Basics of My Approach
I was originally trained by ILADS to treat Lyme and coinfections. The pinnacle of my training was with Dr. Bernard Raxlen in New York City, back in 2008. But after a few years, I was frustrated by the twenty-five percent or so of my Lyme patients who had trouble getting better, despite my education and clinical experience. I knew there was something missing. While researching detox options for Babesia (a red-cell parasite passed by ticks), I came across Dr. Ritchie Shoemaker, the real pioneer of mold toxin illness. At that time he was just starting his new mold website and was offering a certification program. After doing some research and implementing some of his detox protocols and recommendations regarding both lab testing of patients and mold testing of buildings, I realized this was the “missing link” I’d been looking for. That segment of my patient population that was stuck started to get better. In 2013, I became the 3rd doctor and the first naturopathic physician in the US to be certified through Dr. Shoemaker’s program. With time, learning from colleagues and clinical experience my approach has changed from strict “Shoemaker Protocol” medicine to something more, but his research forms the basis of what I do.
Protocols are funny things: as a doctor, it’s tempting to rely on cookie-cutter medicine because it relieves you of the burden of having to recreate from scratch a plan to get your patient better with every new person. But as a naturopathic physician, I was taught to approach every case with understanding of the person’s uniqueness. Naturopathic medicine is individualized medicine.
An example of how protocol medicine does not work well: Sometimes patients come to me after having read about the Shoemaker Protocol on-line, and having tried to implement on their own or with their untrained doctor’s assistance. Commonly, the patient and/or the doctor has read somewhere on-line about using Cholestyramine powder to start the detox process, and they’ve done this at the standard dose of 1 packet, mixed with water, four times a day! This is a recipe for disaster, and quite possibly an emergency room visit.
So, in general terms, realizing that the patient’s symptoms and the other illnesses, intolerances, family histories, and vulnerabilities they have come to me with deserve attention, this is how I treat mold toxin illness, most of the time, in order:
1. Do testing and get a proper diagnosis
Mold toxin illness can look like a lot of illnesses, and vice-versa. There’s no point in treating the wrong disease! See more on tests I do.
2. Remove from exposure
First, figure out if the patient is currently exposed, or their exposure is from sometime in the past (see Environmental Testing). Patients need to be in a clean environment to get better. If exposure is current, we figure out how to make it tolerable. I often refer them to a few select IEP’s (Indoor Environmental Professionals) who know how buildings make people sick and how to fix it (believe it or not, not all do). I have three in the U.S. who I refer people to.
For the best and quickest results, patients stay out of any moldy or water-damaged building, including school, work, church, vehicles, and other people’s houses during this part of treatment. Some situations can be remedied by thorough cleaning and the use of air purifiers. Every person has a different tolerance for mold; we need to get their environment “good enough” for them to get better, which may take some investigation and elbow grease (see more on cleaning), and possibly avoiding certain activities for a time.
3. Start detox
I almost always use binders like Cholestryamine or Welchol to start, but if people are very sensitive I might start with a supplement like Binder Blend (it contains charcoal, chlorella, bentonite clay, and slippery elm). For children I almost always use Welchol because it is the best-tolerated. Also see detox supplements and medications
To speed things up, I like to add IV nutrients with NAD+ and peptides at this step. NAD+ helps with energy, mood, sleep, and is a cellular-level detoxifying agent. It’s important to go very slowly with NAD+ at first so that detox is not so fast that the body is overwhelmed. I will often use 10-pass ozone via IV as well. This helps the oxygen-deprivation that many patients experience. It’s also great for bacterial infections and chronic viruses.
Detox improvement is demonstrated by Visual Contrast Sensitivity (VCS) testing, symptoms, and sometimes mycotoxin testing in the urine (see Tests).
3a. Address Underlying Issues
This step generally overlaps with the detox step. Many patients can benefit from some IV peptides early on in treatment. I choose peptides based on the individual, and might include Cerebrolysin for cognitive issues and brain inflammation (biotoxin illness is a brain injury), Thymosin beta-1 for immune support, especially chronic viral infections, Thymosin beta-4 for musculoskeletal issues and pain, and many others. Peptides are some of the safest medicines I know of.
I have also been trained by William Walsh in treating mental-emotional disorders using nutrient therapy. Oxidative stress from biotoxin illness can create these nutrient deficiencies. If depression, anxiety or ADD symptoms are prominent, I do nutrient testing and rebalance any deficiencies or excesses, either orally or IV.
If GI symptoms are prominent (nausea, reflux, diarrhea, constipation, abdominal pain, or the person has autoimmune disease), a stool test is done and we treat any infections, flora imbalances, gut immune issues, or digestive imbalances during this step. Detox is an important result of digestive health (see Tests).
If histamine intolerance is present (hives, itching, sensitive to high histamine foods, stomach pain), we address this with supplements and/or nutrition choices.
If patients have the time and are willing, I might introduce DNRS (Dynamic Neural Retraining) or Dr. Gupta’s Neural Retraining program (book and/or program link).
4. Treat MARCoNS (see test)
After at least a month of detox, treat MARCoNS if the nasal swab test is positive for this bacteria. Nasal spray for 30-90 days, in most cases, is used here. Nasal sprays might include silver; nystatin, itraconazole for fungal fragments; EDTA or other agents that break through the biofilm layer (protective covering surrounding bacterial colonies); budesonide or cromolyn sodium, for allergic symptoms and swelling; and Mucolox, for helping the nasal spray medicine adhere to the nasal tissue. Sometimes nebulized JUWA Nebuilzer Machine or Compact Piston Compressor Nebulizer and Sea Minerals are also used.
5. Lower MMP-9 (see test)
A low starch diet, omega-3’s, herbs like curcumin, resveratrol, boswellia, SAM-e, methionine are choices depending on individual needs. Usually this step takes 30-60 days.
6. If passing VCS, MMP-9 under 350, and MARCoNS is gone, do a VIP nasal spray trial
In the clinic or in the lab, patients are given a test dose of VIP nasal spray (another useful peptide!) and blood tests are done both before and 15 minutes after this first dose. If inflammation goes down (or stays the same, but doesn’t increase) we are good to go on using VIP. This is important for down-regulating any inflammatory pathways that are still in motion on the gene level, as well as restoring oxygen-carrying capacity, lowering chemical and mold reactivity, and normalizing hormone function.
If blood pressure is normal to high, I often use the blood pressure medicine Losartan to lower TGFB-1 after the VIP trial.
7. Reintroduce to indoor environments
With the aid of binders, if needed, continued VIP spray, and possibly DNRS, patients are encouraged to start visiting buildings and getting used to going places that might have been intolerable to them at the beginning of treatment. Eventually, people are able to leave their daily VIP behind and use it as needed for a big exposure (out of an abundance of caution rather than guaranteed return of symptoms), along with binders. Eventually, people should be able to return to normal life without any aids at all.
Dr. Robin Thomson
