Air Date: 6-21-2019|Episode 551
Life after mold and the
International Society for Environmentally Acquired Illness (ISEAI)
Today’s guest on IAQradio was Dr. Lauren Tessier, a Naturopathic Physician licensed by the state of Vermont. Her practice, Life After Mold, uses a patient centered approach to help recover those suffering from mold related illness. Her approach is informed by her Naturopathic Medical education, in combination with Functional and Integrative Medicine. These tools allow her to truly address the entire person who establishes care with me. She is a Shoemaker Certified Physician who specializes in the treatment of Chronic Inflammatory Response Syndrome CIRS as a result of exposure to mold and water damaged buildings. She also specializes in the treatment of non-CIRS mold related illness: mycotoxicosis, mold allergy, fungal infection etc.
Nuggets Mined from Today’s Interview:
Waterbury, VT flooded in the 1920’s and again in 2011 Hurricane Irene. Parts of Main street was flooded. May flood again due to the environmental impact of not dredging the river.
Undergraduate occurred at Massachusetts College of Pharmacy and Allied Health Sciences. Went on to train at Bastyr University, received doctorate of Naturopathic Medicine in 2012. She moved to Vermont in 2013.
Has personal history of experiencing mold illness- common neuro symptoms of mold exposure: headache, dizziness, brain fog, her home currently undergoing mold remediation.
When she was a teen, her uncle succumbed to Wegener’s Granulomatosis, a very rare disease that affects many organs and body systems. As fungal growth was visible in the apartment, she now feels her Uncle’s disease may have been fungal related.
Once removed from inflammagens most sensitized people get better.
Not all Naturopaths are equal. The real deal; currently 23 states license Naturopathic Physicians for which a 4 year doctorate level degree is required. In some of these licensed states ND’s have full prescriptive rights- including Arizona, Vermont, Washington, Oregon and potentially others. While medical residency is available, it isn’t required as NDs don’t perform surgery and other invasive procedures, so extended training in these specialties is not necessary. In the states with the largest scopes of practice (VT, WA, AZ and some other states) Naturopathic Medicine, as practice by a LICENSED Naturopathic Physician may be covered by some health insurance policies. The imposters; if there is no licensure in place, nearly anyone can call themselves a “Naturopath”. Most of these “Naturopaths” complete a 6-week correspondence course so that they can claim Naturopathic training. Prospective patients need to inquire as to how their Naturopathic Physician was trained.
She understands differing approaches and interventions and uses both traditional (western medicine) and nontraditional treatments in her practice. Although many drugs are isolated from natural sources, it may be of benefit to use the natural source (i.e. herb) as there is often a synergy in using the entire plant, rather than just part of it (ex. active medicinal chemical enhanced by additional antioxidants).
She greatly appreciates the pioneering work of Dr. Ritchie Shoemaker, MD on CIRS (Chronic Inflammatory Response Syndrome). She opines that people get stuck in inflammatory response and that this is the biggest health issue of the 21st century- with causes of CIRS reaching far beyond mold and into various infections and other exposures. CIRS diagnosis involves expensive lab tests. CIRS overlaps with other mold related illness which are low hanging fruit such as: mycotoxicosis, allergy, or infection. Mycotoxicosis is when the body builds up mold related toxins and hits a maximum amount tolerable, after that the body expresses disease, spitting out symptoms. Neuro symptoms often manifest first: headache, dizziness, brain fog, light sensitivity, etc.
As mold illness doesn’t happen in a vacuum, she also considers other disease states in her work up (ex. Diabetes, Lyme disease, Co- infections, autoimmune issues, Epstein-Barr, etc) . She asks the patient for feedback and then listens. She then digs deeper and if patent doesn’t get better then considers CIRS as a worst case scenario. Some cases easily resolve with initial interventions, other folks will have to go through treatment for CIRS to fully recover.
IEPs need to both listen and hear—as do physicians!
Mycotoxins are VOCs such as benzene, methane and other organic chemicals. When mycotoxins get into the body the body tries to detox and push mycotoxins out. Detox is a body defense mechanism. The skin, liver, lungs, kidneys and GI tract all detox. “Glutathione is an antioxidant produced in cells. It’s comprised largely of three amino acids: glutamine, glycine, and cysteine. Glutathione levels in the body may be reduced by a number of factors, including poor nutrition, environmental toxins, and stress.” Source https://www.healthline.com/health/glutathione-benefits. (Great!)
Nrf2 is a basic leucine zipper (bZIP) protein that regulates the expression of antioxidant proteins that protect against oxidative damage triggered by injury and inflammation- including the production of Glutathione. Mycotoxins naturally inhibit Nrf2 which can prevent creation of Glutathione- which causes difficulties with proper detoxification of mycotoxins! Several drugs that stimulate the NFE2L2 pathway are being studied for treatment of diseases that are caused by oxidative stress. Source https://en.wikipedia.org/wiki/Nuclear_factor_erythroid_2-related_factor_2
She uses a cautious step-by-step approach to protect the body from mycotoxins that are on the way out.
There’s a warmer welcome to out-of-the-box medical thinking in Germany and Sweden where there is also more governmental flexibility on research, doctors there are doing some good medicine. In the US, notable researchers include: Jeanette HOPE (gluthatione work) , Joseph Brewer (antifungals) and Mary Ackerley (brain MRI’s and psychiatric/neurcog impact of mold exposure).
The CIRS protocol is reliant upon using drugs for off-label purposes as a means to correct inflammatory markers. CIRS correlated inflammatory markers are tested en masse and are treated ion a step-by-step manner.
Cholestyramine (CSM) is an FDA-approved medication traditionally used to lower elevated levels of cholesterol. In the CIRS protocol it acts as a binder of mycotoxins and also bile acids that carry the mycotoxins out of the liver.
Welchol (colesevelam hydrochloride) is similar to CSM, but has a lower binding ability than CSM. So we tend to use it in people that don’t tolerate CSM, or who need to detoxify slower.
Actos is used for the treatment of type 2 diabetes in adults. A black box warning, also called boxed statement warning is the most severe advisory that can be given about a medication. Information required by a black box warning must be printed at the top of prescribing information, enclosed in a thick, black border. In this case Actos has a history if causing bladder cancer!
Removal of toxins from the body requires a binder, this is because the body recycles bile acids which contain the toxins. When binders pass the sphincter of Oddi (where the bile dumps out from the gallbladder/liver) they are able to “catch” the toxins and carry them out of the body, rather than allowing them to be recycled. Binders include: CSM, activated charcoal, clay, and others- even okra.
Dr. Tessier has done a deep dive into animal studies and human studies with incidental findings, seeking gentler alternatives to the drugs being used off label as treatment for inflammatory markers. She found: Green tea, Resveratrol, and Berberine, among others.
Selecting an IEP? First search for credentials and certification (ACAC), years in business. Then speak to them by phone. Will they answer questions and explain things? Do they communicate well? Ask them what tools they use (particle counter, moisture meters, infrared camera, are important)? Do they sample inside interstitial spaces? When they air sample do they sample in multiple rooms? Do you feel comfortable?
What Is ERMI? The Environmental Relative Moldiness index (ERMI) was developed by the U.S. Environmental Protection Agency, Office of Research and Development (ORD) as a research tool to investigate mold contamination in homes. The methodology is based on using mold-specific quantitative polymerase chain reaction (MSQPCR) to quantify 36 molds and calculate an index number for comparison with a database of reference homes. Disclaimer: The EPA has not endorsed or validated any tools or methods to determine mold burden in homes including MSQPCR and ERMI.
Public May Be Making Indoor Mold Cleanup Decisions Based on EPA Tool Developed Only for Research Applications. https://www.epa.gov/sites/production/files/2015-09/documents/20130822-13-p-0356.pdf
According to Dr. Tessier, while ERMI is controversial and not ideal; she looks for the logic and wiggle room behind the number. Dogmatisms will always get you into trouble! PCR is used to obtain the ERMI score. Would like to have MSQPCR performed on interior wall samples. Prefers PCR technology because of the ability to speciate vs. the difficulty in speciation with light microscopy as used with air testing. Is it Aspergillus fumigatus, Aspergillus niger or a more benign Aspergillus species? Fungal species identification is important. Knowing the species in the environment also allows her to correlate the exposure to the specific mycotoxins found on the urine test.
Mycotoxins show up in urine samples. Inform case management. Show how well detoxing is progressing. The cons are that only a handful of mycotoxins are routinely tested for. All testing requires not only a control, but also a standard to which the test compares the sample- if the standard isn’t available (ex. obscure mycotoxins aren’t available for sale by lab standard companies) then it’s not able to be tested. The testing is costly. Also there is difficulty in determining what caused the spikes in the urine levels- was it a recent exposure, or are you detoxing better? There are mycotoxins in food which may correspond to a low level exposure- but exceptionally high levels can usually be connected to environmental exposure.
Ochratoxin A (OTA) is a naturally occurring foodborne mycotoxin found in a wide variety of agricultural commodities worldwide, ranging from cereal grains to dried fruits to wine and coffee. It is produced by several different fungi including Aspergillus ochraceus, A. carbonarius, A. niger and Penicillium verrucosum. Source https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247821/
Aflatoxins are a family of toxins produced by certain fungi that are found on agricultural crops such as maize (corn), peanuts, cottonseed, and tree nuts. The main fungi that produce aflatoxins are Aspergillus flavus and Aspergillus parasiticus, which are abundant in warm and humid regions of the world. Source https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/aflatoxins
Tissue, sputum or nasal wash sampling can also be done- this allows for more direct measurement and may better reflect internal exposure. Some of this testing may be covered by insurance.
Pushes for thorough professional remediation and PRV. Warns that thoroughness can get lost. Visible dust is a problem. Advocates: static wipes, HEPA vacuuming, thyme-based cleaners, and soda blasting. Admits that she is not an expert in remediation, and believes that physicians and IEPs need to communicate as to what will be best for the client.
ISEAI (International Society for Environmentally Acquired Illness) was formed to find answers for complex cases. ISEAI is a niche. Was started by enviro doctors: Ackerley, Rapaport, McMahon, Berndtson and Shoemaker.
ISEAI’s welcoming, warm and respectful. The organization has 218 members and 150 affiliates. Affiliates have access to research database. Meanwhile Full members have access to the research database and list serve where docs and IEPS dialogue. ISEAI is in service to people that dogmatism has hurt.
If you are a thorough IEP or remediator don’t be afraid to reach out to enviro docs in your geographic area- reach out to physicians listed on www.iseai.org
Z-Man signing off