with Dr. Ben White and I am so excited to actually today be interviewed by him on mold toxicity and Dr. White is in Santa Monica, California. Hopefully the weather is better than it is here. It's 36 and snowy. It's about 75 degrees and sunny right now. Oh, lovely, lovely. Well, I'm going to hand it right over to you. We're going to switch roles a little for my Facebook lives. Kind of like you do for your podcast. This is going to go to both outlets, but I will just hand it right over to you. Awesome. Thank you, Jill. So our topic for today is toxic mold. It's effect on our bodies, how to get rid of it and how to get rid of it with Dr. Jill Carnahan. Exposure to mold and mycotoxins can affect many people and is often an undiagnosed underlying trigger for many other symptoms and conditions. Many people are unwittingly living or working in water damage buildings and this exposure can be causing many negative effects on their health and not only can mold and mycotoxin exposure cause a host of symptoms that we will go into, but it can also be an underlying trigger or root cause for many other serious health problems, including affecting our hormones, thyroid, adrenals, fibromyalgia, hypertension, heart disease, autoimmune diseases, Crohn's disease, Alzheimer's and even cancer. When looking at a patient from a functional medicine perspective, we usually focus on likely underlying triggers and root causes of their health condition and mold may be one that is frequently overlooked. Dr. Jill Carnahan is a medical doctor who runs the Flat Iron Functional Medicine Clinic in Louisville, Colorado. Dr. Carnahan is one of the first 100 doctors certified by the Institute of Functional Medicine. Dr. Jill is a survivor of breast cancer, Crohn's disease and mold toxicity. That's quite a lot to be having gone through in your life, Jill. Dr. Carnahan is a sought after speaker at conferences when we use staff conferences and often teaches other health care practitioners the functional medicine approach and she's one of the most recognized experts about mold and mold toxicity, which is our topic for today. Thank you, Jill, for joining me today and for me, thank you for letting me join you on your Facebook live. Yeah, thank you, Dr. Weiss. I am delighted to be here.  Sounds good. So why don't we start by, perhaps maybe you could tell us a few things that are not commonly known about mold and mold toxins. You got it. And I'm going to go into just a two second version or quick version of the story because story always drives what I do. 2015, after the huge flood in Boulder in 2013, I realized that my office had mold in it and it had been causing, which is some of the symptoms we'll talk about for me, respiratory issues. I had shortness of breath, trouble running, difficulty catching my breath when I'd walk upstairs. I had a more brain fog trouble with words and names. So finding like, you know, names and words of things, I'd say cat instead of dog or something like that. And I noticed when I was typing emails or letters, sometimes I would actually type the wrong word too. Now cognition problem solving wasn't so affected, but it's weird how mold can kind of selectively affect portions of the brain. The other thing I noticed was focus and concentration. So where I could maybe write a blog in an hour before it took me a little bit longer to really focus and concentrate and be productive. So all of those things and then mold can trigger a mass cell response, we'll probably talk more about that and cause histamine issues. So for me, I had rashes and highs and I had swelling of my lower extremities.  It was really severe. I had redness in my eyes. I had congestion in my sinuses. I had more acne breakouts. I had skin lesions on my scalp. And I could go into more, but those are just a few of the things. Some of the unique things you ask about. Some people have kind of electrostatic charge on the surface of their skin because they're sweating out sodium, they're losing sodium. And so they create kind of a gradient or a battery on their skin. So it's not uncommon to have electrostatic shocks when you touch metal or doorknobs or to actually break watches or computers if you've had mold exposure. That's one of those really unique things. And another thing, frequent urination, which is along the same lines because your body, the ADH, the anti-diarrheic hormone, which controls our hydration is dysfunctional. It goes very low. So you don't conserve water.  And a lot of these patients will get up during the night three, four, five times to urinate at night during the day. And they're walking around, they can be drinking loads of water, but they're chronically dehydrated because they can't maintain the volume in their vascular system. Some of the other things that happen are there's an enzyme called aromatase, which up regulates and converts all of our hormones into estrogen, especially testosterone. So men will have man boobs, weight gain around the middle, decreased libido drive. Women will have excessively heavy periods or painful periods, or they'll have fibroids or endometriosis or all kinds of things to do with estrogen dominance. It affects, like I said, mast cells. So histamine reactions, more sensitivity to foods. And we didn't even talk about the gut, but mold will directly affect the integrity of the gut lining, causing leaky gut and causing more sensitivity to foods and more issues with the gut as well. So tell us a few things that we didn't know about mold and mold toxins, things that aren't commonly discussed. Yeah. So did you know mold can cause increased risk of infertility in both men and women? So this is interesting. Yeah. And it's interesting because a lot of our studies on mold come from, so the animal livestock industry is a big one because a lot of the food can be contaminated with mold. And so for the farmers who raise cattle and pigs and sheep and all these animals that could have contamination in their food, they see a loss in the bottom line dollar when there's mold contamination in the food because they don't produce, their herds don't reproduce as well. So they have notice fertility issues. They have rashes just like humans. They have gut issues just like humans and all kinds of things. So you've seen these. So in the animal studies, they'll show these. And then of course, it's very, very similar in humans, but there's lots of research on mold contaminated feed and cows and pigs and all of these things, especially fertility. That's fascinating because when working up a patient for fertility problems, I don't think many people consider mold as one of the possibilities. We're looking at thyroid, we're looking at a whole lot of other things, maybe toxins in general, but we don't really typically think about mold. Yeah. Some of the other unique things, Alzheimer's disease, Dr. Dale Bredesen works a lot with Alzheimer's patients has written multiple books on the topic. And he claims that one third of the patients that he sees half mold related Alzheimer's. He wrote a paper about five years ago now called Inhalation Alzheimer's. And it was basically related to inhaling mycotoxins from mold going into the cribiform plate right into the brain and causing dementia like symptoms, especially in someone who's like in their fifties, they're so young for Alzheimer's. Like I've had a case, for example, an attorney 55 years old who all of a sudden can't practice because of dementia like symptoms and it was all related to mold. A few other unique things would be, like I said, the gut issues like it can present with Crohn's or colitis inflammatory bowel disease because it has a massively inflammatory effect on the gut lining. And so some people will present with auto immunity of other types as well. Mold can raise TGF beta, which is one of the drivers of auto immunity. And so if patients have that process going on, they might present with MS or Hashimoto's or Lupus or Crohn's or colitis and it actually be mold as the underlying cause. Interesting, interesting. So, you know, a lot of the medical profession today, the conventional medical profession has traditionally been very skeptical of this concept of mold toxicity. Are they starting to come around to accepting that this is a common problem for patients? Yes, just like mold, this is a sticky situation. And it's interesting because I've had even people almost anchorly. I get the double entendre there sticky in terms of possibly legal issues. Yeah, exactly. And you know, it's interesting because I've even had patients on Facebook groups and things either kind of angry because they're like doctors, why don't you do something about the way that we can't talk to our landlord and there's no regulations and the entrances aren't reimbursing. And granted, I mean, what I like to do is stay in my lane, which is I'm a physician, I take care of patients. I don't, I mean, what I do is I know, know the experts who deal with the environmental issues like environmental air quality specialists. And I know enough to help them navigate that world. I think that's important. But I'm not a, I'm not a person who can remediate your home.  Again, we stay in our lane, but I think we need people of more awareness. I think it started way back mold is super common. Insurance companies know this, there's about a fourth of all homes and buildings in the US that have some sort of water damage. And we could even expand it when I say water damage, what that includes is anything that's, we used to have homes that were built up more like stone or brick. And that's very impervious to mold. Nowadays we have these nitices that are basically like cardboard. So our drywall or sheet rock, which is very, very commonly a source or a problem with mold. If it gets wet, it's the perfect growth substance for mold. And most houses now are more quickly constructed with these types of materials than the materials that are used are more prone to mold. And then during the construction process, they can bring in wet woods that, you know, maybe have mold already starting to grow on them. Or even in during the construction process, depending on where it's being constructed, it can actually rain in the house while it's, you know, open and all of these things. And then as you build a house, you can have washers, dryers, you can have windows that leak, you can have poor construction and more and more. There's quick and construction methods that aren't as detailed and done well. And so there's more likely for problems even in new homes. Yeah, I've actually heard a similar problem in, and this is especially the case for some reason in California, they tend to build a home so airtight that there's no ventilation. So in between the walls, if there was a little bit of moisture, that venting would decrease the likelihood for mold, but they make them so airtight that any moisture in there is more likely to cause mold. So you can have poorly constructed homes, you can have homes that maybe are too tightly constructed. Yes, that's 100% true. In fact, I talked to a, you know, a highly paid investor in New York City that was part of the LEED certification. So this is a certification that certifies the greenness of the building. So the kinds of process that are the building materials that are recyclable and the airtightness of the efficiency of the building. And what's happened in some of these buildings, not all of them, but they're super efficient. And by nature, they are very sealed from the external environment. And so that breathability of the building can be an issue, because I'd rather be in a 100-year-old log cabin than I would in one of these super airtight, efficient buildings that has no airflow. Some of the times when you have a patient with a mold in their environment, just opening the windows and getting a little airflow to dilute, we always hear this, it's not, I'm not the original, but dilution is the solution to pollution, which means as soon as you get some outdoor air in there or you get a fan bringing some airflow in, that will automatically decrease the toxicity of your internal environment. So that can be part of the solution. So when you are going through some of the symptoms of mold that you had, and a lot of the symptoms that other patients get, they're common to many other conditions. So when you have a patient that presents with some of these symptoms, what really alerts you to the thought that they might be dealing with mycotoxins? Yeah, I love this question, Dr. Weitz, because one of the things patients always says, oh, it's so expensive to see a functional doctor or a functional chiropractor, or to do all the testing. And I would say that just by taking a great history, I am usually 95%, maybe even a 99% accurate on where the direction needs to go, and if I think there's mold involved. And that's just a history, which granted, the office visit is part of the expense, but it doesn't take a lot of expensive testing. So usually I know before I do the test, the direction I'm headed, and my office staff jokes with me, because my batting average is like 100%. It's like, so far, there's not one person that I've suspected of mold that hasn't had the lab results to back it up. But the questions are important. So let's go through a few of those. I'll often ask, when did you first start feeling poorly? Because the timeline in my mind is so critical to 10 years ago, 20 years ago, five years ago, oh, when we moved into that new house, that's a big one. And if the other family members also have some symptoms, they may present differently, the daughter may be perfectly fine, the son may have depression, the dad may have congestion, and the mom may have chronic fatigue and fibromyalgia. So it could present highly differently among the individuals with some of them being less affected. And that's because there's a genetic variance in our ability to get rid of these antigens, these toxins from her body. So the say the mother's extra symptomatic, she might have more difficulty in tagging and getting rid of these toxins from her body. But all that to say it can be variable. So history is key. And then I'll ask them, if I just ask someone, do you have mold in your home? Everybody says no, I'm fine. Or there might have a musty smell, but it's like mildew. And that's just not true. So first of all, musty smell is VOCs, volatile organic compounds released from mold. So there is an issue if there's a musty smell somewhere. Second thing is, you have to ask the right question. So are there condensation on your windows?  Does the wash or gasket rubber smell when you open that up?  Do you have a tile or grout that's discolored? Do you have leakage around the shower pan? Is it properly sealed? A lot of people don't know some of these really expensive types of tiles that go in beautiful, you know, multimillion dollar homes and bathrooms are actually quite porous. So if your contractor has not put a vapor barrier or a sheet between the tiles and your wall, you can have, I just saw a beautiful multimillion dollar home was loaded with mold in the master bath, nothing visible. And what happened is they had slapped up tiles right up against drywall with no barrier. And these are permeable tiles. And after eight years, there was massive black mold all underneath there. And there was nothing visible. The bathroom looked beautiful. So all of these kinds of things. And then basements. So there's crawl spaces. If they're earth crawl spaces where there's damp moisture, and that is venting into the home. If you have a sump pump that's open and enclosed, and there's water that's standing anywhere in your home. If you have water that seeps in through the landing, and there's no barrier there where you get condensation or water into your basement. There's so many different ways this can leak in. Attics can be a big place. So if the attic isn't sealed, and there's lots of heat and condensation, those can be a big place too. So part of that is looking for the problem. And then also eventually a good remediator will seal off your wall cavity from your home environment so that you're not getting that air from the crawl space from the attic, or from the in-between walls to exchange into your home. Interesting. So have you ever had a patient, for example, as a way to test if they're dealing with mold, have them just go out of their home for a while, take a mold vacation? Yeah, so often I'll just ask the question. Nowadays no one's going on vacation, but before I would ask, have you been to vacation or gone for 10 days or seven days or a period of time, and did you ever feel better? Now interestingly, I've had a couple situations. One patient of mine, I always suspected mold. She had recurrent colitis and fatigue, and she had infertility and amenorrhea. So stopped having menstrual cycles. She's in her 30s, so she should be normally cycling infertility and then the colitis and fatigue. And she had a condo in Winter Park in the ski area and then a home in Boulder. And she always said, well, I feel poorly at both locations. So then you're like, well, maybe no mold. Well, she went camping for 10 days. And she said, Jill, Dr. Jill, my colitis went away. My fatigue was amazing. I didn't feel fatigued. And of course, her cycles didn't start back in that 10 days, but a lot of symptoms improved. We found out both her ski home and her home in Boulder both had mold. So she posed at both places. So what's the best way to test your home for mold? Yeah, so this is also a tricky one because there's a lot of inspectors and remediators that don't really like early testing. But what I like about that is it's so early testing, what is it? You can get a test sample of the dust in your home. If you do this, the couple rules about it are you want to get it from two feet above the floor so you're not getting like outdoor dirt and stuff tracked in. So maybe it's shelving or door handles or kitchen cabinets or things like that, or shelving in your living room or like behind me here. But you wouldn't want to get on the floor itself. And then you want to wait like seven to 10 days after your cleaner so that you actually have some dust accumulation. And you can collect the sample yourself and send it in. There's Environ Mentobiotics. I'll have to get the name for that for sure and post it. And then there's Micometrics. There's a couple companies that do this. And then you get a readback of the PCR, the DNA of the mold that's in your dust. And even though that's not perfect, and I actually don't use the Ermey score, I just look at the individual molds, I can often tell if there's a big issue because if there's like 30 of ketomium or stachy batteries on that test, that's a big problem. Even if there's five of some of those really toxic molds, it's a big issue. So I will often look at that. And then that can tell us do we need to get an inspector in or look further. Ideally, everyone would have a complete inspection, but that can be costly. So I'm always kind of weighing the balances of the cost. And I do still feel like Ermey is good. And then there's those little plates that Petri dishes you can buy at Home Depot or Lowe's or any, you know, to store. And you can put those out in your house. And here's the cheap and easy way. You don't even have to send them in. If you just want to gestalt, you can set them out for 24 hours and then cover them. You can put them in different rooms and then you let them grow. I think the kids are like seven to 10 days. You can look at the colonies. If there's zero to four colonies growing of anything at all, that's pretty normal. If there's five to eight colonies, that's a moderate problem. And if there's nine or more, that's a big issue. So even though that's not perfect, these are a little very inexpensive ways to test to start the process. So how do you test the patient for mold? What's your work up in terms of testing? Yeah. So like I said, I don't want to forget history because that's free and a good clinician. Yes. Great questions. And then two things that are also free in my office. I have a screening cluster symptom analysis where I have them check off boxes. And there's a scoring system that tells me there is more likelihood of mold or not. And then the second thing is a visual contrast test, a VCS test. You can do these online for free or Dr. Shoemaker site surviving mold.com has another one. I think it's five or $15. That's the one I actually prefer, but they're both excellent. And in my office, I actually do this in person. So we have an actual visual contrast board and my staff knows how to do that. And that will test for this visual acuity. What happens is when we have biotoxins from mold, they affect our retina and our retina's ability to differentiate black and white lines. And so you'll actually, these are little circles with black and white lines at different angles. And so as you do it, you hold one eye closed and you say, oh, it's left, right, central and left, right. And if you miss those on some of the smaller lines and increments, there's a more likely chance that you have had a biotoxin exposure. Do you ever start to treat a patient as a result of history and maybe a questionnaire or the visual contrast test without doing lab testing? Yeah. So, and I didn't get to lab tests, so I'll get there next. Oh, I know. We're going to do that. So, yeah. So say someone comes in, they have a positive visual contrast. They're highly symptomatic. It all started when they moved to this home. There's a musty smell in the home. And then three people in their family are also sick. I'm like, okay, there's a little high likelihood. What I know to be true is they're going to eventually need to get away from that exposure, remediate or do something. But in the meantime, some sort of a binder, which we can talk about, and some basic liver support, things like glutathione or the precursors like NAC, NAC, lipoic acid, vitamin C, glycine, glutamine, those can all be helpful. And they're pretty safe for all of us, especially we start low doses and work up. So I'll often start a detox protocol no matter what. And you ask about other testing. So I do use urinary mycotoxin testing. There's a lot of controversy about that. But I do believe after five years of doing this on many, many, many patients, thousands of cases, I see a very good clinical correlation. There's three labs that do that right now. There's real time labs, there's great planes labs, and there's vibrant labs, and they're all excellent. There's different variances depending on them. And I do have my favorites, but those all are good test companies to use. There's blood work.  And those are serum labs that can be done in any lab. Right now, I use LabCorp, but you can use typical hospital labs will sometimes do them. It's a little tricky to get some of them on Quest, but it can be done as well. But those are kind of options. And those are the things. What do those labs actually tell us? Yeah, so there's a term that Dr. Shoemaker came up with called Sears chronic inflammatory response syndrome. And it was his way of describing this inflammatory response from a water damage building and all the inflamagens. And when I say inflamagens, I'm broadening it, there's molds clearly and microtoxins, but both bacteria can grow there. And other things like methyl brevi and algae and candida can all be in a water damage environment. So it's not always just mold. But all of those things can trigger an immunological response in the body. And it's not just the mold attacking the body, but it's actually the mold causing immune activation. It's very similar to COVID and the virus with this IL-6 response in this immune activation that causes collateral damage and side effects. It's very, very similar, both the virus and then things like lipopolysaccharide, gut toxicity, so leaky gut can cause this and so can mold. So many, many things cause this inflammatory response in the body. And when I mentioned those labs, it's basically looking at all of these inflammatory cytokines and saying, are many of these that are common to mold active or abnormal? And if most of them are abnormal, it paints a picture for more likelihood of mold being part of the picture. So here's a question. First, say a practitioner like myself who's a chiropractor. When I send patients out for serum labs, I'm assuming they're not going to be covered by insurance. You might have different experiences as a medical doctor, but we're assuming most of the time it's not going to be covered. Let's say I have a patient who's a little bit cost sensitive. If I was going to choose between the urinary mycotoxins and these blood biomarkers, what do you think is the best bang for your buck? Yeah. So the urinary biome, well, first of all, urinary mycotoxins, I do on almost everybody. And again, you have to know, first of all, what you have to know is it is excretion. So number one, you could have a patient who is so toxic, they're not excreting, and you get a false negative with nothing in the urine because they're so toxic, they're holding onto it.  And they're not fine. So that's one thing. Number two, if you start treating a patient, you're actually pushing that detox pathway and you want that to go into the urine and be excreted. So a lot of patients after two months will be like, Dr. Jill, can we retest the mycotoxins? I can say we can if you want, but guess what? It's probably going to be higher. And we want it to be higher because you're excreting. So as a physician or a patient, you have to know when you're testing. I will, as a rule, unless a patient absolutely begs or demands to be retested, I won't test before six months after treatment. And even then the levels might be higher. So knowing what you're doing and then mycotoxin testing range from $300 or $400. So while it's not cheap, if you have to have one thing, it kind of guides. And now we have more data on the types of binders and treatments and pathways for each toxin. So that will actually say I have ochrotoxin versus a T2 toxin or gliotoxin. I might use different binders and different pathways for that. So that actually guides my treatment. So that's my number one test. But again, you have to know what you're doing because it's not perfect. You have to know your measuring excretion. Number two. By the way, where's the best source for that connection between specific binders for specific mycotoxins? Yes. So Dr. Neil Nathan has written about it a little bit and he just posted some work on his blog. And then in his book, it's also available, I think, in a chart with the binders. Dr. Herrera, who's an expert on mast cell, has done some work as well with the pathway. So I think in her website, she has it posted as well. And I think that's mastcell360.org. If you just search Beth O'Hara and MCAS, you'll find her website. And of course Neil Nathan as well. He's an MD. Those are some good sources of that information. Blood work for patients who can't afford it. So first of all, I do often get it covered. Not always. And if it's not covered, it's really, these are thousands of dollars. The lab core can be so expensive. So you're right. But there's a trick. Life extension has navigated a discount with lab core for, it's called the mold biotoxin panel. You can go on it as a patient, order it yourself. It's usually three or four hundred dollars spent on if it's on sale or not. So still rather, I mean, there's hundreds of dollars, but way better than thousands of dollars. And a patient can actually order this themselves. So that's a way that I'll do it if I want. And it's only five of the markers, but it's, it's pretty helpful if that's all I can get. It's a way cheaper price for the patient to get it directly from life extension. And that's basically not measuring the mold, but it's, it's measuring whether you're reacting to the mold, right? Yeah. And again, it's kind of this, I have, if I had a million dollars for every question that I had was what's the one test for mold, right? We get that all the time. What's the, what's the one treatment or the one test? There's, there's no one test, but kind of again, so I look at the one pill, the one pill, the one test, I wish we could give it to you. Well, actually, I choose just another study about the poly pill. There's one pill that everybody could take that would promote your long-term health. Gosh, if we only had that, right? But you and I practice individualized medicine. There's no one size fits all. Of course. I have, I have a lot of colleagues who have protocols and I have no disrespect for them, but I like have resisted so hard. I really, truly don't have protocols. I do some of the same things depending on the situation, but every patient's individual, and I like to treat them that way. So we talk about testing and cost. And then your last question, let's see, you would ask about the direction to go, depending on, oh, if it, if it, if there was one test, yeah, there really isn't. I know, I know. Okay. So, what was I going to say? So let's get into treatment.  Yeah. And let's talk a little bit about this, because the confusing thing is, if you have a remediator that is not aware of the sensitivity of the types of patients that we see. So a remediator is somebody that you pay who comes to remove the mold. And they have a specialty in that. Yes, yes.  IEPs are indoor air professionals. And like, for example, I'm on the board of ICICI.org, but there's no, this is nothing paid, but it's a great resource. It's all free. It's International Society for Environmentally Acquired Illness.org. So, I-S-E-A-I.org, free resources, free professionals that have been trained in mold. If you're looking for some resources, that's a great place to start. And there's blogs and things on there. I think it's a nonprofit. They teach physicians. And I just love mold and love teaching. So I'm part of them just for that sake. But that's a good resource to start with. And same with surviving mold.com, which was Dr. Shoemaker's website. He has a lot of free resources and literature there, if you're wanting to start on the journey. But back to remediators. So, remediators, indoor air quality professionals might be someone that either virtually or in person looks at your quality of air. And they're beyond the scope of just mold. They might look at radon. They may look at EMFs. They may look at a broader spectrum of air quality. Remediators in the mold industry can be a varied batch. I kind of like to joke. It's like used car salesmen. There's some wonderful ones and there's some, not so wonderful ones. And so you got to know who you're dealing with because you might get five different answers from five different remediators. The main thing is, number one, they have to have containment and negative air pressure so that the rest of your home doesn't get contaminated while they break down that wall and take out the mold. Number two, if they're not wearing personal protective gear, that's a problem. They don't know what they're doing because mold is super toxic, even to someone who doesn't feel it over the time, over years. And by the way, protective gear, it doesn't mean one of those really inexpensive masks that they get from home people. It really should be a high intensity. What's called a ventilator? Yeah. And nowadays we know because of COVID, the N95s, that's a minimum. And I'm talking N95s with the charcoal filters like the paint used. And ideally, they have a complete suit. And sometimes in the severe cases, they'll have complete their own air supply. That's a little less common, but I have known situations where they're so bad that they are completely, almost like in an astronaut type of get up with their own oxygen and own air supply.  But I might not smell it or see it. And so patients are confused because like there's no mold in my house. I don't see anything. Most of the time it's not visible. So it might be behind this wall because there's a pipe that burst and it leaked into my home or in my basement and caused damage behind the wall that's not visible. So you might not see it, you might not smell it, but those toxins released from the mold could still go into your air supply. So say that's the issue, the remediation would have to come in, put off plastic, viscane, put off negative air pressure, come in and take out that piece of the wall, replace it. And that's not the end of the story because number one, they have to do that appropriately. And then after that, you need to clean your vents and clean your house because that mold has been spewing toxins into your environment. And that dust left in your house, that's what we check with an ERME test, can still cause illness in someone even after the main mold source is gone. So typically what I recommend is get a remediator, get the source out, get the crawl space fixed, get the attic fixed, get the sump pump fixed, seal the windows, do the work. Then number two, clean your HVAC system if you have one because that's been circulating toxins and dust and you clean that first. And then number three, a small particulate cleaning or somewhere where you have someone completely, there are instructions for this, you can get it from your IEP, you can do it yourself or hire someone. And they literally wipe down every surface of your place. And then you want to get rid of porous materials if you've been really affected, that would be like the books behind me. If you're, I don't really love to tell people to get rid of everything in their home, I don't think that's the right way to do it. But a lot of times those porous materials like paper or things that you can't clean easily will continue to make you sick. So if in question, like say these books behind me, you could store them in a plastic bin while you get well and then go back later and open it up and see. And then after the small particulate clean, some people will do a fogging or they might do the fogging with an enzyme and then a small particulate clean in that order. Before we get into the rest of the treatment, I wanted to bring up a point of confusion that sometimes comes up when I discuss this topic with patients. So there are some related conditions that are different. So you can have exposure to mycotoxins just like you were talking about. You can also have fungus growing inside your body, it can be growing on your lungs, it could be on your skin, it could be under your fingernails, it could be in your vagina and other organs. And then you can have fungal overgrowth in GI tract like Candida. How related are these? How should we think about these? Oh, I love this because this is one of those kind of secrets where I'll see people who have been to, you know, five, 10, 20 other doctors and they're still not well. And understanding that you can be colonized or infected with molds or with fungus is really part of the puzzle. There are some doctors that teach that that doesn't exist. Well, there's tons of literature to support the fact that you can have aspergillus in the sinuses, in the lungs, in the gut. I mean, it is very well documented. This is not anything new. In fact, some diseases like multiple sclerosis, they're using antifungals and having great success because it's so common to have fungal colonization. So let's talk about the difference. Yeah, it is. And there's a lot of articles. My neurologist friend and I sometimes talk about this, how big the fungal burden. So the first thing I want to talk about is just the mycotoxin exposure. So you can have exposure to mycotoxins where they don't grow in your body and they can cause this immune damage and the cytokine storm and you can be very, very sick but not be colonized. And some of the ways to differentiate would be you can do urinary organic acids. And there's something called furans that come in the urine that show aspergillus or some other types of species. You can do the urinary mycotoxins. And if they're coming out in your urine, you've probably had an exposure and been partially colonized as well. So there's these things. And again, then you have to figure out is it sinus, is it gut? Systemic antifungals can treat both sinus and gut, but topical, you might use nystatin, which just treats locally in the gut. It's very effective. Or you might use something like grapefruit seed extract in the sinuses. And again, you're treating locally. So you can do everything from sinus sprays. You can do nebulized antifungals, which goes to the lungs. Or you can do oral herbs and medications for the gut or for the whole entire system.  They can be toxic to the liver. So you absolutely want to work with a doctor who knows what they're doing. But in some cases, they can be life saving because if someone's colonized with fungus in the gut, that's an issue. Now, the other thing you mentioned is CFO or small intestinal fungal overgrowth, super common, hard to detect often it won't show up in the stool, but it will show up in the urine. Or it might show up with serum Candida antibodies or Saccharomyces antibodies. And this is a big deal because both the mold toxins and the yeast metabolites like acetyl aldehyde, they will further weaken the immune system. So part of this balance is the mold tends to weaken immune system and yeast in general is opportunistic. So what that means is it takes advantage of a weakened system. If you have a really strong, robust immune system, you're probably not going to have a fungal colonization issue. Nowadays with EMFs, with poor diet, with stress, with isolation, all these things, many of us have a weaker immune system. So it's very common to see colonization with Candida and other things because of our weakened systems. Cool. So what if a patient does have, say, fungus under their nails? Is that at all related to systemic fungus or mycotoxins? Yeah. So this is interesting on two fronts that technical name is called Onicomycosis, which is the fungus. If you look and have the real discolored toenails or thickening or the, you know, sloughing, that is often that fungus. Two things, often the periphery, like extremities, if they're a little cooler due to either dysfunctional thyroid or adrenals, then you can have more growth there because just that slight degree change in temperature and the periphery will enhance the ability of fungus to grow. So there might be a thyroid or adrenal issue contributing. And then the second thing is, systemically, that can be a sign of systemic fungal overgrowth as well. So I've seen actually nystatin is supposed to be a drug that treats just the gut locally, not systemically, but in certain cases I've seen because of reservoirs in the gut, if we treat with nystatin, sometimes the nails will actually improve, which isn't supposed to happen. Interesting. What about if you use your mold, mycotoxin removal strategies, which we're going to talk about in a minute. Do those also help with fungus-sundered nails? They can. Again, the gut is a lot of times the reservoir.  Again, the nails are not, there's not a lot of blood flow there and it's on the periphery, so it's cooler. So they're hard to treat and typically docs who treat them are going to treat them with three months of a heavy hit or antifungal and even then it might not clear it. So I always want to look at the terrain because of the terrain, if it's a weakened immune system, poor thyroid function, poor adrenal function, you kind of want to fix those first or at least in conjunction with the nail fungus because to me that's just a symptom of something bigger. The other thing that can contribute or can correlate with it is blood sugar issues. So if you're diabetic, uncontrolled, those blood sugars will make fungus more happy and growing because they love sugar. So that's another piece of the puzzle. If your blood sugar is not controlled, do you want to work on that in addition to working on the nail fungus? Yeah, I know that you recommend a low-mold diet as part of the treatment plan. Maybe we should talk about that. Yeah, so this is again, there's some controversy among other doctors. Do you really need a low-mold diet? I find the less exposure to mold even in your diet while you're getting well will help and maybe the bigger thing is histamine. So there's also a low histamine diet and a lot of patients who have had mold exposure, they have mass cell activation and more sensitivity to histamine. And if that's the case, they're going to be very reactive to things like fermented foods, bone broth, aged meats and cheeses, leftovers, those are all high histamine. So that can be an issue for patients as well. Interesting. So what constitutes a low-mold diet? Yeah, so this would be like berries can have mold on them. And like I said, blue cheese, anything with visible mold or growth, a similar way leftovers are things that have left out. And then nuts and seeds and grains can be contaminated. I have a suspicion that one of the reasons that paleo and grain-free diets are so popular is because grains are one of the most highly contaminated food sources of mold. In fact, a lot of our data on the gut is from African children where their grain supply had been contaminated with mold and they got inadvertently fed moldy grains and they developed leaky gut and even sometimes billus atrophy, which is the same thing you see with celiac disease. And is that because the grains are stored in these silos for periods of time? Yeah, so I grew up on a farm in Illinois, so I'm a little bit about grains and storage. Yeah, I'm a city boy, so I really go on farms. Yeah, right. So I grew up and it's funny because I had horrible allergies as a child to corn and soybeans, which were the main crops. Now, looking back, I feel like I understand this so much more. I might still have been sensitive to the corn and soy, but what I believe, Dr. White, is it wasn't just the corn and soy, it was the molds and fungus that were growing on the corn and soy.  And then you store them a little bit damp. Part of the purpose of the grain bins is to dry the grains out because they have to have a certain moisture content to be sold. So this is kind of wet and damp grain sitting in huge bin and there is massive mold growth. And again, there's levels. What's sad about the United States is our levels of tolerability for mold toxins on grains is actually quite high compared to Europe. So for example, coffee and chocolate are things that often contain mold as well. And there's a European standard of coffee and if it's above the certain level, they won't accept it into the country. Guess who gets those leftovers that aren't accepted? We accept them in the US.  I know now I drink a really clean brand called Purity and I'm so clean in my diet that if I get a cup of Starbucks, I don't feel well. I can tell immediately that sense of headache or not wellness. A lot of processed foods, things like jellies, all have mold in them and there's so many foods that contain small amounts of mold that we're not aware of. Yeah, children's apple juice, you've seen those videos. Oh yeah, horrible. Basically anything that comes in a squeezable, plastic kind of container, don't eat it. Yeah. So let's talk about the rescue mold protocol. I know Richie Shoemaker talks about using some of these prescription bile binders like colostyramine. Yeah, you use those? Yeah, so y'all talked real quickly about treatment protocols and kind of the scamming. And I also want to mention I have on my website, again, I'll link it here and then for your podcast, we'll give you a link. The low mold diet is there. Search my website, jillcarnian.com. If you want to know exactly what's on it, it's there. I also have a free mold guide. I'll make sure your listeners as well as mine link to that. Most of my listeners already have it. It's all free. But lots of the stuff, if you don't remember the details or want more to read, it's all on my website. So you can go find it there as well. So treatment. So basically, you're thinking about first of all, out of a source of exposure, which we just talked about, and then you're working on getting your body rid of these toxic levels of mold and detoxification. So you're focusing on liver support. We mentioned glutathione. Not everybody tolerates glutathione. And glutathione has to be recycled by NAD. So I'm a big fan of NAD as part of the protocol, sometimes not the initial part. And if you can't tolerate glutathione, you can use precursors, anesthetial cysteine, vitamin C, glycine, glutamine, lots of different things. I almost always put people on milk thistle or some other liver support, sometimes bitters. Those will all help the liver go up later. And then binders. Binders are key. There's many, many types of binders. Dr. Shoemaker is a real heavy on the prescription drugs and binders. I actually don't use those as much because I find some of the natural binders work well and are a little more gentle. I will say with ochre toxin, colostaramine tends to be very effective. So that's the kind of toxin that if they have a very high level of ochre toxin, I might consider colostaramine. But in general, I like clay and charcoal and chlorella. There's also glycomandans or zeolite. There's silica-based binders, which are also great for heavy metals. But I get really good results with clay and charcoal, pretty simple stuff. So supporting liver, clay and charcoal. Now, while you're doing this, you're doing a complete functional medicine approach. So if they need probiotics or gut support or brain support or adrenal or thyroid support, I'm doing all that as well. I know some docs say before you even go into a detox protocol, if they have leaky gut and a lot of patients do, you should work on fixing that first because otherwise they'll reabsorb the toxins. Yes, yes. And there is a point too, if someone has really bad mast cell activation and permeability issues, sometimes I found, I agree with you and I've done 20 years and started with the gut and love the gut. But once in a while, if you don't get that mold level down, the gut won't heal and you get stuck. So if you're getting stuck with gut protocols, I would go to the mold and make sure you're addressing that at the same time. Yeah, it's always a question of, you know, this is the root cause and that's the root cause of that. And what's the root cause of that? Yes. So let's see, what else? I think we pretty much covered most of the things. What about air purifiers that remove mold? Is there a best one on the market? Yeah, so there are some that are out there and there is a specific name that is eluding me at the moment, but I'll give you some examples, air oasis and molecule. And what they do is they actually can neutralize the toxins in the air and they can actually, they've shown to improve air quality. So it's almost like it's an air, you know, modifying the air quality. However, there is a caveat with that because when mixing that type of device that can produce some ozone when it reacts with the molecules in the air. So someone like me with a history of the lung sensitivity, those kinds of air filters actually would irritate my lungs. That's not common with everybody. And those are really great air filters. So I'm not saying those are bad or wrong, but if you have any sensitivity with the lungs, you might be hypersensitive to the little bits of ozone they actually produce when they combine with the air molecules. I tend to use the ones that are just filtration and they have a HEPA filtration and a VOC filter. Those would be like Austin air and IQ air. So an air oasis and molecule are the other types. They're all good and they're all different. I have Austin air two here in the condo and five at the office and I've just loved them. On the average, how long a protocol does it take to remove mold? Is it reasonable to think that patients are going to get significant benefit from a month? Do they need three months? Does it take six months? Does it take a year? Yeah, so great question because people can be frustrated with the timeline. I usually say six to 18 months is kind of the savage. I haven't really- Of going through treatment that whole time. Yeah. Yeah. And again, not that you can't start to feel better in two months, but it'd be really unusual for someone to just turn around in a month or two. It takes some time, especially if you've been significantly impacted and depending on the time and the amount of time. And I've seen sometimes it's two years, but not that you're not making progress. It's interesting. One of the things that I developed with Quicksilver is the mold detox box. Yeah, you can go molddetoxbox.com to find out. Now, this is not for everybody and it's a fairly, I mean, it's an aggressive, great treatment. So if you're on the super, super sensitive side, you either want to go really slow products one by one because it will detox, but it's a 30-day kit. And I didn't do that because I thought that 30 days would cure everybody. But what we wanted to do is put everything you might need for the detox all in one package for 30 days. And so I think about it that way, but I've had to clarify a lot because people are like, can I get well in 30 days? And it's like, no. I mean, you might be able to get a significant handle on it, but it's usually six months minimum and then sometimes a lot longer. And so a lot of times when we're using herbal protocols, we'll rotate the herbs on a detox protocol for mold. If you have something after the first month that seems like it's helping, do you just stay on the same protocol? How do you decide when to change things? Yeah. So again, history is so good because I'm always checking in and I will tell them to start things individually. So start things one by one and see if there's a reaction or a problem. And sometimes it's a dose. So binders can be something that basically with binders, you're grabbing from the bile, these toxins that are stored after they're thrown from face one, face two into the bile from the liver, and you're pulling them out through the stool. That's a great way to detoxify. So if a patient is having trouble tolerating it, often we'll have to go to, you know, a quarter teaspoon or an eighth of a teaspoon or a pinch to get them to tolerate. And what's happening is on the way out is they're pulling those toxins out of the body. They can kind of get re-exposed. So you have to factor that into how you dose since sometimes you're doing very small increments. So it doesn't mean the detox failed. It just means go slower. I'm not a big fan. There's herxheimer reactions or things that happen when you try to treat an infection.  I mean, you can also have a herx reaction when you're trying to detoxify. And I'm not a huge fan of pushing through those kinds of reactions. To me, that's like, there's always this concept of mobilization of toxins and excretion. So you're mobilizing metals or toxins from mold or toxins from infection. And then you're trying to get them out of the body through the urine, through the breath or lungs, through the sweat, through the stool, all these ways that we get them out of the body. And if you have a reaction, you're probably mobilizing faster than you're excreting. So the my job then is to slow down the mobilization and increase the excretion. And that can be done with things like infrared sauna, just increased hydration or electrolytes, alkaline water or mineral water, things like Epsom salt bath at night, dry brushing, castor oil packs, even coffee enemas, those can all be helpful for excretion. So patient has a reaction and they say, Oh, I can't take that. The answer is, it's not necessarily that you can't tolerate. It's just a dosage.  Yeah, there's three things. You could be allergic to something and not tolerate it, period. That usually will get worse over time instead of better. And some people just know, no matter how low of curcumin I take, I don't tolerate it. Number two, it could be dosage dependent. So as you go very slow and very small, and you're mobilizing not too much for excretion, you're tolerating and then over time you tolerate more. And number three, you could actually have a deficiency of NAD. So you're not recycling glutathione. So every time you take it, it becomes oxidized and causes more toxicity, or you could have a limit of B12 and you're trying to take methylfolate and not working. So there's really is an order of operations. And I find even for myself years ago, there's a lot of things I didn't tolerate that I can tolerate now. That's a sign that that toxic load is decreasing. Cool. I think we really covered it. Do you have any final thoughts? No, but thank you for coming on. Thank you for doing the interview. This is really fun to talk about mold. And I think we did really cover a lot of the areas that people might have questions about with mold. If you have any questions, I'm going to be sure and link Dr. Weitz's site so you can know more about him and all the things I mentioned with the mold detox box and my free blogs and all that. We'll make sure and link those as well so you can stay tuned. By the way, what is your website? Website is just JillCarnahan.com and then Dr. JillHealth.com is where you can find products and mold detox box and that kind of thing. Awesome. Thank you, Jill. You're so welcome. Thank you so much.