PC.

Ann Shippy, MD

Yeah, that’s my like if I could pick one thing on a desert island, one supplement I have dropped into me, it would be. PC. Because I know it’s part of why I was able to work through the health challenges as well. I think it really helps to be able to and we’re so lucky that we get to help people every day because it keeps you focused on that. My son, on what you’re going through at the time helps you to make that jump to take it well.

Kelly McCann, MD

Absolutely. That’s my mold history. I don’t know if you have more questions or you want me to answer more.

Ann Shippy, MD

Oh, well, I’m sure we’ll we’ll have some more things to weave in. But I love this topic that we’re going to talk about today, hypercoagulability and biofilms, and how all this fits in together with the other things that we need to address to help people to get well. Let’s start with hypercoagulability, which just means, well you you go ahead and define it how you see it.

Kelly McCann, MD

Sure. It’s a mouthful. Essentially it means increased clotting. If you remember at all from biology, there are two cascades that happen. On the one side, you’ve got what we call the clotting cascade or the coagulation cascade, and there are multiple different proteins and they cleave and cut and make other proteins, and that forms the building blocks of a clot. The molecules of the building blocks are called fibrin. Then on the other side, you have fibrinolysis. We got fibrin sticking together and then fibrinolysis or breakdown of clots. If you think about it very simply, if you cut yourself, you want your blood to clot to stop the bleeding. Then once that cut is healed, you want the body to break down the clot so the blood flow can resume its normal way of flowing. In people who have a genetic predisposition to making more clots, you can either have a problem on the clotting side or the breakdown of clotting. If you make too much clot, you’ll have what I would call sticky blood. I haven’t come up with a better term for it.

Ann Shippy, MD

I think that’s a great term because I some kind of imagine it.like, Oh, exactly.

Kelly McCann, MD

It’s a little sludgy.

Ann Shippy, MD

Moving through the capillary beds and getting better needs to go. It’s kind of sludging.

Kelly McCann, MD

Yeah, a little sludgy, sticky, and the same thing. If you’re not breaking down the clot adequately enough, you’re going to get that same problem of the sticky blood. That’s coagulation.

Ann Shippy, MD

If you have too much hypercoagulability, things just really don’t work right. Then you get increased risk for heart attacks, stroke, pulmonary embolism, DVT, all those kinds of things. We usually pick them up when they’re to that extreme. But I think what we’re figuring out, especially with all this experience we had over COVID where people got hypercoagulability from COVID, is that it’s a spectrum. Like you can be you can have this sticky blood clot kind of clogging up the capillary beds and your organs without actually, having had it be life-threatening with a heart attack stroke or pulmonary embolism. I think, a lot of us that were involved in treating mold early were more aware of the where they were actually bleeding. We were on the lookout for that, but we weren’t thinking, oh, well, okay, when these whole pathways are in disarray, we might have things on the other side. What are you using to try to figure out if your patients are in this spectrum of hypercoagulability?

Kelly McCann, MD

It’s a good question. I think the other piece that I eventually want to weave in that biofilm, but will it will stick with clotting for now. Most of the time in conventional medicine, we don’t work up if somebody is a risk for clotting until after they’ve had a couple of clots or miscarriages, for example. Miscarriages, increase clotting risk and can increase your risk for miscarriages. We evaluate that. Very important to know about. I think that some of the genes that we know about one is called factor V Leiden, there’s a prothrombin 2 gene mutation and those are some of the most common ones according to the literature and to hematologists. Then there are some other ones, protein C, protein S deficiency, and antithrombin three deficiencies. You can also get an increased clotting risk, not genetically, but because of an autoimmune condition. There’s an autoimmune condition loosely associated with lupus called Antiphospholipid antibody syndrome. If you think about that, that’s phospholipid. We started talking about phosphatidylcholine, which is also a phospholipid. There’s a relationship with the cell membrane and it’s not functioning properly when you’re talking about an autoimmune condition that increases the clotting risk. 

There’s a couple different things besides genetics that will increase your clotting risk. The big concern in conventional medicine is to actually form a clot like Ann we’re saying, the pulmonary embolism or the deep vein thrombosis. That tends to be more associated with things like factor V Leiden. As with everything in environmental medicine, the genes load the gun, the environment fires the trigger. Not everyone with a genetic predisposition is going to have a clot. There has to be some sort of inciting event, which could be a surgery, a trauma, or prolonged immobilization. Sometimes people have heard about it where you take a long car ride or a long plane ride and you don’t know that you have this genetic predisposition and all of a sudden you have a swollen leg. One leg gets one, you get a DVT. Now you’re off to the races with your clotting disorder and what we know from the Lyme world because I also see a lot of chronic Lyme patients, biofilms and clotting are a huge component of illness for people. I’m not sure if it’s the infection itself that is triggering that inflammatory cascade and leading to an increased stickiness of the blood in a genetically susceptible person all the time or if it’s just the nature of the bacteria wanting to help itself while off and protect itself in that clotting risk. But we know from Lyme that hypercoagulability is an issue.

Ann Shippy, MD

It’s probably a combination of both. With this signature that says it’s and again, I mean, COVID has been such a teacher for us.

Kelly McCann, MD

Exactly. Then more recently, I learned about another genetic predisposition called Plasminogen activator inhibitor one or PAI1. It turns out all of the other ones that all the other genes that we’re talking about, those are mostly on the coagulation side. But PAI1 is on the breakdown of the clot side. I’ve been testing my patients for the past six, six to 12 months now and out of all the people that I’ve tested, probably 90 plus percent have PAI1.

Ann Shippy, MD

Oh, my gosh, this is ground breaking. I hope you’re going to publish this. This is amazing.

Kelly McCann, MD

That’s the intention. When you go into the medical literature, PAI1 is thought to be very rare. Of course something is rare if you never test for it. When we say that something is rare if we don’t ever test for it. But historically hematologists have said that PAI1 is as rare and it does have this association with increased risk for diabetes and cardiovascular disease. In the medical literature. But I think that nobody’s actually really looking at this. I’m going to look at it. I’ve learned about it from my mentor, a woman named Ruth Kriz, K.R.I.Z.. She’s a retired nurse practitioner and just amazing woman who has taught me about coagulation and biofilms. But she used to check the PAI1 activity so you can check an activity in a lab and see if it’s actually increased activity. Then if there’s increased activity, she would defer and then go check the genes. The only people I see who have PAI1 activity increased have insulin resistance and diabetes. The PAI1 activity is not necessarily associated with genetics. Some of the people who have elevated PAI1 activity have normal genes, they just have really bad metabolic dysfunction. There is not a correlation that she was assuming and doing this work. Now we’re really excited to look at a patient population that have a chronic illness patient population for the most part. The fact that so many people have this gene variant, myself included, I’m homozygous for PAI1.

Ann Shippy, MD

This test through like a LabCorp, Quest.

Kelly McCann, MD

LabCorp, Quest. Absolutely.

Ann Shippy, MD

Usually covers it just like they do the antiphospholipid antibodies and factor V and all of that.

Kelly McCann, MD

Yeah, as long as you’re using appropriate ICD ten codes. I’m not checking this in everybody all the time, but I’m looking at the pattern of illness. I’m looking at things like fibrinogen activity. Then there’s another screening test called prothrombin fragment one plus two or 1.2 depending upon if it’s LabCorp, Quest, same marker. That’s really probably the best test for that stickiness of the blood. If somebody’s prothrombin fragment is normal, they may have a genetic predisposition, but they’re not yet.

Ann Shippy, MD

Activated.

Kelly McCann, MD

Activated into that sticky blood.

Ann Shippy, MD

This is one of those things where I think we’re going to probably be testing babies before they’re born or when they’re born and have this whole scan of things and know what to do to prevent illness like I do. I’m so lucky. I do have a segment of my population of patients that are like, “Tell me what to do. I want to stay healthy now.” I’ve got both populations, but and then so many people that they want their kids to like know what they can be doing from day one or early on to be healthy. I think this is going to end up being a really important one. I bet the people who ended up being hospitalized for COVID that this could it’s like if they were on the right. 

Kelly McCann, MD

Yeah, I’m sure it was huge.

Ann Shippy, MD

The infection. This might have prevented the hospitalization.

Kelly McCann, MD

Certainly the micro clots so we knew that there was an association with obesity, with diabetes and potentially an activation of PAI1 that would increase the risk for clots. What I’m finding and what I’m looking for now is I think that the PAI1 gene variant has probably a component of cardiovascular disease and cerebrovascular genes, much more so than a DVT, because I just think I don’t know that’s my intuition. We’ll see. 

Ann Shippy, MD

We need our research centers that we could just go to town on these things.

Kelly McCann, MD

Exactly. In anyone who has a family history of cardiovascular disease, or cerebrovascular disease, we can do this evaluation. Anyone who has a family history of cancer, we knows that cancer can trigger hypercoagulability. Those people should be evaluated. Then anyone with a chronic illness, chronic Lyme disease any sort of underlying inflammatory to basically you’re talking about a huge broad spectrum.

Kelly McCann, MD

Almost everybody should.

Ann Shippy, MD

It should be part of our workup screening.

Kelly McCann, MD

Just like we’re looking at MTHFR, we should be looking at APOE gene variants to help people navigate their cholesterol management, and their neurological health so I believe for those of your listeners who don’t know, that’s the gene variant that’s associated with increased risk for Alzheimer’s and cardiovascular disease. Super important to understand your genes.

Ann Shippy, MD

Yeah. you have that gene. There are so many things that you can do to be on top of the prevention piece. I know a lot of people are really hesitant to get their genes tested because they feel like it’s pre-determining. But I love your analogy with the gun. The gene to the gun.

Ann Shippy, MD

But then there’s the environmental trigger. You can be more cognizant of those triggers and other things that help to downregulate those pathways that are at risk. That’s really empowering.

Kelly McCann, MD

Absolutely. I mean, people understand that when they have a family history of diabetes, will they need to make different choices, or me, my mom have celiac disease. Years ago I gave up gluten because I knew that my risk for developing celiac disease was very high, like 40%. Why would I do something that’s going to increase my risk of developing an autoimmune condition I don’t want?

Ann Shippy, MD

Oh, and now you have the APOE gene.

Kelly McCann, MD

I’m I actually believe I’m 33, so APOE gene is good. Well, it’s not good. It’s out.

Ann Shippy, MD

Then you have the PAI1

Kelly McCann, MD

But I got the API1. Ineed to take some special enzyme in order to make that sticky blood not happen. Then do everything that I can to manage Lyme and mold and minimize my inflammatory cascade. 

Ann Shippy, MD

It also kind of helps you retrospectively to like, Oh, why? Why did I have these things happen in the past? This is probably part of the biology, the physiology that was happening that made your system not be able to handle in the mold. Yes, that being a blessing too, because it’s really better to not be in it even if you’re not having symptoms because of the other risk factors that go along with that.

Ann Shippy, MD

You’re doing awesome. You explain things so great.

Kelly McCann, MD

Okay. It’s really simple. I have to keep it simple.

Ann Shippy, MD

I mean, honestly, these are things that most physicians would have no idea what you’re talking about. They did a little physiology. They have their basic labs that they run and they’re not really going back. Integrating the two and coming up with these hypotheses about, okay, well, what’s really happening here? What’s the root cause of this? Why is this happening in this particular person? What can we do about it? Really great job of explaining things. 

Kelly McCann, MD

Thank you. 

Ann Shippy, MD

What are the next steps then when you move.

Kelly McCann, MD

If you can get your practitioner to check at least fibrinogen activity, and if it’s over 300, then there’s some sort of inflammatory thing happening. Or if you have an elevated high sensitivity C-reactive protein, you definitely want to try and get this assessed and then that prothrombin fragment 1.2 if you’re going to Quest one plus two, if you’re going to LabCorp,, those are the initial screening tests that I would at least ask for if they’re normal doesn’t mean you don’t have the genetics. It just means they might not have been triggered yet. Ideally, hopefully, you’ll find a practitioner who is listening to this talk and now you can collaborate and get your workup done.  But let’s just say you have a family history of cardiovascular disease or you’re in a moldy situation. What can you do? Some people reach for aspirin.

Aspirin affects platelets and it is not going to impact our coagulation or our fibrinolysis cascade. Aspirin is not the go to solution for this particular situation. Things that work better for this situation are what we call fibrolytic enzymes or fibrinolytic enzymes. For people who don’t have an elevated fibrinogen or prothrombin fragment, I tend to use Nattokinase because I don’t think that they’re actively clotting and will use the Nattokinase. And with Nattokinase or with any of these proteolytic enzymes, they have to be taken away from food and supplements..That’s super important because we want it to get to and kind of break down your sticky blood, not your food. Take them away. Usually a half an hour before or 90 minutes after you’ve eaten. 

Ann Shippy, MD

It’s a little tricky. If you have people doing binders and proteolytic enzymes, it’s like a pill carrier for every time of day.

Kelly McCann, MD

Yes, it’s definitely tough. Yes. You can’t take it with your binders. They really have to be taken on their own. Sometimes, ideally, you’re taking it once a day. If you’re not symptomatic twice a day if you are symptomatic. It does get a little tricky with all your binders. Do the best you can. Maybe intermittent fasting would make that easier because then you don’t have to worry so much about the food piece of that. That’s Nattokinase. Natto is derived from soy. Some people are super soy-sensitive, have to be aware of that.

Ann Shippy, MD

There really seem to have people with having problems with theoretical.

Kelly McCann, MD

It’s theoretical.

Ann Shippy, MD

Kind of like PC. I mean I, I find that people with soy allergies can usually tolerate that just fine as well. Do you think?

Kelly McCann, MD

Yeah, I do. Technically in the PC, the PC, the body biopc that I think we usually use, there is no soy protein in it. It’s just the lipid component. There’s nothing that people typically get reactive to. I just turn out there just in case I don’t see it personally. There are a couple of other kinds of enzymes. Serrapeptase is another enzyme that often gets used.

My favorite really is Boluoke or Lubarkinase. I do find that the brand name Boluoke works more effectively. That’s what Ruth Kriz recommends. That’s what other mentors who have taught about hypercoagulability for far longer than I have recommended. I tend to reserve the Boluoke for the people who are more symptomatic or who have elevated levels of that prothrombin fragment.

Ann Shippy, MD

Any similar dosing?

Kelly McCann, MD

Similar dosing. We’ll talk about biofilms at a second, but you can start with just one capsule once a day and then ideally you’re ramping that up to get the the prothrombin fragment into a normal range.

Ann Shippy, MD

Okay. So you follow labs on it again?

Kelly McCann, MD

Yes. That one you need to follow labs on. Technically it’s not supposed to increase bleeding risk at all or some people complain about bruising. I think bruising is tough when you’re older anyway, and you don’t have a lot of subcutaneous tissue and you’ve got little tiny arms like me, but or my mom.

Ann Shippy, MD

Or your hypermobile.

Kelly McCann, MD

For your hypermobile, you might get a little bit.

Ann Shippy, MD

Yes.

Kelly McCann, MD

There might be a little bit of extra bruising, but that’s not supposed to be an issue. It’s not supposed to contribute to bleeding at all. Although I did have one patient and put her on Baluoke and she normally had, two, three day cycles, and all of a sudden she had a ten-day bleeding cycle. Just FYI, it could happen.

Ann Shippy, MD

That also kind of makes you wonder a little bit about Endometrial biofilms.

Kelly McCann, MD

Yes. Very good point.

Ann Shippy, MD

Segue going here.

Kelly McCann, MD

That’s perfect segue. So, what are biofilms? I think biofilms are really amazing. There’s a biofilms are what bacteria create when they live in a colony. There are lots of examples in the nature of biofilms. When you go look at that pond and there’s like the scum on the top of the pond, that’s a biofilm. When you leave your glass and the water evaporates because it’s sat for too long and the water evaporates and there’s that grimy ring around that’s like minerals, that’s a biofilm. There’s bacteria that live in the water they create a biofilm. That is the mineral deposited left by the biofilm.

Anywhere in the body where we have bacteria. Well, let’s see our skin, our nasal passages, our mouth, the gastrointestinal tract for females, the vagina, and bladder, you’re the bacterial biofilms in the bladder. Now, we’re not supposed to have bacteria in the bladder, but let me just say, that in doing certain kinds of tests, we’re finding a lot of biofilm in the bladder.

Ann Shippy, MD

It does make sense because it’s part of it one of those surfaces that’s really outside the body kind of protecting us from what’s coming in. Of course, there’s going to be organisms that help that mucosal lining to try to stay intact and keep the outside organisms that aren’t supposed to get actually into our bodies in their places.

Kelly McCann, MD

There are biofilms, and the way that I think about them they’re kind of like this mucoid structure. There’s minerals, there’s mucus polysaccharides. It’s this goo. Another great analogy is when you see a little snail-like the trail, that the snail leaves, that shiny stuff, that’s biofilm. I hope you have an idea of what biofilm is. They’re everywhere in the body and they’re important. We can have a kind of healthy biofilm we can have because they’re healthy bacteria. Your microbiome in your mouth, if it’s healthy, the microbiome in your gastrointestinal tract, those organisms are hopefully healthy and being protected by the biofilm. But there are certain circumstances where the bacteria are pathologic, they’re problematic. They can cause illness, inflammation, disease, and they’re stuck in a biofilm. For example, with Lyme disease, Bartonella, those organisms create biofilms in the body and it makes it a thousand times harder to kill some of those organisms. There was research done with her by a woman named Eva Sapi and she discovered that Lyme disease behind a biofilm is a thousand times more difficult to kill than Lyme disease without that biofilm.

Kelly McCann, MD

We often utilize things like Boluoke or Lubarkinase and these different proteolytic and fibrolytic enzymes to break down biofilms in Lyme and Lyme disease treatment. It turns out that in those people here’s the kicker In those people who have this genetic predisposition to make clots, there is a fibrin from the blood that is being incorporated into the biofilm in these genetically susceptible people, strengthening the biofilm, making it more resilient and resistant to treatment.

Ann Shippy, MD

Drumroll.

Kelly McCann, MD

Drumroll. This is so important. The people with this hypercoagulability have stronger biofilms. Now, I don’t know whose fault it is. I don’t know if those if it’s the bacteria that are like, give me that fibrin, I’m going to incorporate it into my biofilm. Or if it’s the body’s way of trying to protect itself from these pathological organisms, I don’t know. We don’t know the intention, but the end result is that’s what’s happening clinically. I don’t have the randomized double-blind controlled trials yet to say that this is what’s happening. I can say clinically this is what’s happening. I’ll have to go do my deep-dive research and I’ll get back to you.

Ann Shippy, MD

But you’re saying and applying this information with your patients, which I’m so excited for you to share.

Kelly McCann, MD

Yes.

Ann Shippy, MD

I’d love for you to talk about how you’re evaluating the biofilms.

Kelly McCann, MD

Okay. One of the symptoms that shows up in many, many of our mold-exposed patients is chronic sinus issues They have allergies. They have sinus issues. They have breathing issues. They have upper respiratory issues. They might have headaches or migraines. We know that there’s a nasal biofilm. Part of the reason I think part of the pathology of being in a mold the environment, is that you’re inhaling those mold spores, you’re inhaling those mycotoxins, you’re inhaling whatever toxic bacterial soup is in the water, damage the buildings.

Exactly. You’re inhaling all that, and then they’re setting up housekeeping in your biofilm, in your nose, and it makes it that much harder to treat. But the problem with conventional medicine is they just kind of give you, a zip pack or Augmentin or what have you for your sinus infection. What really needs to happen is we need to identify what’s actually in them in the microbiome that’s pathologic and treat it. There are because most of the time most doctors don’t even do swabs. We’re not looking for the organisms we’re just assuming that it’s the usual suspects that should be responsive to augmentin, azithromycin. Oh, we don’t actually know what they are. Even if you’re looking for MARCoNS, that’s just one organism in a biofilm. There’s a lot of other organisms in the biofilm. MARCoNS for those of you who aren’t familiar, that’s the multi-antibiotic resistant, correct negative stuff. It’s a kind of stuff. I like that lab. I think they do good work. It’s cool that they test for that biofilm, but I think there’s more to the story than just MARCoNS. Definitely. Clinically, I didn’t really see a whole lot of improvement when I just treated MARCoNS. And certainly, it just came back. Why would it come back? Because we didn’t treat the rest of it or you would see a clinical improvement temporarily. But I didn’t see that continuing to test and continuing to treat and continuing to test in like,, making sure that they dealt with their MARCoNS like habitations and all of that never made a clinical difference. What has helped is giving biofilm busters orally giving alpha and busters intranasal and that could be ex clear. That could be something with EDTA. I mean there’s a bunch of topical biofilm busters, but then the real beauty is looking at next-generation sequencing too. Identify what organisms are actually really living there. This is cutting-edge technology. We should be doing this not just PCR, not just culture.

Ann Shippy, MD

Explains a little bit more about what that is and how easy it is to do.

Kelly McCann, MD

Well and out of microbiologists. It enables. Imagine that there’s a catalog of tens of thousands of organisms and what’s the test company can do as take a swab and match the organisms that are in that swab to their catalog of 70,000 organisms. Figure out exactly what organisms are in the space, whatever you’re testing, whether that’s the nose or the urine. They can give such specificity that they are able to identify how many bacteria roughly is at a high count. Is that a medium count as a low count? They’re able to identify exactly which organisms, genus, and species. Some of the words are words that are very difficult to recognize. Some of them, like when you do a urine.

Ann Shippy, MD

You’ll see how many different types of strep there are. Even.

Kelly McCann, MD

I’ve never, ever heard of some of these organisms. I always have to look them up because most of them you never heard of like it’s not pathologic. I have no idea. The good guys.

Ann Shippy, MD

There is an answer for sure. Like the nobody’s really studied some of these organisms to know what they do in a chronically ill patient. That. Yes, immunocompromised

Kelly McCann, MD

True.. But you’d be surprised. The ones that I’m like, I don’t know how to pronounce that. There it is. The NIH has some studies. It’s been really amazing. It will tell you what percentage the organism is. It will also tell you what the sensitivity pattern is. What are the antibiotics? Antifungals that will kill that organism? Huge, profoundly helpful, profoundly helpful. We can compound appropriate antibiotic regimens or antifungal regimens to address the specific organisms that are in somebody’s nasal passages, for example, and with and shifted with.

Ann Shippy, MD

The biofilm breaker.

Kelly McCann, MD

With the biofilm breaker, so that we can make sure we’re cleaning the house as much as possible.

Ann Shippy, MD

Getting in there. When you’re treating with these, how long are you usually finding that it’s taking?

Kelly McCann, MD

It’s a good question. It’s still clinical judgment time. Sadly, the company who was offering these tests was taking insurance. They recently stopped taking insurance, which makes that testing more expensive. That has changed the way that we’re doing things, so that we’re treating a little bit longer, trying to really hammer away at the organisms to minimize the expense for people.

Ann Shippy, MD

That they’re not retesting more than. That’s an interesting philosophy. We’re so aligned on this. I find that treating I’d rather treat longer and really get it done because it’s like it’s like putting a topical antibiotic on your skin. I think so little of it’s actually getting absorbed so little, it’s actually going to affect the gut microbiome. I too would prefer to treat a little longer and then and then test and see if we’ve got it.

Kelly McCann, MD

Yeah, I mean, it’s a balancing act, If we’re talking about a bladder biofilm and we’re giving systemic oral antibiotics and we have the potential of really disrupting the gut microbiome because we have to treat with oral antibiotics, it’s a fine line. To your point, I’m trying to really minimize the damage and minimize the cost because life is expensive enough as it is that.

Ann Shippy, MD

Well, and the insurance thing is so interesting. I wonder I guess, it’s just one of those things that end up saving the insurance companies money, like if they actually did look at their costs for for patients getting better, it would be like.

Kelly McCann, MD

Yeah, it would be a game changer rather than having to do water and installation and deal with the consequences of urinary incontinence and elderly people and recurrent urinary tract infections that cause delirium and dementia, not to mention prostate cancer, and prostate hypertrophy in elderly men. What if that’s just a biofilm, bacterial biofilm problem. if we actually treated it when they were younger and we stopped having so many issues in our elderly population because we were actually treating biofilms, which are the cause of the problem. As people age, as people age, what happens, oh, I’m getting up on tonight to urinate. I’m getting a two and three, four times a night to urinate. We just assume that’s normal. Guess what, folks? That’s not normal. What has happened is that we’ve accumulated biofilm in the bladder or the prostate or men and or both.

The bladder is responding to the irritation of the organisms that are present and causing that urgency, frequency, and inability to hold urine. I had a 50-something-year-old fireman and he was sharing that sometimes he would have to pee in a soda can on his way to a fire because he had so much urgency, that he couldn’t pull off and go find a restroom. 50 something. It turns out he is homozygous for PAI1 and he’s got a biofilm and hypercoagulability and that synergy is causing extra biofilm to be laid down and more urinary issues. Treat the biofilm, treat the organism. And guess what? It’s not happening anymore.

Ann Shippy, MD

That’s beautiful detective work. I mean, that’s a whole different quality of life.

Kelly McCann, MD

That changed his life, changed his life. 

Ann Shippy, MD

I’m curious what antibiotic you ended up having to use for that one. Was it a typical.

Kelly McCann, MD

Every time it’s different. Here’s my analogy. I’m still working on these analogies. You’re doing great. I think it’s a little bit like a lasagna. Now. I’m gluten-free having made lasagna in years, but as I recall, it’s you put the whole layer of the pasta down and then you’ve got your meat sauce and your cheese and you put another layer of pasta down. Imagine that the layer of pasta is your biofilm and then your bacteria are the meat sauce and the cheese. You take a biofilm buster and you peel off the layer of the lasagna, the pasta, and then you’ve got your bacteria there, and then you kill those bacteria and then you peel off another layer and you’ve got a different layer of bacteria underneath it.

Commonly the pattern is the first layer of of biofilm. The first time we do that test will often see Ecoli.  And Ecoli is a bacteria that is very common in your gastrointestinal tract. It sneakily gets into the bladder. Many people, when they get urinary tract infections, it’s Ecoli. Here’s the image for a urinary tract infection. What I’m talking about, the bacteria usually live in the biofilm and then occasionally you’ll get sporadic little guys that will peel off from the biofilm and then they’ll reproduce. If you get enough bacteria that are growing and reproducing away from the biofilm, that’s when you get a urinary tract infection. We identify that by culture. Culture technology is 40 years old. You can we’re using 40-year-old technology to identify that you have a urinary tract infection. And you have to have certain criteria. The lab says, “Oh, there were over 100,000 colony-forming units, so there was a lot of bacteria. Therefore you have a urinary tract infection. We’re going to treat you.” But what happens if you only have 10,000 colony-forming units? Well, it’s not enough to qualify you for a urinary tract infection, we’re not going to treat you. But there’s bacteria there. We were taught in medical school that the bladder was sterile.

Ann Shippy, MD

Not so much.

Kelly McCann, MD

Not so much. Not so much at all. After we see Ecoli, usually the second layer is enterococcus fecalis, which is again another another colonizer, another organism that we typically see in the gastrointestinal system. But sometimes I’ve seen lactobacillus species. What? What’s the lactobacillus? Where do we usually see that? In the vagina. I’ve seen lactobacillus species, normal, healthy bacteria in prostates. We’re swapping bacteria back and forth with our partners all the time. 

Ann Shippy, MD

It’s definitely a shared microbiome.

Kelly McCann, MD

It’s a shared microbiome. We have an expectation that these bacteria are going to stay in their playing in their playground like vaginal bacteria, stay in the vagina, and colon bacteria stay in the colon. They don’t do they move around a lot. We have our life experiences that make us share these things. The layers are different and unique in everyone. Typically with these tests, when we’re testing men, we’re doing semen analysis to look at what’s in the prostate and urine analysis, to look at what’s in the bladder.Then with women, we’re doing vaginal, vaginal swabs and the urine swabs too. Sometimes in some women, they’ll get normal vaginal bacteria, some lactobacillus species that are normal, that are supposed to be there. We don’t keep looking at that because that’s not necessarily adding to the problem in the bladder. It depends on what their primary presenting issue is.

Ann Shippy, MD

What percentage of patients are you seeing have a fungal component with the biofilm?

Kelly McCann, MD

It’s not as much as you would think. It’s really not as much as you would think. I’d say it’s probably more like 10 to 20%.  There’s definitely some there, definitely some there. As part of my mold treatment. Circling back to mold, yes I do often treat with antifungal nasal sprays, even if I don’t have a test that tells me that they have fungal or yeast colonization in the nasal passages.

Ann Shippy, MD

That’s so fascinating. We almost have to get on these calls to.

Kelly McCann, MD

Interview so we can share information, sharing information.

Ann Shippy, MD

A little bit more. That’s great. It’s really great. Then circling back to mold, I know you have some theories on why, in addition to the hypercoagulability mold patients are more susceptible to these biofilms and get in this predicament right.

Kelly McCann, MD

Yes. I mean I think I think it goes back to the total load idea on a certain level and what I mean by that for those of you who aren’t familiar with that total load idea is the body is a vessel. I like the sink analogy myself. That’s my favorite analogy because we understand it. You turn on the faucet, the faucet is all of the environmental chemicals, the mold exposure that are coming into your sink. The size of this sink, whether it’s a big deep sink or a little teeny tiny shallow sink, is determined by your predispositions and then the size of the drain. That’s also genetic, but it can be compromised by the amount of toxins that you have. If you have a big large drain because you are great, got great detox, but it’s all gummed up with toxins, just like a pipe can get gummed up with stuff, you’re going to have a theoretically smaller drain and you’re going to have more problems with detox and getting that stuff out. Patients who have mold exposure, that’s just one of the things that they often have going on. We’ve seen in many of our patients, that mold patients also tend to have chronic infections or if they were tolerating their chronic infections beforehand and then they got mold exposed. The mold suppresses the immune system and enables these organisms to flourish. Now you’ve got more symptoms, more problems, more root causes that we need to address.

Ann Shippy, MD

It before it gets to be such a vicious cycle. 

Kelly McCann, MD

It really does and it’s very complicated. I do find that we do have to address the mold at the beginning, though, I know a lot of people feel okay, Lyme is the thing or parasites are the thing. No mold is the thing. I think that the most disruptive to the immune system, the most suppressive, the most inflammatory. When we’re talking about hypercoagulability and biofilms and mold and yeast and fungus can get into those biofilms as well. That’s going to complicate things. The only thing that I think needs to come before mold in treatment protocol is muscle activation hypersensitivity. If people are exquisitely sensitive, and not able to tolerate treatments, then absolutely, we have to address that first, I have to calm down that nasal activation hypersensitivity reaction first and then go after the mold and the mycotoxins, and then worry about Lyme, Bartonella, parasites, virus viruses or last viruses or not. I don’t find that to be clinically relevant for the vast majority of people. If some people come in that I have Epstein-Barr like you may, we all do. We’ve all heard of Sambhar. If you’re over 20 years old or older, you probably have Epstein-Barr. Maybe not clinically as relevant as you think. Then probably last, I would worry about heavy metals. I really don’t do chelation and I don’t do heavy metal work until people are 70% better because they’re just too you’re just too fragile. You just can’t.

Ann Shippy, MD

Say fine with the heavy metal. It’s just by doing the things that help to detoxify the micro toxins, the metals come down to saccharine. It’s a beautiful, gentle process. But as long as they’re not getting new exposures to the metals or eating too much fish, using aluminum foil, having led cookware, or those kinds of things.

Kelly McCann, MD

Smoking is huge for cadmium, and cadmium is a big player.

Ann Shippy, MD

You’ve really gotten to be well known for the mass. Do you want to just spend a couple of minutes on that? Because I know you have your course on Mass Island. There are going to be people interested in that. Let’s just give a little preview to that.

Kelly McCann, MD

Yes, happy to do so. I love to talk about myself. Okay. Especially because it’s so important. For mold patients that become hypersensitive, it’s dire. You have to understand mast cell activation, because many practitioners out there, shoemaker practitioners out there, they don’t notice their mast cells. But even some of the functionally trained naturopaths and functional doctors, they may not know how to manage hypersensitive patients. You need to find a practitioner who does get mast cells. What is this mast cell thing? Mast cells are a normal part of our immune system and they are born in the bone marrow. They’re related to our red blood cells. In our white blood cells. They then move to the periphery and they line the areas of the body to protect us from the outside world.

Many of the areas that we were talking about today, that’s where you will find your mast cells and nasal passages and your sinuses and your mouth and your GI tract there and your lower GI there, your lower respiratory tract, too, in the lungs. They’re in the skin and they have a high affinity for the blood vessels and the nerves. They hang out around there, too. Their job is to survey the land for foreign invaders. When they see a foreign invader turns out that they’re filled with all these chemical messengers, they’re very pretty cells. They got these little granules. When they see a foreign invader, they dump their chemical messengers that we call mediators, which are cytokines and chemokines and histamine and inflammatory mediators to send out a signal and say, “Alert, alert, there is a danger here.”

We want our mast cells to do this. This is what they’re programmed to do. However, in some wacky people, there’s some sort of genetic component to this. The mast cells. can become hyper-vigilant and hyper-reactive, hypersensitive, however, you want to phrase that. Especially when patients are in a moldy environment and they’re exposed to mold all the time and they’re breathing it in, those mast cells go haywire and they start to misperceive foreign invaders and start to react to things that we should tolerate, like the food that we eat, our dog or cat smells, perfumes, fragrances, just about anything.

Ann Shippy, MD

Everything.

Kelly McCann, MD

Temperature changes, vibration, touch. You can get that dirt chromatograph. If you can write your name on your arm or your leg, you probably have mast cells, or at least you have one symptom. But because these mast cells are a so many different places in the body and the genetics are more somatic than germline, so the genes are still being worked out, but on average, mast cell activation is thought to be in about 17% of the population, 18% of the population.

That’s a huge number. That’s one in five. If you have a family of five living in a moldy house, at least one of them will probably have mast cell activation symptoms. What happens is that they become really sensitive to everything. You have symptoms in multiple systems in the body so people can have fatigue, muscle aches, joint pains, brain fog and neurological symptoms, headaches, migraines, tingling, numbness, psychological anxiety, depression, mood disorders, and then every system in the body can be impacted. Some people have a lot of allergy symptoms. Some people don’t have any allergy symptoms. It looks like so many different diseases and it looks different in every person, but it’s very difficult to identify. It’s really a clinical diagnosis. What I’m looking for or what my colleagues are looking for in making that diagnosis is multiple inflammatory allergic or growth symptoms in multiple systems in the body.

There are two broad groups we call them consensus one and consensus two, who test and treat for mast cell activation. Consensus one is mostly your conventional allergist and immunologist. They have defined criteria which is very strict and looking at usually just tryptase is a marker they look at in blood and many, many people who clinically have mast cell activation would not meet their criteria. If you don’t meet their criteria of elevated tryptase levels, go find another practitioner. Consensus two is Dr. Laurence Afrin, myself, and many of my other colleagues who wrote an article on the diagnosis diagnostic criteria of nasal activation. In that, we list out the clinical criteria for the definition of mast cell activation, as well as some of the laboratory values that you can look at. People can also have biopsies of tissue such as the bladder or colon, esophagus, and duodenum so anyone over age 50 who’s had a colonoscopy you can ask for a special stain to be done in the biopsies that were taken. The special stain is called CDX 117 If there are greater than 20 mast cells per high power field, particularly in the duodenum, but also anywhere in the colon, that also meets the criteria and supports the diagnostic definition of mast cell activation. The treatment is very complicated, but the good news is there are lots of options. Antihistamines, there are pharmaceuticals, there are some pharmaceutical mast cell stabilizers, not too many, but a number of them. There are a ton of supplements, things like Quercetin, luteolin, Pycnogenol, resveratrol, and Paramin there are certain probiotics that can be helpful. There’s a low histamine diet that can be helpful. There are a ton of things to do for mass activation syndrome.

Ann Shippy, MD

That was great.

Kelly McCann, MD

But nice little though, very quickly.

Ann Shippy, MD

Gives a really awesome overview. I think it really is the first thing to really look at. It’s so clear with the clinical diagnosis and then starting to treat you start to see improvement. You’re on the right path.

Kelly McCann, MD

Exactly. That’s one of the other kind of diagnostic criteria is if we give you something that treats mast cell activation and you get better, great. 

Ann Shippy, MD

We don’t need the biopsy.

Kelly McCann, MD

Exactly. Yeah. I don’t send anyone for a colonoscopy unless they need it for another reason.

Ann Shippy, MD

Some people do really want that diagnosis down to that degree because that’s just it makes them feel better about having a clear diagnostic. It’s fine for the people that want it, but for the people that just want to start feeling better, we can get going.

Kelly McCann, MD

Absolutely. Yeah. I mean, I do believe that diagnosis is important, particularly if you have a number of conditions and you have a number of practitioners on your team. If you have cancer and you have a cardiologist, you’ve got an oncologist and a cardiologist and a nephrologist and you’re a functional doctor who’s working with you and your other doctors are nice, but they don’t necessarily believe in this whole functional thing. A diagnosis is really important.

Ann Shippy, MD

Is important.

Kelly McCann, MD

Yeah. Testing is tricky, though. Blood and urine, they have to be handled properly, so the practitioner has to be on board with finding a lab that’s going to handle things properly. The blood has to be chilled, spun in a refrigerated centrifuge, and kept cold from the drawer into a chilled tube all the way to the lab. It’s really difficult to have that chain of command be all on board and in. It’s a lot of legwork on the part of the practitioner to make sure that they have a lab that works well. Unfortunately, conventional labs like LabCorp and Quest only have a couple of markers that they can do. But the couple of markers that they do if, say, for example, you have a histamine drawn at Quest or LabCorp and it’s high and it’s hard two times. Guess what? You’ve met the criteria because we want to have at least we want to have two labs that are positive and they can be positive at the same time. Histamine and an elevated tryptase or Chromogranin A. You can have those drawn at LabCorp’s request and if they’re elevated at a second time. you’ve met your criteria pretty cool.

Ann Shippy, MD

Well this has been just so fun to get to and have you share your brilliance and your heart and your care, and you are definitely making a huge impact in this world of a chronic illness and piling new territory and putting new puzzle pieces together. I’m so grateful for you.

Kelly McCann, MD

Thanks. I’m so grateful for you and for all the work that you’re doing in helping people get more information so that they can get well.

Ann Shippy, MD

Thank you. Let’s share how to find you.

Kelly McCann, MD

Yes, I am. I have a brick-and-mortar practice in Southern California. It’s called theSpringCenter.com  You have to put the in there theSpringCenter.com . And I also have my personal website, drkellymccann.com and I have things that you can check out there too.

Ann Shippy, MD

Thank you so much. I look forward to the next time we get to talk.

Kelly McCann, MD

Me to me to take care. Thank you.