|Chronic Inflammatory Response Syndrome Treatment|
This page contains educational material about Chronic Inflammatory Response Syndrome due to a water damaged building (CIRS). This is a biotoxin illness that is caused by mold and the interaction between mold, bacteria and chemicals used in building materials. Other biotoxin illnesses have similar signs and symptoms. They are also treated similarly. Some of them are discussed on this site. This information is for educational purposes only. Nothing in this text is intended to serve as medical advice. All medical decisions should be made only with the guidance of your own personal medical authority. I am doing my best to get this data up quickly and correctly. If you find errors in this data, please let me know.
Dr. Tilgner's Book: Herbal Medicine From the Heart of the Earth is Available Here!
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First, proper diagnosis is necessary before treatment
Identify if the person has a past history of exposure to mold and a precipitating incident. (To test their house, the best test is an ERMI.)
Identify signs and symptoms of mold.
Test for identifying biomarkers that are altered in CIRS - due to water damaged buildings.
Biotransformational/Detox Pathways are very important. A look at the full toxin load, not just biotoxins, as biotoxins are just one type of toxin category. All toxins together create a toxic load level that the body may or may not be able to handle. For data on how our body removes toxins and ways to support these biotransformational pathways, take a look at this page.
Identify if the person has any heavy metal issues, microbial, parasite or viral issues that can add to the drain on their health. Look for colonization of microbes specifically in the sinuses, lungs, gut, bladder, and vagina. Additionally, look at their home/work/school environment to see if they are around any toxic chemicals that could add to their toxin load. The total body burden must be examined for all toxicities. This means a complete examination of the person's lifestyle.
Identify all causes of inflammation in the body. They may be induced by the mold exposure or they may be caused by some other factor. All of these people usually have inflamed guts that need to be addressed. Many have leaky guts caused by or in addition to the CIRS-due to water damaged buildings.
Examine all sources of stress and identify what is working well in their life and what makes them happy and feel better.
If Diagnosed with CIRS - due to water damaged buildings, one line of treatment is as follows:
• The patient needs to remove themselves from the moldy/microbial environment and to be aware that they will need to avoid moldy buildings in their community as much as possible. This is key to recovery. They also need to get rid of any items they can not clean. Here are some helpful links: Mold and Moisture in the House, Mold Prevention & Clean Up, Mold Clean Up Resources
• I also advise folks to stay away from moldy foods or foods suspected of being contaminated with mold. I am not talking about cheese although some folks may be bothered by cheese. I am talking about molds and associated mycotoxins on grains, peanuts etc. They just add to the mycotoxin load in the body and stress your biotransformation system.
• Once in a mold free environment, begin treatment with a mycotoxin remover such as Cholestyramine. Other binders have been used successfully in some people such as activated charcoal and clay. Be sure they use these binders correctly so they do not end up binding fat soluble vitamins or medications. Also watch out for constipation which can be treated with magnesium which they are usually in need of or vitamin C or mild laxatives.
• Other Methods to Remove Mycotoxins: Cholestyramine is the best option to remove mycotoxins for folks who are genetically susceptible. There are a variety of other binders that people have used that seem to be helpful. They are things such as charcoal, tannins, probiotics and other natural supplements. I find they are not as helpful as quickly as cholestyrmine generally. However, some people do get relief from them. Generally, they do not work as quick. Sometimes they can be used in conjunction with cholestyramine to decrease the amount of cholestyramine needed. It is even possible that different binders may be more or less beneficial depending on the type of mycotoxins involved. There are also other methods used to remove mycotoxins. These would include methods such as enhancing ones biotransformation pathways, homeopathics, saunas, photon energy saunas, enemas, and colonics.
• Additionally, I like to use antiinflammatory herbs/supplements at this time to help alleviate the inflammation load. I choose those that are shown to normalize key inflammatory lab markers that are abnormal in CIRS as well as those that have proven to be useful.
• Once Cholestyramine or other binders seem to have accomplished mycotoxin removal, test with the VCS test to see if they now pass the test. If so, the person can continue the Cholestyramine/other binders as needed for re-exposure to mycotoxins. (The longer a person has been exposed to mycotoxins, the longer it may take to get better.) They can also now start addressing the inflammation and body damage left from the prior mycotoxin load.
They should be evaluated for nutrient need and treated as necessary. This can be dietary suggestions or supplements or both.
All individuals with CIRS have an inflamed gastrointestinal tract in my experience. I think this is caused by the mycotoxins and even leads to food sensitivities. Every CIRS person needs to have this addressed. I am big on using healing herbs and fermented foods as well as probiotics and prebiotics. Most people with CIRS will need to remove or limit their intake of dairy and/or grains. All of them need to remove simple carbohydrates while healing and limit them after healed. I have a write-up on the gut and mycotoxins.
They need to support all of their bodies biotransformational processes. (Detoxification Process) I would stress supporting glutathione levels in the body. However, all biotransformational processes in phase 1 and phase II need to be supported. Testing these processes can help determine if they are working correctly. Genetic testing can explain shortages in these areas also. However, a good history and exam can often help you decide which part of the biotransformational process may need some modulating.
Itching of Skin - See more details on itchy skin here.
If you are around a moldy environment and have itchy skin body washes with clay or charcoal can be helpful. The clay and charcoal will bind mycotoxins on contact and you can wash it off the body. Generally you shower, put the product on the body and then wash it off. People report this as being helpful. One product that is useful is the Charcoal Body Wash from Collective Wellbeing.
You can also use charcoal or clay based soaps. For folks getting secondary skin infections or inflammation, you might want to consider that the commensal malassezia may be out of control on the skin and consider apple cider vinegar washes and zinc pyrithione soaps. I have a brand I recommend to folks called Noble Formula 2% Pyrithione Zinc. The link below is for a 3 pack. You can also get individual bars. For more information on malassezia, check out the link above.
If a person has itchy skin and also has a problem with acne vulgaris and/or acne rosacea, they may additionally have a demodex mite problem. Another commensal often ignored but really irritating to folks who have inflammatory problems.
Glutathione is necessary for both phase 1 and phase 2 of our detoxification pathways. Glutathione is necessary to remove many types of mycotoxins. The aflatoxin AFB1 can be metabolized by the Cytochrome P450 system to AFB1-8,9-epoxide (AFBO) which can become quite hazardous or can be excreted via the urine with the use of glutathione. Glutathione S-transferase is needed to conjugate AFBO and excrete it in the urine. If AFBO is not conjugated and excreted it can cause toxicity including cancer.(Brammler and others 2000)
The glutathione antioxidant and detoxification systems play a major role in the antioxidant function of cells. Exposure to mycotoxins in humans requires the production of glutathione on an “as needed” basis. Research suggests that some of these mycotoxins themselves can decrease the formation of glutathione due to decreased gene expression of the enzymes needed to form glutathione. Mycotoxin-related compromise of glutathione production can result in an excess of oxidative stress that leads to tissue damage and systemic illness. This is why it is so important for people with mold associated illness to address low glutathione levels.
Glutathione is the master detoxifier in our body. It is a small protein composed of three amino acids - cysteine, glutamine, and glycine. It is synthesized in the body but toxins, poor diet and pollution as well as stress, aging, trauma, infections and radiation all deplete glutathione levels. The sulfhydryl group (SH) of cysteine serves as a proton donor and is responsible for the biological activity of glutathione. Cysteine is the rate-limiting factor in cellular glutathione synthesis, since this amino acid is relatively rare in foodstuffs. Normally glutathione is recycled in the body, except when the toxic load becomes too great or in the case of mycotoxins actively decreasing glutathione levels in the body. 33%-50% of people are missing normal GSTM1 (a gene) function. This gene is necessary to make enough glutathione.
Eat foods that optimize glutathione levels (For a detailed list of methods to enhance glutathione, see the glutathione write-up.)
Fresh fruits and vegetables will raise levels of glutathione, but cooked foods contained far less.
Sulfur-rich foods: onions, garlic, all cruciferous vegetables such a broccoli, collards, cabbage, kale, cauliflower, kohlrabi, watercress, etc.
Whey from making cheese or whey products: The whey protein needs to be bioactive and made from non-denatured proteins ("denaturing" refers to the breakdown of the normal protein structure). Use non-pasteurized, organic produced milk.
Other foods known to support glutathione production: Asparagus, avocado, raw eggs, turmeric, spinach, unprocessed meats and walnuts.
Exercise& Meditation enhance glutathione levels
Supplements to Support Glutathione
Many glutathione supplements have not been useful in the past. However, acetyl-Glutathione does seem to be clinically useful. Acetyl-Glutathione is a form of oral glutathione that is stable in the stomach and gastrointestinal tract, and well absorbed. There are now liposomal glutathiones that are also useful clinically. Enhancing our production of glutathione is another way to go and what I have mostly done in the past due to poor clinical efficacy of glutathione products. Below aare some methods used to increase glutathione. Starting people on glutathione is often necessary at first. Additionally using methods to make more glutathione such as giving them N-acetylcysteine is beneficial. Eventually, I take them off glutathione and leave the N-acetylcysteine until they can come off that also. Be aware that glutathione is used by the body to detoxify itself of many things. So while you are increasing the ability to remove mycotoxins, you are also increasing removal of other toxins. This can be overwhelming to remove toxins from the tissues if done too fast. If the person reacts, back off and go slower.
Methylation nutrients: Methylation needs to be working up to par for proper production of glutathione. Glutathione production is one of the end results of the Cystathione beta Synthase pathway CBS). Methylation and the production and recycling of glutathione are very important biochemical functions in your body. See more details on methylation here.
Also need following cofactors to metabolize glutathione: Selenium, B1, B2, Vit C Vit E, zinc, magnesium, perhaps vitamin D
Regarding the magnesium: I use a lot of magnesium for folks with CIRS, and other inflammatory chronic illnesses. I find that many are low in magnesium and have symptoms of low magnesium. I tend to use magnesium glycinate. I would also suggest trying magnesium L-Threonate as part of a protocol where there are cognitive issues. Not many companies sell it yet. You can find it from Life Extension. I am giving you a link as it is hard to find currently.
Selenium helps the body recycle and produce more glutathione.
Vit C and E help the body recycle glutathione
Milk thistle: 1 Tablespoon BID
We know Milk thistle increases glutathione. There is some specific research on it in relation to mycotoxins. Mycotoxins (aflatoxins, AF; ochratoxin A, OTA; T-2 toxin and fumonisins, FM) cause oxidative stress and apoptosis in the cell . Mycotoxins generate ROS, which induce lipid and protein oxidation leading to changes in membrane integrity, cellular redox signaling, and in the antioxidant status of the cells. The Milk thistle constituent silibinin is protective against apoptosis and cytotoxicity caused by OTA. Silibinin in doses from 130 to 260 μM prevented chromatin condensation, caspase-3 activation, apoptotic DNA fragmentation and lipid peroxidation that were induced by OTA, H2O2 and ActD/TNF-α, respectively. Silibinin (0.04–26.0 μM) had hepatoprotective effects against OTA- or LPS-mediated TNF-alpha release and also reduced the cytotoxicity of both compounds. Pre-treatment of rats with silymarin (silymarin contains silibinin)(100 mg/kg/BW) prior to AFB1 was found to show significant protection against AFB1-induced liver damage, as evidenced by a significant lowering of the activity of the serum enzymes glutamic-oxaloacetic transaminase (GOT) and glutamic-pyruvic transaminase (GPT) and enhanced hepatic reduced GSH status. Silylmarin (100 mg/kg/BW) also ameliorated toxic liver damage caused by FB? in BALB/c mice by preventing elevation of the levels of caspase-8 and tumor necrosis factor-alpha mediators. See further data here.
alpha lipoic acid - time released (I use alamax CR 600 mg alpha lipoic acid and Biotin 450 mcg per capsule) Start with one cap BID and increase to 2 cap BID taken on an empty stomach.
N-acetylcysteine: Contains sulfur amino acids including a dimer of cysteine. Is readily absorbed and boosts glutathione levels. This has been used for years to help treat asthma and lung disease and to treat people with life-threatening liver failure from Tylenol overdose. It is given to prevent kidney damage from dyes used during x-ray studies. See additional data below under TGF beta -1, including side effects. I find most people with CIRS due to Water-damaged buildings do well with both glutathione and -acetylcysteine in the beginning. Then I take them off glutathione eventually and have them on N-acetylcesteine as long as needed.
SAMe - also known as S-adenosylmethionine: A key donor in the methylation cycle and necessary to ultimately make glutathione.
Active vitamin D - 1,25-dihydroxyvitamin D3 has been shown to increase glutathione levels in the brain and may be a catalyst for glutathione production.
Once you are no longer in a moldy environment and you have removed most of the mycotoxins, you still have to deal with the residual inflammation left from the mycotoxins and your bodies reaction to them which is largely inflammatory. It is this inflammatory reaction that creates many of the signs and symptoms a mold susceptible person has.
Inflammation is measurable with biomarkers such as TGF b-1, MMP-9, C4a. These lab values should all become normalized as the inflammation subsides. The person should also notice an appreciable increase in health.
Here are some of my suggestions for addressing inflammation although we all have our own favorites. I will relate them to the inflammatory markers often used to evaluation CIRS due to water-damaged buildings (& other biotoxin related illness). I have listed some specific items below, but please go to the biomarker links highlighted to see additional possibilities. If you do not use these biomarkers, you can still use these treatments. The biomarkers are simply a useful measurement and for those who do use them, I list the herbs and supplements in relationship to them.
You will see some herbs listed that will both increase and decrease MMP-9 and TGF beta-1. This is confusing for people. Herbalists have a name for this, it is called amphoteric activity. It is the activity of a plant to raise and lower a lab value or increase or decrease some type of bodily activity. Basically it is a balancing of the lab values or body activities.
MMP-9 can be lowered via use of Fish oil and the no amylose diet. MMP-9 is shown in research to be upregulated by TGF beta-1, and decreasing TGF-b1 can down regulate it. MMP-9 can also upregulate TGF beta-1. I mention the no amylose diet as allopathic practitioners seem to recognize this diet and it is helpful often but for other alternative practitioners you will want to use your usual dietary sleuthing to decide what is best for an individual. Often the person has become reactive to a variety of foods due to the mycotoxin-induced gut inflammation. Some culprits are gluten and dairy foods, solanaceae family vegetables/fruits, starches if they have SIBO, the list can be endless as everyone is different. For more details click here. Get the person off of genetically modified food. They should eat only organic food.
No Amylose Diet: Keeps insulin in control as insulin will increase inflammatory cytokines. Eat at least 6 ounces of protein each day and at least 3 servings of above ground vegetables and fruit every day. No simple sugars, maltodextrins, and corn syrup, no grains such as rice, wheat, rye, barley and oats, no bananas, no underground veggies except onions and garlic, – no nuts other than walnuts and almonds. Can eat all fruit except bananas, all above ground veggies and meat.
High Dose Fish Oils: 2-3 grams/day of EPA and 1.5-2 grams/day of DHA
Other things that appear to lower MMP-9 & are useful in CIRS treatment:
Apples, strawberries and beans contain Kaempferol, which is a flavonol that has been shown to decrease the expression and activity of MMP-9 by blocking the PKCδ/MAPK/AP-1 cascades.
Polyphenols in general: Polyphenols are great antioxidants. They include constituents such as curcumin, resveratrol, catechins and many others you probably recognize and I have listed here on this page. They decrease inflammation and support many bodily structures. Eating brightly colored fruit and vegetables will assure you of getting a variety of polyphenols. One of my favorite ways to get polyphenols in to my body is by eating blue berries. Who does not love blue berries.
Designs For Health has Resveratrol Supreme which is trans resveratrol from Polygonum cuspidatum 200 mg /cap with quercetin 200 mg and lecithin 100 mg (from sunflower).
Vital Nutrients has a product with 250 mg of trans resveratrol per capsules
(Resveratrol is high in red grapes with seeds and skin as well as Polygonum cuspidatum - Japanese Knotweed)
There is research showing various mycotoxins elevate NF-Kappa B which has been shown to be lowered with Resveratrol. "Elevated NF-kappaB/Rel binding activity may be involved mechanistically in VT-induced gene expression of the cytokines and resultant toxic and autoimmune effects." (Ouyang YL, Li S, Pestka JJ., 2012)
While down-regulating MMP-9 also consider androgen dysregulation.
I would mention that DHEA has been shown to counteract activation of NFκB as well as the subsequent increase in TGFβ-1. So, if it DHEA is low, this may add to the excessive levels of TGFB-1.
You will see some herbs listed that will both increase and decrease TGF-B-1 and MMP-9. This is confusing for people. Herbalists have a name for this, it is called amphoteric activity. It is the activity of a plant to raise and lower a lab value or increase or decrease some type of bodily activity. Basically, it is a balancing of the lab values or body activities.
TGF B-1 can be lowered by many of the same things as MMP-9 (No surprise). Consider that while you are working to lower one, you are lowering the other. Additionally, many of these things will lower a variety of inflammatory cytokines, so C4a will often be lowered by these same items.
Some physicians use an angiotensin receptor blocker called Losartan to lower TGF Beta-1
Resveratrol – Ecological Formulations 100 mg from Polygonum cuspidatum root. 1 capsule BID - (Resveratrol is high in red grapes with seeds and skin as well as the herb Polygonum cuspidatum - Japanese Knotweed)
The combination of Salvia miltiorrhiza, Ligusticum chuanxiong and Glycyrrhiza glabra decreases TGF B-1 in research. I have mentioned elsewhere that I found the mix of Echinacea, Ligusticum porteri and Glycyrrhiza glabra to be very helpful. The amounts I have used have varied. This is a formula I have often used when people are acute: Echinacea ang./purp35-40%, Ligusticum porteri 25-35%, Glycyrrhiza 25-35%. You could substitute the Salvia L.c. and Glycyrrhiza mix above in similar amounts. Remember Glycyrrhiza has side effects and not everyone can use it. I have used large doses of this in the past: 25 drops of tincture (one dropper) every 3-4 hours as needed or 3-4 droppers three times per day (TID). Do not give to anyone with edema or high blood pressure. Please see contraindications for Glycyrrhiza - Licorice. I would suggest using Astragalus in the place of Echinacea for long term use unless your patient is specifically helped by the Echinacea in the product. The formula with Echinacea is wonderful if someone is under acute attack such a can happen when traveling.
Barley extract (procyanidin B-3 in it) and apples: Procyanidin oligomers in apples and barley counteract TGF-beta1(Have not used this but barley and apples are both nice.)
The combo of Ginkgo biloba and Panax Ginseng and Schizandra chinensis has been shown to inhibit TGF B-1 in research.
Panax ginseng: Ginsan, a polysaccharide extracted from Panax ginseng, has multiple immunomodulatory effects. TGF-β treatment of murine or human normal lung fibroblasts either before or after TGF-β administration led to significant reductions in all of α-SMA, collagen-1, and fibronectin expression levels. Ginsan not only inhibited phosphorylation of Smad2 and Smad3, but also attenuated pERK and pAKT signaling induced by TGF-β. Moreover, ginsan restored TβRIII protein expression, which was significantly downregulated by TGF-β, but reduced TβRI and TβRII protein levels. In a murine model of bleomycin (BLM)-induced pulmonary fibrosis, ginsan significantly suppressed accumulation of collagen, α-SMA, and TGF-β. These data collectively suggest that ginsan acts as an effective anti-fibrotic agent in the treatment of pulmonary fibrosis by blocking multiple TGF-β signaling pathways. (Ahn JY, 2011)
Rhodiola rosea have been shown to lower TGF beta-1.
Ginkgo 24% also inhibits TGF beta-1: This herb has contraindications, so if you do not know them, learn them before using it.
Boswellia serrrata - Has been shown to down-regulate TGF beta-1.
Salvia miltiorrhiza - This is especially helpful if the person also have a kidney transplant or they have CHF as this herb will additionally help in these areas. People with organ transplants have high TGF beta-1 due to medications they take also. They are more complicated to work with.
Taurine: 500mg -2 grams per day. Take in 2-3 doses. - Thorne has a 500 mg Taurine product. The amino acid that is so important for bile conjugation (glycine too) has been shown in research to lower TGF b-1. Many mold folks have bile issues. Sometimes it is a lack of enough taurine for conjugation. You can get a double whammy out of using it here. This and glycine are essential for many CIRS folks who are having trouble with bile production which is noted with a light colored stool. They simply need some help with bile acid conjugation. I often have them take the taurine 500 mg in the AM with food when they are having a bile acid conjugation issue and 500 mg-1 gram glycine at night to not only help with bile conjugation but to also help with sleep.
Green tea polyphenols - Take 500 mg BID or two cups of strong green tea per day. epigallocatechin gallate (Green tea catechins):(EGCG), a major (and the most active) component of green tea extracts inhibits TGF-beta.
Genistein (high in beans): Lots of yummy beans to eat. Always pre-soak them. Red clover tea is nice also.
(S)--Gingerol has been shown to lower TGF beta-1. This is found in Zingiber officinalis - Ginger.
Curcumin (in turmeric) – either use good curcumin product such as Meriva-500 (1-3 caps BID) from Thorne or take 2-3 Tablespoons of turmeric twice per day. I have found the Meriva to work well. Additionally, it appears that curcumin may help break up biofilm. There is quite a bit of resereach regarding curcumins ability to break up biofilms. This is helpful as it is thought that there may be fungal biofilms in the gut in some patients. It has been shown to have anti-quorum sensing activity, ability to keep biofilms from adhering and growing. Curcumin also induces gstA gene expression, overall glutathione (GST) activity, and generated production of reactive oxygen species.
Tumeric has been tested in chickens and shown to decrease the toxic effect of mycotoxins (aflatoxin) on vital organs.(Gholami-Ahangaran, 2015)
Berberine: One of the constituents of Berberine spp., Hydrastis canadensis (Goldenseal), Coptis chinensis (Gold thread) and others. Has been shown in numerous research articles to lower TGF-b1.
Astragalus: I prefer this as a tea. It can also be added into soups as the flavor is nice. There is also research showing Astragalus can increase vascular endothelial growth factor and formation of blood vessels. Many people with CIRS have abnormally low levels of vascular endothelial growth factor.
Sulforaphane: In broccoli (more in the sprouts) has been shown to increase Nrf2 and therefore lower TGF b-1. Most folks think that sulforaphane is a constituent in the brassica plants. Actually, it is not. These plants are high in a glucosinolate, called glucoraphanin that is turned into sulforaphane when it meets up with an enzyme called myrosinase. You can read more about it in an article I wrote here. The whole brassica family supplies the glucosinolate, but broccoli and specifically sprouts are really high in it. Some varieties more than others.
Glycyrrhiza: This herb is commonly called Licorice. It helps to lower TGF B-1(Isoangustone A)
as well as assisting in water retention, normalizing low blood pressures, assisting the liver in detoxification, decreasing the work of the adrenals, and may reduce hyperglycemia, hyperinsulinemia, and abdomnial fat accumulation (rat studies). This is one of the herbs I have given to people with CFS for the last 25 years that has helped quite a bit. In my opinion many of the CFS cases are due to mold sensitivity or other biotoxin reactions. I have written detailed data about Licorice in my book, Herbal Medicine From the Heart of the Earth. Contraindications of Glycyrrhiza - licorice: For folks sensitive to mold you should be aware that some licorice has been found to have ochratoxin A contamination. You can read more about it in this blog I wrote. Licorice is contraindicated in high blood pressure, heart failure, left ventricular hypertrophy, kidney disease, liver cirrhosis and cholestatic liver disorders. The contraindication in liver stasis disease is due to choleretic action, although this action is minimal in comparison with other choleretic herbs. Chronic licorice use mimics aldosteronism by increasing sodium resorption and potassium excretion by the kidneys. This action is due to glycyrrhizic acid content. De-glycyrrhinized licorice has been investigated for its clinical use and safety. Its use has been controversial. There is 2-9% glycyrrhizin in licorice root. The de-glycyrrhinized root extract has a maximum of 3% glycyrrhizin (glycyrrhizic acid) in it.
Vitamin D & Sunshine: Vit D decreases levels of TGF-β and NF-kappaB. Monitor levels fof vitamin D for correct dosage. Most patients who are treated for Mold Illness will have a low Vitamin D level rise to normal levels after treatment even if you do not give them Vitamin D. However, if they have not been treated their D level is usually low. If low, it may be beneficial to give vitamin D3 at least in the beginning of treatment until it is normalized. There is a massive amount of research connecting low vitamin D levels to many disease processes. However, we do not know for sure that supplementation is working as we would wish it to, so sunshine is really the best way to go. I have found that people with CIRS can easily react to the sun and I think it is due to the low MSH levels. Once the person removes themselves from mold and they use a sequestering agent to remove the mycotoxins they are usually able to go into the sun without getting terrible sunburns as well as other skin reactions they get from the sun. I have actually had three people report getting burnt through their clothing.
N-acetylcysteine: N-acetylcysteine is a specific inhibitor of TGF-β signaling targeting different components of the TGF-β signaling machinery.
Due to various reasons not everyone has enough gluathione and N-acetylcysteine is an important building block in the pathway to glutathione. I find that low glutathione is an issue for everyone with mold issues. Attending to it with glutathione or by supporting glutathione production is very important. See my page on glutathione.
Doses to stop fibrosis from TGF-B in research have been high. Up to 2000 mg per day is used. Some people have reactions to it. There is concern that it may cause bronchospasm in people with asthma if inhaled or taken by mouth. This is possibly a sulfur reaction. N-acetyl cysteine crosses the placenta, but there is no evidence so far linking it with harm to the unborn child or mother. However, N-acetyl cysteine should only be used in pregnant women when clearly needed, such as in cases of acetaminophen toxicity. It can cause nausea, vomiting, and diarrhea or constipation. Rarely, it can cause rashes, fever, headache, drowsiness, low blood pressure, and liver problems. When inhaled (breathed into the lungs), it can also cause swelling in the mouth, runny nose, drowsiness, clamminess, and chest tightness. N-acetylcysteine is used to remove mercury via urinary excretion. Some people can get very sick when they remove mercury from their body. I suggest you make sure clients donot have a high mercury level or a sensitivity to sulfur before using this supplement.
Oral proteolytic enzymes: It has been demonstrated that proteolytic enzymes reduce TGF-beta levels in serum by converting the protease inhibitor alpha2 macroglobulin (alpha2M) from the "slow" form into the "fast" form, whereby the "fast" form binds and inactivates TGF-beta irreversibly. They have been shown to lower the concentration of TGF-beta1 in serum of patients with rheumatoid arthritis, osteomyelofibrosis and herpes zoster. Treatment with oral proteoytic enzymes had no significant effect on TGF-beta1 concentration in healthy volunteers or patients with a normal level of TGF-beta1. In patients with elevated TGF-beta1 concentration (> 50 ng/ml serum), they reduced TGF-beta1 in RA (P < 0.005), in OMF (P < 0.05) and in HZ (P < 0.05). They found starting out with very low doses can also be helpful. (Desser, 2001) Examples of proteolytic enzymes are papain, bromelain, trypsin, and chymotrypsin.
Poria cocos: (I have not used this but list it here.) Fu-Ling, the sclederma of Poria cocos (mushroom). It has long been used as a sedative and diuretic in traditional Chinese herbal medicine. One study demonstrated that the substances extracted from Fu-Ling by 50% hot ethanol significantly augmented the secretion of interleukins IL-1 beta and IL-6 6 h after in vitro cultivation of human peripheral blood monocytes. The augmented effect was dose dependent. Tumour necrosis factor-alpha (TNF-alpha) secretion was also increased as the cells were treated with 0.4 mg/ml or higher doses of Fu-Ling extract. By contrast, Fu-Ling extract significantly suppressed the secretion of transforming growth factor-beta (TGF-beta) 3 h after the in vitro drug treatment. The suppressive effect was shown at doses as low as 0.2 mg/ml of Fu-Ling extract. Since Fu-Ling extract enhanced the secretion of immune stimulators (IL-1 beta, IL-6 and TNF-alpha) but suppressed the secretion of an immune suppressor (TGF-beta), the substance in 50% hot ethanol extract of Fu-Ling might have potentiated the immune response. (Tseng J., 1996)
Chocolate lovers: It appears that Cocoa procyanidins decrease TGF b-1. It is my personal experience that ingesting lots of food with procyanidins in general helps decrease inflammatory symptoms associated with CIRS. I tell people to eat lots of bright colored vegetables and fruits and they will be lowering inflammation in a natural manner.
Research shows safflower and canola oil increase TGF b-1
There is more, but I will stop for now. This gives you a lot of choices. I will add additional protocol methods as soon as I have time.
Sleep is Important
Restful sleep and enough sleep is important. In CIRS insomnia is the norm. So, I tend to use tryptophan or 5-HTP or melatonin. Lack of melatonin can be caused by the low MSH that biotoxin illness is associated with.
I start my patients out on 3 mg of melatonin at bedtime and increase it up to 10mg if needed. As they start to feel better, I have them lower the dose slowly back down. I also find giving them 5-HTP at the same time can be beneficial in conjunction with the melatonin. I start them at 50mg at bedtime. For most this is all that is needed along with the melatonin. If these two do not do the trick I have have found adding tryptophan may work better than 5-HTP. I realize that tryptophan turns into 5-HTP that turns into serotonin, that turns into melatonin and so it seems taking melatonin should do the trick. I am guessing that it is timing but there is so much we do not understand. All I know is to tell you to play with these three and if there is a low melatonin issue some mixutre of these three will almost always do the trick.
Some people find that melatonin works great to help them sleep but then eventually does not work any more. Most of them find if they stop taking it for a few days, and then start up again, it will once more assist in a good nights sleep.
How to naturally raise melatonin levels
I find meditation that focuses on the heart and pineal gland can be helpful to enhance levels of melatonin naturally in the body. Any meditation will be helpful. There is a need for regular periods of mediation of an hour or more for this to work for most people. I suggest meditating for one hour or more each day.
Melatonin is protective against ochratoxin A damage to kidneys and testes.
For more details on melatonin click here.
Nervines: There are of course a variety of herbs that are useful in people with insomnia and it can be helpful to add in those specific to the individual you are working with. This could be any of the relevant nervines that are specific to the individual you are working with.
There is research on supplements reducing specific aflotoxins in the body:
Lycopene protective against ochratoxin A damage to kidneys.
Endocrine System, The Gastrointestinal System & Other Issues
If you have not already addressed any problems with endocrine organs or other bodily organs, you should do it now. Many folks with mold issues may have thyroid, adrenal or ovarian, testicular hypofunction. This may clear on its own or need to be attended to. Many of them have low DHEA levels, cortisol, testosterone, androstenedione, some have low ADH levels, some of them have a bleeding issue which correlates with an abnormal von Willebrands profile when they are having bleeding episodes. These people will sometimes have abnormal iron, ferritin and CBCs. Additionally many of these folks have inflammed guts and you will see they temporarily have elevated antigliadin, AgA, IgG tests which correct themselves after they stay off of gluten products for a few months and are treated for mold. They may also have elevated anticardiolipin levels. Their D3 is often low, but will raise on its own as they get better. There are inflammatory markers that are also examined before treatment and they are checked after treatment is underway to make sure people are indeed getting better. Depending on the signs, symptoms and lab result of each person depends on how the person is treated at this stage.
I mentioned the inflammed gut. This is key to attend to as early as possible. They get such an inflammed digestive system that it causes leaky gut and they become sensitive to all sorts of foods and it can cause autoimmune conditions. Healing their gut becomes a priority. See my write-up on mycotoxins and the gut.
Bile is necessary to remove many toxins and many of these folks have issues with making enough bile. This has to be remedied if it is a factor. See my write-up on bile in the glutathione conjugation section. Check liver enzymes, bile flow and evaluate if they need taruine/glycine for amino acid conjugation.
Your Patient Gets Static Shocks
Many of these patients have low antidiuretic hormone. They have low blood pressure, increased urination and thirst and may have tachycardia. Sometimes Docs think they have postural orthostatic tachycardia syndrome (POTS) due to pulmonary hypertension. However these folks usually have volume depletion due to antidiuretic hormone deficiency.
Measurement of an increase in pulmonary artery BP with exercise that exceeds 8 mm or mercury. Seeming postural orthostatic hypotension with tachycardia. If volume depeletion from antidiuretic hormone deficiency and rise in PA pressure, then not Potts, CIRS.
They are susceptible to static shock as antiduretic hormone low and osmolality in the blood is so high that their sweat glands will secrete sodium against gradient out of blood and onto skin. This creates static shock as it creates and electric discharge force that discharges to a grounding source. To help them, I usually use Glycyrrhiza as it is known to have a pseudoaldosteronism action in the body. It helps to maintain body fluid, increase blood pressure and decrease the shocks. Do be aware of all the contraindications of Glycyrrhiza.
If you are allopathically minded then you may want to explore use of Desmopressin (synthetic vasopressin analogue).
The use of VIP
Vasoactive Intestinal Peptide use for mold folks was originated by Dr. Shoemaker and has been useful to many people who have removed themselves from moldy environments, used binders, and anti-inflammatories etc and still are not feeling well. It is also useful to folks to recover faster when they are re-exposed to mold. He has a great research article available on its use that I suggest you read. One of the issues with using VIP is that it is only availbe for research generally. You can sometimes get it from compounding pharmacists but not in all states. So, the biggest issue has been availability. It can really help some people and I hope that reserach increases on VIP and availability also increases.
Most of these folks crash when they exercise. I tell them not to do anything that makes them crash. As they recover they can exercise and they will find out when that is. Please don't think they are lazy and that exercise is good for everyone. Exercise will usually give them shortness of breath, fatigue and muscle pain. They will have good days and bad days. On a good day, they will think they can exercise or get work done and over-do it. Then they need a couple days to recouperate.
Epson Salt Baths
Many people find epson salt baths to be helpful. This is due to the fact that it is magnesium sulfate and mold folks need both sulfate for sulfation (phase II biotransformational conjugation method) as well as magnesium for a myriad of bodily activities. They are usually deficient in both of these.
Things That Seem to Work For Everyone!
Environmental Avoidance of Mold: Staying away from moldy homes, work places, schools etc. Hard but necessary. They also need to be sure their belongings are not contaminated and do not get contaminated. People will use methods such as going to pristine locations in the mountains or in deserts to avoid mold. They also are careful to clean or decontaminate all their belongings before coming home. Additionally, it is important to wash their own body and change their clothing as soon as possible when exposed. The quicker the better.
Avoiding chemicals: These folks are usually sensitive to chemicals in the environment, their food, the air, cosmetics, laundry soaps, dryer softeners etc.
Binders: Seems to be necessary for folks who have genetic suscptibility. Not for folks who are not genetically susceptible. See my haplotype data for details.
Healthy Food: Avoid mold in food, eat organic, non-GMO, non-chemical food. Eat colorful food. Eat fresh raw food as often as possible. Remove foods that they are sensitive to for good or as long as they remain sensitive. (This often changes once treated.)
Stress Reduction/Relaxation: This is important and always makes a difference. Anything that relaxes them is useful. Some suggestions are meditation, prayer, yoga. Meditation has been shown to enhance glutathione levels.
After this, individual treatments of foods, supplements, herbs, biotransformational support, hormones, etc. are used as necessary for each individual.
Exercise: This is helpful as long as they are able to exercise. Some people will find it takes them days to recover after exercising. These people are extremely sick and should not be pushed to exericise. They usually have mitochondrial dysfunction. Exercise has been shown to enhance glutathione levels.
Some additional therapies that some people have used with success: Ionic foot baths, coffee enemas, Sweating therapies (Be careful, if they are volume depleted it is a poor idea.), cannabis, raw juicing (I prefer raw, whole foods.)
When Will A Person Feel Better?
The individual should begin to feel better at one month after removal from a moldy environment and beginning cholestyramine treatment or before. Some will have a detox reaction and feel worse at first. You want to examine any reaction to get an idea of what is causing it. The person can be reacting to the choloestyramine, the movement of mycotoxins as they leave their tissues and are redistributed and removed in the bile, could be a reaction of cholestyramine binding a medication if they take them together. The Cholestyramine links go into more detail on this. The person should check with their physician that prescribed the cholestyramine if they have a reaction. Their Doc can explain the reaction usually and decide if anything needs to be changed or if it is a normal detox reaction.
If the person is not feeling better they need to examine their surroundings to make sure there is no continuing mold expsoure. They need to address all buildings they go into. They need to be sure they are not down-wind of a neighboring building that has mycotoxin air wafting towards them. Some sensitive individuals are bothered by this. Most folks notice they are much more sensitive to all chemicals as they get better. I personally think this is our bodies natural method of warning us of danger and that when we are under chronic onslaught we tend not to notice any more. As we clear the biotoxins out, we beome more aware of all toxins in our environment. If they are not in a moldy environment and they have taken the cholestyramine for a month and still do not feel better, they may need more time on the cholestyramine but it is more likely they are either missing mold in their environment or they may have Lyme's, Multiple Antibiotic Resistant Coagulase Negative Staph (MARCoNS). The extra sensitivity that many people feel intitially tends to disappear over time. So, don't be worried if you are going through a mold mycotoxin protocol with your practitioner and you notice you are more senstitive to chemicals and moldy environments. I think you are just noticing an acute reaction whereas before you were so sick from a chronic reaction that you did not notice the acute problems. Over time most folks find these acute reactions get toned down, so they will not be so intense. For some people they need some serious work with their biotransformation systems. You can find some detailed data on these systems specific to mold folks here.
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