How Mold Toxicity Can Zap Your Energy and Cause Brain Fog with Dr. Keith Berndtson

 

About Dr. Berndtson

Dr. Berndtson is a graduate of Rush Medical College. He has practiced in Chicagoland for over 28 years and has clinical and administrative experience in both conventional and alternative medical settings. He has served as a clinical instructor for students at local medical and health professional schools.
He is the author of Seek Wisdom: The Modern Quest for Health and Sustainability, a collection of essays on health care and what’s needed for us to become wiser stewards of nature. He co-authored The Immune Advantage and has been a consulting editor for several health publications including The Reader’s Digest Guide to Vitamins, Minerals, and Herbs.

Dr. Berndtson has a strong reputation for helping restore healthy function where usual medical care has failed to do so. What makes this possible? It’s not that he’s any smarter or that he any works harder than his colleagues – it’s that he approaches his problem solving task from a systems perspective. This approach is known either as systems medicine or functional medicine by those who practice it.

He sees patients in the Chicago area at Park Ridge MultiMed

Also Discussed in This Podcast:

Mold Warriors by Dr. Ritchie Shoemaker

Surviving Mold http://www.survivingmold.com/

Show Notes:

02:44 Dr. Berndtson’s Journey: When he first opened his practice in 2007, a patient introduced him to the book Mold Warriors by Ritchie Shoemaker. He also subscribed to the newsletter, Surviving Mold. He began taking on mold affected patients.

03:58 Sick Building Syndrome: In 1973 during the OPEC embargo, builders began building homes that were tightly sealed to trap heat. Moisture, however, had nowhere to go. We began to see Sick Building Syndrome. Under certain recurrent moisture conditions or after water intrusion/leaking events, molds can take hold. Mold requires moisture and cellulous to grow. Dust contains cellulose. It is important to discover these intrusions and remediate them quickly. Mold grows within 48 hours. Not all molds are toxin producers. Some molds are genetically coded to release toxins when they receive stress signals, like when it encounters manmade chemicals in drywall. They make spores that carry toxins. When things dry, the spores go dormant. When moisture returns, they become active and could be releasing toxins.

06:04 More Than Mold: In heavily water damaged buildings, there are other inflammagens: microbial organic compounds, manmade volatile organic compounds, fungal fragments, and bacterial fragments.

06:25 Mold Toxicity Syndrome: About 1 in 4 people carry one or more specific 12 HLA genotypes that render people susceptible to poor clearance of toxins made by living things (biotoxins). Of biotoxins, mold toxins account for 80% of the clinical problem. HLA means that it is on chromosome 6 and it has to do with the part of the immune system that processes then presents antigens from one cell to another. It begins the process for coordinated cellular and antibody response to something like this, should you encounter it again.  Bacteria, parasites, and fungal strains can produce toxins that may colonize mucus membranes. Candida albicans has been shown to make gliotoxin which can find its way into the microglia of the brain, causing disruption. Many mold toxins are cytotoxic, arresting cell cycles and mitosis, causing oxidative stress, and/or causing ribosomal stress. If you have difficulty clearing toxins, you become sick over time. In many people, it requires a priming event, like a major stress, an accident or bout of mono. The next time you are exposed to biotoxins, inflammation begins.

08:36 The Complement System: It is part of the innate immune system. It is genetically programmed to respond to dangerous molecular patterns to which our ancestors have been exposed. Most of these molecular patterns are from microbes. C4A is a complement protein, which is the activated form of C4, which seems to specialize in responding to toxins made by living things. In those of us who have the genes making it difficult to clear them, C4A responds repeatedly as though it is seeing it for the first time. Each time, it initiates a cascade of downstream inflammation, though not with classic inflammation makers, but with markers like TGF-beta 1 and MMP9. Also included are three regulatory neuropeptide hormones made in the hypothalamus.

09:53 Antidiuretic Hormone (Vasopressin) tells the kidney to conserve water. When it is not being synthesized, the kidneys are not getting the message to conserve water and you will be dehydrated. If you are dehydrated enough, you are thirsty, drinking lots of water and urinating at the same rate. You may also experience static shock constantly.

10:48 MSH (Melanocyte-Stimulating Hormone) is a field general coordinating immune defenses for mucus membranes in the body: respiratory tract, the gut, urinary tract and skin. MSH is bound to POMC (Proopiomelanocortin). When leptin binds to its hypothalamic receptor, it initiates downstream pathway activation including a process that would cleave POMC from MSH to free up MSH. POMC gets cleaved into melatonin and beta-endorphin. If the leptin receptor is blocked by pro-inflammatory cytokines, you are at risk for poor sleep, amplification of pain feel and not having the field general coordinating mucus membrane defenses.

12:18 Vasoactive Intestinal Polypeptide:  This is the third hormone marker in chronic inflammatory response syndrome (CIRS). VIP is a master regulator of immune function and a master regulator of blood flow distribution in the microcirculatory regions of the body. When VIP approaches the undetectable and TGF-beta 1 is active enough, it can cause remodeling in the inflamed areas. Airborne toxins first inflame lungs and bronchial tree, so TGF-beta remodeling results in fibrosis. Fibrosis involves the narrowing of the arterials in the lungs, putting increased pressure on the right side of the heart, which pushes deoxygenated venous blood through the lungs. The back pressure becomes an acquired form of pulmonary hypertension. This form is often reversible.

15:01 Diagnosing Mold Toxicity Syndrome: To make the diagnosis you need to have a multi-system/multi-symptom illness. Among 37 or 38 symptoms recorded, patients had 23 symptoms on average. Healthy controls had 3 out of 37 symptoms. You can’t have fewer than a dozen symptoms. You need to have at least 1 of the HLA susceptible genes. Genes load the gun. You need the markers of exposure.

17:58 Symptoms of Mold Toxicity Syndrome: One is severe fatigue, where it is hard to function. This is often accompanied by disrupted sleep. It is possible that the inflammatory cascade that does not shut off, begins to wear out the anxiety and depression buffers, like serotonin and GABA. When these wear out, you stay in a state of excitotoxicity. The inflammation also keeps the brain on alert, which manifests itself as anxiety, OCD or panic, as well as increased sensitivity to light, harsh sounds and sometimes tactile sensations. Another symptom is the falling behind in higher order cognitive processes like executive function, word finding, difficulty with recent memory, and memory consolidation. This often involves frontal lobe subcortical circuits which can effect emotion, motor function and cognition.

21:16 MRI and Mold Toxicity Syndrome: On a NeuroQuant MRI, when you take a standard MRI image without contrast and run it through the NeuroQuant process, it removes the valleys and inflate it into a sphere so all of the brain regions register on the same sphere. Then the volume of brain centers is analyzed. Patterns occur with people with Alzheimer’s, traumatic brain injury, PTSD or Lyme disease or mold toxicity syndrome.

22:31 NeuroQuant and Mold: Often seen is the enlargement of some centers and shrinkage of others. The enlargement correlates with micro interstitial edema. If there is shrinkage, it often means that there is a decrease in dendritic pruning and neuronal regrowth. Both are reversible.

23:47 Headaches: Migraine-like headaches focused between the eyes or bridge of the nose, which can involve sinus involvement, and tension headaches can be symptoms. Heavily water damaged buildings are associated with the growth of coag negative staph in the deep nasal space. It has been viewed as a normal bacteria for decades, so insurance will not cover a swab for it. This type of coag staph can be multiply drug resistant. It has been show to make an exotoxin, a toxin made outside the body, which gets absorbed into the mucus membranes. It seeks out MSH (the field general hormone) and assassinates it. It participates in biofilm communities.

26:16 Mold Toxicity Prevalence: NIOSH estimates that 50% of the structures in the country have suffered from water intrusion. With the estimate that 1 in 4 are susceptible, 80 million Americans are susceptible. There are few doctors qualified to treat mold toxicity.

28:12 More Markers: C4A, the TGF-beta, regulatory neuropeptides, C3A, and vegf (vascular endothelial growth factor) which could be high or low in this condition.

28:38 Treatment: The only way to get started with treatment is to remove yourself from ongoing exposure to sick indoor air. There are binders for these toxins available. Cholestyramine and Welchol were initially designed to lower cholesterol and to bind bile salts. They each contain quaternary ammonium, which has a nitrogen with a positive charge about the same size as the negative charge in most biotoxins.

29:34 Re-Exposure: If you go back to work or home to be exposed again, you are not getting ahead. You may even mobilize toxins into your circulation, increasing inflammation. Thus, re-exposure will make you feel even worse.

30:17 Remove Ongoing Exposure: Often the property owner, employer or landlord will get a remediator to do a spore air sample. Many times the test comes back negative. Dr. Berndtson utilizes the environmental moldiness index developed by the EPA. They look for mold DNA in dust to determine if it is a toxic producing variety. You can remediate and clean, move, quit your job, go to a different classroom, drop out of school, or get worse. It can be a huge upheaval for the patient and their family.

33:10 Feeling Better: Once exposure has been eliminated and the binders are being taken, it is a matter of weeks to months before you start feeling better. As the toxin level goes down, the inflammation goes down and your body’s pathways begin to function again.

35:00 Nutritional Support: Toxin mobilization creates symptom intensification. Magnesium, curcumin in bioavailable forms, glutathione, sustained release alpha lipoic acid, Epsom salts soaks, Alka-Seltzer Gold can make a big difference. Some homeopathics and botanicals can help. Get plenty of vegetables for the powerful phytonutrients, eat whole foods and avoid junk.

36:53 Exercise: Exercise is an issue for patients recovering from mold toxicity syndrome because they have a decreased anaerobic threshold. When they push too hard, they crash, just like chronic fatigue syndrome. Exercise, though, is important for recovery, so take it slow and gradual.

37:58 Testing: Do the genetic testing for HLA-DRB1, HLA-DQB1, and HLA-DRB3, 4 and 5. You need a TGF beta and a C4A. If both of these are high, we know that something is going on. Testing for the other markers is done to gauge improvement. Dr. Berndtson uses Quest labs because the testing is complicated.

 

Podcast Transcription:

Mike Mutzel: Hi there, welcome back to High Intensity Health Radio, this is Mike Mutzel. I’m so grateful that you’re with us. Today is Episode #52, and we’re going to catch up with an integrative medical expert, Dr. Keith Berndtson, to learn all about mold and mold toxicity, and how the assessed mold toxicity, not just in yourself, but in your home, your school, or potential workplace. So he’s going to dive through all the details in so much more detail that I have ever even imagine. This is a really complex topic. And I think a lot of people that have fatigue-related issues, cognitive issues, sleep issues—if you’re one of those people that you’ve bounced around a bunch of different doctors and you can’t seem to get help, I think you might really enjoy this because he’s going to provide some additional level of testing that I’ve never even heard about, and I’ve been doing this for 10+ years. So I think you’re really going to enjoy this. Now if you’re listening over on iTunes, you can hop over to YouTube and actually watch this. Now if you’re on YouTube and you want to listen to it, you can go over to iTunes and that’s just High Intensity Health over on iTunes. So I really hope you enjoy this episode and we’re going to catch up with Dr. Berndtson again to learn about Lyme disease in just a few weeks. So if you like his presentation style, his level of detail, then you’re certainly going to want to pay attention to that one. I would encourage you to subscribe over on iTunes or YouTube if you haven’t already, and I hope you enjoy this episode—and we’ll catch you on the next video. I’m very excited to be with you, Keith. How are you doing today? 

Dr. Keith Berndtson: Great, my pleasure.

Mike Mutzel: Fantastic. Let’s open up a can of worms on mold and mold toxicity. We’re talking before we start…

Dr. Keith Berndtson: You sure you want to do that?

Mike Mutzel: Yeah.

Dr. Keith Berndtson: Now there’s a great need to do it. People often want to know how I got into this. And back in 2007 when I opened this practice, a patient walked in with this book called “Mold Warriors” by some guy named Ritchie Shoemaker. And you know, I finally got around opening it and reading a little bit, and began to feel like I was drinking from a fire hose because there’s so much information in it—a lot of path of physiology, but also getting into the patients’ stories and legal ramifications; and implications for agricultural practice, construction practice; remediation, inspection, and cleaning; and all that kind of stuff. So I wondered what I got myself into, but I’ve then subscribed to the newsletter from Surviving Mold, his website, which now gets about 3 million hits a month, and built up my confidence to start taking these patients on. Even at that point, I was kind of at the lower end of the learning curve. But what’s important to understand here is that this is not just about mold toxicity. Back in 1973, when there was a OPEC Embargo and there were long gasoline station lines and so forth, there was a premium on conserving energy, and so builders decided they would step up and they would start building homes that were pretty tightly sealed that you could trap heat and save money during the winter and all that.

Mike Mutzel: Sure.

 

Dr. Keith Berndtson: But creating conditions were moisture had nowhere to go. The buildings weren’t breathing the way they used to, and so we started to have more of what’s called “sick buildings syndrome,” which in the beginning wasn’t very well understood and kind of got laughed at the room and a lot of grand rounds and that sort of thing. But now we know much more that under certain recurrent moisture conditions or after water intrusion events­—roofs leak, leaks under sinks, flooding of course, flooded basements—that molds can get a leg up. And all molds need to grow is moisture and cellulose; dust contains cellulose, so they pretty much have growing conditions almost anywhere where there’s been enough moisture. So it’s very important to discover these intrusions and remediate them quickly because within 48 hours, you’ve got mold growing. And not all molds are toxin producers, either; but the ones that are have genes that code for toxins that they use to defend themselves when they pick up stress signals, and that could be running into manmade chemicals in the dry wall or whatever. They make spores that carry toxins. When things dry up, the spores go dormant; but when the moisture returns, they become active, they could be spitting out toxins. And heavily water-damaged buildings, it’s not just mold toxins, there are other inflammogens—microbial, volatile organic compounds, manmade volatile organic compounds—they all enter the mix; there are fungal fragments, bacterial fragments. So anybody can get pretty sick in a building like that. But in what’s commonly referred to as “mold toxicity syndrome,” about one in four people carry these HLA genes; HLA means it’s on chromosome 6, and it has to do with the part of the immune system that presents antigens from one cell to another, processes those antigens first, and begins this process where you can acquire a coordinated cellular and antibody response against something like this should you come across it again.

Mike Mutzel: Sure, okay.

 

Dr. Keith Berndtson: But in one in four people, there are now 12 genes that have been identified—12 HLA genotypes—that render people susceptible to poor clearance of toxins made by living things, or biotoxins. In the category of biotoxins, molds account for 80 percent of the clinical problem; but bacteria can generate toxins, parasites, fungal strains, that might colonize mucous membranes—also capable of producing toxins that are nasty. Candida albicans, for example, has been shown to make something called “gliotoxin;” it’s called “gliotoxin” because it can find its way into the microglia of the brain and disrupt things. And we know that many of the mold toxins that have been described are cytotoxic as well; they can arrest cell cycles, they can arrest mitosis, they cause oxidative stress, they cause ribosomal stress—so they’re bad actors. And I fear one of those four, or one in four, was a hard time clearing these things; you become sick over time. You might not, on your first exposure, and in many people it seems to require a priming event of some kind, like a major stress, or an accident, or a bout of mono, or something like that. And once that’s happened, the next time, now that your immune system is primed to martial a big response—next time you’re exposed to biotoxins, it’s going to start to cause this inflammation, because the complement system, which is part of the innate immune system, is genetically programmed to respond dangers in molecular patterns that we’ve been exposed to over the eons through our ancestors­—and most of them come from microbes. There’s one complement protein called “C4-A;” this is the activated form of “C4” that seems to specialize in responding to toxins made by living things. So when you’ve got these toxins on your body and you’ve got the genes that make it hard for you to clear them, C4-A is responding to this again and again and again like it’s seen it for the first time, and when that happens, it initiates a cascade of downstream inflammation that ropes in a bunch of other markers, but not C-reactive protein, not the classic markers of inflammation that we see.

Mike Mutzel: Sure.

Dr. Keith Berndtson: Things that aren’t familiar to many people, like they were to me when I first learned about these things—like TGF-beta1, MMP-9. There are three types of hormones in those regulatory neuropeptides that are made in the hypothalamus; they get roped into this problem. One is called “antidiuretic hormone” or “vaseopressin”; it tells the kidneys to conserve water, and so when it’s not getting synthesized and when we measure it, it’s often undetectable.

Mike Mutzel: Yeah.

Dr. Keith Berndtson: That means the kidneys are not getting the message to conserve water, and you are getting dehydrated; and if you get dehydrated enough, you become symptomatic—you’re thirsty, you’re drinking water like a fish, but you’re peeing it out in about the same rate so you’re not gaining on it. At some point, if the osmolality, the electrolyte concentration, goes up high enough, you may become a static shock machine.

Mike Mutzel: Wow.

Dr. Keith Berndtson: And so that’s actually one of the symptoms that could provide a tip-off that something like this is going on. So antidiuretic hormone. And then, there’s something called “MSH (melanocyte-stimulating hormone)”—I know everybody gets tripped up on that one because they name these things whatever they find it doing when they first discovered it.

Mike Mutzel: Right.

Dr. Keith Berndtson: But in the immunology literature, alpha-MSH is viewed as a field general coordinating immune defenses from mucous membranes in the body. So the respiratory tract, the gut, the urinary tract, and the skin is also involved here. So we know that synthesis of MSH is actually not a synthesis issue. MSH is bound to something called “POMC (proopiomelanocortin),” and when leptin (which you know plenty about) binds to its hypothalamic receptor, it initiates downstream pathway activation, including a process that would cleave POMC from MSH to free up MSH.

Mike Mutzel: Okay.

Dr. Keith Berndtson: Well, and POMC gets cleaved in to melatonin and beta-endorphin. So if that’s not happening because the leptin receptor’s partially blocked by pro-inflammatory cytokines, then your risk for not sleeping as well, for having your pain feeling amplified, and not having this field general coordinating mucous membrane defenses for you.

Mike Mutzel: Wow.

Dr. Keith Berndtson: And then, the other one is called “basal reactive intestinal polypeptide.” So those are the three regulatory neuropeptides that can get involved in this chronic inflammatory response syndrome that we call “CIRS.” Chronic does start with the hard C, CIRS is a soft C, but if we use the hard C, it would be curse, and that just seems like piling on.

Mike Mutzel: Right.

Dr. Keith Berndtson: They’re sick enough already.

Mike Mutzel: Sure.

Dr. Keith Berndtson: So basal active intestinal polypeptide is a really big player. I mean, it’s considered a master regulator of immune function and a master regulator of blood flow distribution in the microcirculatory regions of the body. When VIP is approaching the undetectable range, it’s not uncommon for these patients to have unusual shortness of breath, air hunger at times, and at some point they get chest pains because they’re trying to breathe so hard just to oxygenate. And what we find is that when TGF-beta1, which I mentioned earlier, is active enough, it can start causing remodeling in the areas that are inflamed; and if it’s airborne toxins, the first place where inflammation starts is in the lungs and in the bronchial tree. So what TGF-beta has to do is remodel, and that often results in a little bit of fibrosis.

Mike Mutzel: Wow.

Dr. Keith Berndtson: The fibrosis involves the arterials in the lungs so they narrow, and that puts increased pressure on the right side of the heart, which is trying to take this deoxygenated venous blood and send it back through the lungs, so that again, in the left side of the heart, and then back up, and around the horn. So what happens when you’ve got this back pressure is really it becomes an acquired form of pulmonary hypertension, and this is a new understanding of a form of pulmonary hypertension that is theoretically reversible, and in practices in most cases, reversible.

Mike Mutzel: Wow.

Dr. Keith Berndtson: Because people go online and read about pulmonary hypertension, and it almost reads like a death sentence.

Mike Mutzel: Yeah.

Dr. Keith Berndtson: This is good news if you got pulmonary hypertension, but it’s this kind; it’s good news because this condition is treatable. There are several other markers, as well, so if we want to make a diagnosis, what you need are three things. You have to have a multisystem, multi-symptom illness. If you only got three symptoms, you don’t have this problem.

Mike Mutzel: Explain that a little bit so listeners can understand that better.

Dr. Keith Berndtson: Dr. Shoemaker has kept datasets for 16 years or so now. And one of the things he did was track symptoms in people, and as he started piecing together path of physiology, he came close to diagnostic criterion for the diagnosis. He found that among 37 or 38 symptoms that patients had 23 on average, whereas healthy control had three out of (I think it was) 37 symptoms. And so, you may see visible mold in your home, you may smell mustiness, you can then tell the doctor you’re mold toxic. The first question is, “Well, fill out this symptom form.” And if you only got a handful of symptoms, it’s not very likely that you’ve got this problem, because we know what happens when it gets unleashed.

Mike Mutzel: Yeah.

Dr. Keith Berndtson: You can have fewer than a dozen symptoms, at least. So a multisystem, multi-symptom illness, then we want to see that you’ve got at least one of the 12 HLA-susceptible genes, meaning that you’re not going to clear these toxins very well, so you’re going to stay inflamed because you’re retaining them. And then, we want to see genes load the gun basically; they don’t pull the trigger, you need the markers of exposure to show that the trigger’s been pulled and you’ve got this kind of inflammation. So imagine being one of the patients that we commonly see in this field who’s been to a half a dozen or more doctors, and it’s usually allergy immunology, possibly ENT, neurology, psychiatry, rheumatology, and each specialist got in-depth understanding of their field and sometimes they’ll find reasons to do their workups because they’ve got enough suspicion, but they still can’t fit them into anything and occasionally they will try to fit a man to a shoe that doesn’t quite fit, try some treatments, because the patients are desperate, but the treatments don’t work out.

Mike Mutzel: So we’re talking about the symptoms. You mentioned that if you don’t have more than, say half a dozen or a dozen somewhat symptoms, let’s go some of these. We mentioned autoimmunity; let’s talk about maybe headaches, migraines—things that people may experience that may lead to a test.

Dr. Keith Berndtson: Yes, one most common would be fatigue, and I mean the severe fatigue where it becomes really hard to function. People soldier through as best as they can until the point comes where they can’t work anymore. That’s often accompanied by disrupted sleep. We think what happens here is that the toxins and the inflammatory cascade that won’t shut off, start to wear out the buffers against anxiety and depression that are needed to help you orchestrate normal sleep—serotonin and GABA chiefly. But there are other inhibitory neurotransmitters that are breaking against these constantly and they can’t keep up. When those breaks wear out, then you’re stuck in a state of excitotoxicity; the brain is staying in this excitatory state when it should be giving way to sleep chemistry, and so that’s part of what makes them tired. And the inflammation always creates a yellow alert signal to the brain, so that keeps the slider up toward the excited part. They develop neuro-excitability manifested by increased sensitivity to light, harsh sounds, sometimes even tactile sensations; so they’re very excitotoxic. So along with that goes anxiety, and sometimes it, for reasons that are not so clear, will manifest as panic or as OCD—anything on the anxiety spectrum. And of course, when they’ve seen doctors that are not coming up with the answers and they got all this anxiety­, you know where they’re headed.

Mike Mutzel: Right.

Dr. Keith Berndtson: And they go on medications. It may move the slider a little bit, but it’s not getting at the root cause. The other thing that gets roped in is cognition, so they start noticing that they’re falling behind at some of the higher order cognitive processes like multitasking or executive function, which is being able to be organized and get through a series of tasks from beginning to end without getting too distracted or losing your way, then they may notice word-finding issues, difficulty with recent memory, but also memory consolidation—the things that you learned yesterday, you can't recall today. Circuits are not working that way they’re supposed to, and they often involve these frontal lobe subcortical circuits; there’s a whole series—five to seven of these circuits that can affect motor functions, emotions, and cognition. We even see some of the subcortical structures get involved when we do a kind of MRI image processing called “NeuroQuant;” this is a very interesting technology that has a lot of potential. What we find is that when you take a standard MRI image without contrast and run it through the NeuroQuant process, they remove the valleys—you know, the brain has the peaks and the valleys—and then they inflate it into a sphere so that all the brain regions register on the same sphere, and they analyze the volume of brain centers, right to left. And there are patterns that are showing up—patterns that, say, Alzheimer’s, or traumatic brain injury, or PTSD, or because Shoemaker’s developing enough cases and we’re going to start doing some of these ourselves, you’ve got Lyme or you’ve got mold, or you’ve got a panel suggest maybe both. But it just goes to show that what we see is enlargement of some centers and shrinkage of others, and the enlargement appears to correlate with the process called “micro interstitial edema” so it’s a micro swelling. You don’t see it on an MRI because it’s a macro image. Radiology science can’t pick that up. But when you spherify something and do the math on it, you can see that they’re swelling there, and if there’s wreckage, it usually means that there’s a (This is for the clinicians out there.) decreased dendritic pruning and neuronal growth, but both are reversible; we see it happen—these cognitive issues, and the sleep and the mood issues, and the fatigue, and so forth almost always reversible. Okay, so we’ve got fatigue, we’ve got sleep issues, we’ve got anxiety, depression, sometimes OCD, and then we’ve got cognitive issues. Headaches—headaches that seem very migraine-like, headaches that are focused between the eyes at the bridge of the nose, sinus involvement, tension headaches—they’re all part of the mix. I mentioned the sinus headaches; one of the things that associates with heavily water-damaged buildings is growth of a type of staph called a “coag negative staph” in the deep nasal space in the sinuses. The interesting thing here is that coag negative staph has been viewed as normal commensal bacteria for decades. Insurance won't cover a swab for it, but they’re not keeping up with the literature clearly, because we know that this kind of coag negative staph can be multiply drug-resistant; it’s been shown to make an exotoxin­—that’s a toxin made outside the body technically, but gets absorbed in the mucous membranes—and guess what this thing does? It seeks out MSH to field general, coordinating the defenses against it, and assassinates it—cleaved it. So nature is selecting these mechanisms for these microbes—perhaps to take care of the human problem.

Mike Mutzel: Wow.

Dr. Keith Berndtson: And it does other things, too. It participates in biofilm communities. A lot of people are hearing biofilm now. It’s a particular kind of structure, and it’s based on this notion of quorum sensing. So if there are enough bacterial and fungal strains and anybody else that got genes that can participate, when they sense that there are enough of them densely packed together…

I can empathize with physicians who might not trust the validity of these things and are hesitant to kind of step into the ring because I felt that way myself, but once you get into the current of it, especially if you start to back it up with your own PubMed searches and so forth, you find that this is extremely valid; it’s very prevalent. We can only guess, but NIOSH, the National Institute for Occupational Safety and Health, estimates that 50 percent of the structures in the country have suffered water intrusion. Now there are 350 million people in the country, so if it’s one in four, let’s just say 80 million are susceptible. Fifty percent of the buildings have been water-damaged, so let’s say 40 million—but then, let’s be conservative, say 10 percent of those buildings harbor the growth of toxic molds and other inflammogens. It’s still 4 million people, and that’s about half as much as the undiagnosed diabetics out there, so it’s a big problem.

Mike Mutzel: Right.

Dr. Keith Berndtson: There aren’t that many doctors. I mean, Shoemaker’s starting to certify doctors, and I was glad to see what a rigorous process it was. I mean, I was pulling my hair up during it. You can have a lot of confidence and help a lot of people by getting into this. I would just forecast this, too, that when regional health systems that are preparing for a global payment in advanced model realize how much cash they’re burning on especially workups that aren’t helping people like this, they might want to have somebody with this kind of expertise in house because they’ll burn less cash. And if you’re stepping up to global payments in advance, you’ve got to be a master at expense control. So just putting that out there.

Mike Mutzel: Yeah, that’s great.

Dr. Keith Berndtson: So to assess people, they have to have enough symptoms. That’s hardly ever a problem. We check them for the HLA genes; if it got at least one, then we know that they’re susceptible. And we look at the markers—we look at the C4-A, the TGF-beta, we look at those regulatory neuropeptides; couple of others I didn’t mention: C3-A, and VEGF (vascular endothelial growth factor) that can be high in almost all condition. Just to get a clear idea to whether there’s enough of a pattern of this particular kind of inflammation to make the diagnosis, and once we make the diagnosis, patients are thrilled—finally, they’ve got an explanation. Then I proceed to describe treatment their hearts begin to sink again—if it’s their house, or their workplace, or their school that’s affected because the only way to get started with treatment is to remove yourself from ongoing exposure to sick indoor air. The reason being, we’ve got binders for these toxins; they came on the market to lower cholesterol and to bind bile salts—cholestyramine and welchol. They each contain quaternary ammonium, that’s a chemical group. The nitrogen in which has a positive charge, about the same size as the negative charge in most bile toxins, and so it does a great job of binding these things. Each dose is like a bustful of MPCs waiting to be filled up with toxins and get shipped out of the body. But if you’re going home or you’re going to work and you’re just getting another ingress, you’re not getting anywhere. And sometimes, you’re immobilizing toxin in the process; when you starting shipping them out of the body instead of recirculating them, what’s happening is you’re shipping them out, and so the more loosely bound toxins in the system get drawn in the circulation. Now you’ve got a higher concentration in the circulation than you’re used to, so the inflammation’s higher. And if you’ve got that going on—plus ingress—you feel worse, and you’re cursing the day, you haven’t followed my advice. So how do you remove yourself from an ongoing exposure if you don’t have the funds to even do a mold inspection? Not alone a remediation. How do you approach working with the school district or employer or landlord about this issue? What I've seen time and time again is that the property order or the school board or whatever, when a remediator come in and do an air sample—spore trapping or something and come away with a conclusion, “What are you talking about? This building is fine.” When I come back and say, “Well, from the industry standard, okay, that’s fine, but I’m a physician treating people. What predicts who can get better and who can't in a given space is the Environmental Relative Moldiness Index developed by the EPA. A lot of remediators don’t like that test, but that’s for their purposes. I have to have it for my purposes.” They sampled us, they look for mold DNA, they amplify it; when they find it and they can tell exactly what species it is, they’ll put it in a toxin-producing category or common non-toxin-producing category, and they’ll come up with a score between -10 and 20; and what the dataset shows that if you’ve got a score of 2 or above, it’s going to be very hard for you to get better in that building taking cholestyramine when you’re welcome. And so then I’m forced to tell people, “You can remediate and clean, move, quit your job, go to a different classroom, drop out of school, or get worse.” And they’re going, “Oh, man, now I don’t wish I had this problem.”

Mike Mutzel: Wow.

Dr. Keith Berndtson: Alright. So there are social consequences—family members who don’t want to go through the stress of all this on something that’s been substantiated by one doctor. I’ve seen marital discord, I’ve seen divorces, I’ve had a couple of patients who have lived out of their cars. One found a good Samaritan pissed his tent in the middle of last winter, which is a horrible winter in Chicago; I mean, horrible.

Mike Mutzel: Yeah.

Dr. Keith Berndtson: So he’s lost his marriage, got kicked out of his in-law’s house, slept in a tent on the deck in the middle of winter, and started breathing normally for the first time in years.

Mike Mutzel: Wow.

Dr. Keith Berndtson: I would make this appeal to physicians who were seeing patients with multi-symptom illnesses. Just because labs you’ve done don’t explain what’s going on with these people, don’t assume that they’ve got a somatic symptom disorder, or that they’re depressed or anxious. There are labs that show what’s going on; they’re not making this up. An additional cross for them to bare is to be told that there’s nothing wrong, or that they’re just depressed, or that they’ve got some secondary gain going on. Understand that there are doctors who are familiar enough with this stuff that know how patients navigate this difficult path. But once you get away from ongoing exposure, you start using the binders.

It’s a matter of weeks to months before you start feeling better; as the toxin carriage goes down, the inflammation goes down; as the inflammation goes down, the body’s pathway start getting the band back together. We don’t have to do a lot of fine tuning; it just starts to come together. But it’s a grueling process where you’ve got to deal with the legal implications. And remediation—my opinion on that is get an old inspector, who’s at least open to why I need an ERMI test, who can examine for visible mold, and use moisture meters and infrared and whatever, and do a good casing of the house to come up with a conclusion, which may or may not involve a remediation plan, but if it does, let the mold inspector ride it so that the remediator does what he’s suggesting, instead of remediators that can come in.

I know there are a lot of reputable remediators out there, but there are some who are not; they’ll just insist that you need the works, and you really don’t, and it burns a lot of cash. So this is a growing, very prevalent problem. With big weather, there are going to be more water-intrusion events, and these people are wandering out there; they’re bouncing between specialty silos like pinballs, and they go online or they hear from a friend, “Here’s a doctor who might know how to deal with this stuff. Maybe you’ve got this, go check it out,” and we’ll sort it out for them. The treatment path may be complicated, but with the right kind of support, most people are getting better.

Mike Mutzel: Yeah. Fantastic. What have you found to be effective on the nutritional science? You’re using the cholestyramine, bile acids sequestrants on the pharmaceutical side. Anything in particular just for the immune system that you find to be effective?

Dr. Keith Berndtson: Yeah, so the toxin mobilization creates a symptom intensification. We equate it with a Herx that’s technically not a Herx; it’s a different thing. That’s an antibiotics showing your immune system where the action is and you feel worse for that reason, but we figured that in terms of Herx moderators. So magnesium makes a big difference. We find that curcumin especially the bioavailable forms, glutathione, alpha lipoic acid (The sustained release alpha lipoic seems to work better than plain alpha lipoic.), Epsom salt soaks, Alka Seltzer Gold. There are some homeopathics and botanicals out there that can help a little bit. For lifestyle, medicine doesn’t become a non-issue here just because they’ve got this condition; they’ve got to get plenty of vegetables. Ourselves have figured out how to solve lots of problems using phytonutrients that come in through the diet, and I describe earlier how much these toxins can mess with cellular metabolism. And then, decreased junk and fried food and so forth. You know, the usual. I hear some people doing better on a Paleo or modified Paleo. Some people on a lower carb, some people are vegetarian or vegan, others are doing FODMAPs diet, and so forth. It’s unclear at this point whether a particular approach to diet helps more than just avoiding junk and getting whole food. Exercise is an issue for them; they have approached it very carefully—they’ve got a decreased aerobic threshold so when they push it too hard, they can crash for a couple of days, just like a chronic fatigue syndrome patient. At the same time, we want them to do something for five minutes for a week, and if they tolerate it, then we see if we can make it 10; it might be with hand weights or stretches or something like that to begin, and it might turn into something mildly aerobic over time, but it just doesn’t work very well to get the inflammation down.

Mike Mutzel: Sure.

Dr. Keith Berndtson: But that’s a good question because we should never forget the foundational stuff.

Mike Mutzel: As we wrap up—there are so many different labs here—from HLA-DQ, MSH, leptin, VIP. Is there a one package or panel? If someone has all these signs and symptoms and maybe doesn’t have access to a practitioner like yourself, but they can work with a practitioner to get some of this testing done. Is there any go-to?

Dr. Keith Berndtson: Yeah, you need the genetics—HLA-DRB1; HLA-DQB1; and HLA-DRB3, 4 and 5. I’m sorry, I didn’t invent this nomenclature. This is why we use the Rosetta Stone to translate it. But you need that, you need a TGF-beta and a C4-A. That’s the very minimum.

Mike Mutzel: Okay.

Dr. Keith Berndtson: If the C4-A is high and the TGF-beta is high, we know that something’s going on. C4-A reacts to biotoxins. TGF-beta can be elevated for two reasons; one is it’s trying to suppress an overactive immune response, like an innate immune response that cannot get out of this loop that it’s in—that’s in the bloodstream. In tissues, TGF-beta seems to activate Th17 cells which are like cytotoxic T cells. So when we see a high TGF-beta1 level, we get a portion—you know, the relative contributions of those two—but it doesn’t matter, we know that that’s a problem either way. We like to follow some of the other markers to gauge progress, but they are expensive, and usually, insurance is covering them; we haven’t had any pushback, except for the very tiny insurers who have to push back against everything.

Mike Mutzel: Right.

Dr. Keith Berndtson: So yeah, the HLA genetics, C4-A, TGF-beta—that’s enough to kind of decide whether you’re in this category or not.

Mike Mutzel: Now what companies package that together? Do you have any go-to that you recommend?

Dr. Keith Berndtson: Well, I use Quest only because they work so hard with me to make sure that the difficult drugs get processed properly.

Mike Mutzel: Oh, okay.

Dr. Keith Berndtson: If you walk in to any of the phlebotomists with one of my orders, you’ll see the blood rush from his/her face. You may have to pick them up the floor.

Mike Mutzel: Right.

Dr. Keith Berndtson: Because there are like five frozen specimen; they have to go on dry ice, and then there’s a tricky double spun processing that has to be done on the MMP-9. And so we spent a lot of time working with Quest, and they’ve been very responsive to every little wrinkle that we throw at them.

Mike Mutzel: Great. That’s awesome. So as we wrap up here, Dr. Keith, how can practitioners and patients learn more about your work, your website, and how can they contact you?

Dr. Keith Berndtson: Well, you can go to Park Ridge MultiMed. I’ve got some slides posted under mold toxicity. There is some overlap with Lyme, too, because we know that Lyme’s spirochetes have plasmid DNA, and there’s at least one study that identified the toxin that they can produce. Bacteria and fungus strains produce toxins in their own defense. But if you’ve got Lyme and you’ve been treated with aggressive antibiotics for a long time and you’re not getting better, we have to wonder if it’s because you’re not getting rid of the biotoxins that they made. And you may have beat Lyme in the submission, but the reason you’re still sick is we’ve got to deal with the second thing that’s inflammation that’s caused by biotoxin. So those new are covered on the website. Park Ridge MultiMed is taking these kinds of patients, so people can call to schedule or more. There’s a lot of information on survivingmold.com, Dr. Shoemaker’s site, especially for physicians who are interested as to whether they might want to get into this or now.

Mike Mutzel: Sure. That’s really great. That’s survivingmold.com?

Dr. Keith Berndtson: survivingmold.com. Right.

Mike Mutzel: Fantastic. Thanks so much for being here.

Dr. Keith Berndtson: My pleasure.