Week of March 4, 2024
1/ Ammonia
QUESTION: I have been told that ammonia denatures mycotoxins. Is this correct?
ANSWER:I know of no published data showing that ammonia (NH3) is effective to remove health risk from exposure to mycotoxins. I routinely recommend people use quaternary ammonium compounds (NH4+) to help with cleaning and removal of dust and particulates that have been in bioaerosols. The key here is not attempting to denature just any part of the mycotoxin molecule. As long as the exposed acetyl groups of mycotoxins are detectable by ficolins, part of the MASP-2 signaling system, the mycotoxins will continue to set off inflammatory responses.
2/ Androgens, aromatase, erectile dysfunction
QUESTION: I have been in a water-damaged basement for five years. Over the last year I have had multiple health symptoms appear without explanation including cognitive problems, vertigo, headaches and erectile dysfunction. Is erectile dysfunction a common symptom from exposure to a water-damaged building?
ANSWER: There are several elements in your question that I think need to be addressed. First is that if you still have exposure to the interior environment of a water-damaged building you are not going to have the same response to treatment as those who have accomplished the first goal which is removal from exposure. I strongly suggest that you obtain ERMI or HERTSMI-2 (please use Mycometrics understanding that I have no conflict of interest to
report with that entity) to adequately define what organisms you are exposed to and just how bad your basement continues to be.
In the inflammatory response to antigens found in the chemical mixture existing inside water-damaged buildings there is direct adverse impact on levels of MSH. As MSH falls, as it does in over 95% of affected patients, there will be development of abnormalities in androgens in over 40% of patients. We look at levels of total testosterone (don’t spend the money for free testosterone), DHEA-S and androstenedione. We also measure levels of estradiol at the same time. The problem with erectile function in patients with low
MSH stems from up-regulation of the enzyme called aromatase. Aromatase will convert testosterone into an estrogen, estrone, which in turn is converted to estradiol. The more active the aromatase is the worse the androgen problem is for males.
Should you seek medical attention for your erectile dysfunction and simply use testosterone replacement without affecting aromatase, you are doomed to failure. On the other hand if you correct the inflammatory process and normalize aromatase it is likely
that your testosterone levels with stabilize.
A word of caution regarding aromatase inhibitors: These drugs, used in postchemotherapy regimens in breast cancer, will cause a typical CIRS syndrome in people with low MSH.
3/ Androgens, replacement
QUESTION: I read that it is not a good idea to replace testosterone, can you elaborate on that?
ANSWER: To assess correction of deficiency of androgens, we must look at MSH-deficient compared to MSH-normal patients. If MSH is deficient, very often there will be disruption of normal pituitary release of hormones called gonadotrophins (LH and FSH).
For many people, low testosterone is recognized as an illness for which treatment is indicated. Simply using androgen creams or testosterone supplements delivered in a variety of ways can paradoxically make the deficiency of testosterone worse.
Why? The rebound suppression of gonadotrophin release happens in a manner similar to use of birth control pills. By giving the end organ hormone (testosterone) we actually suppress gonadotrophin release, as the pituitary “thinks” that there is enough androgen present and therefore reduces the release of the pituitary hormones that stimulate
peripheral production. An additional concern with low testosterone has to do with the function of the enzyme called aromatase. Aromatase will convert testosterone to estrone which in turn is
converted into estradiol. Aromatase activity is often increased in inflammatory illnesses independent of MSH levels. If one has enhanced aromatase activity and takes testosterone, the testosterone is converted even more rapidly to estrone. What this means
is that the patient may initially feel better with increasing testosterone levels only to find levels crashing shortly thereafter. In fact, increasing aromatase activity creates an additional burden of additional feminizing hormones being produced. What does a person
do? “The testosterone helped at first but now it isn’t working, so I need to take more.” Aromatase really gets cranked up now! The vicious cycle continues.
It is important to understand that androgen deficiency is best treated by reducing inflammatory burdens first and then using upstream precursors of androgens that eventually will be funneled into testosterone production.
4/ Anesthesia
QUESTION: Is it ok to get minor surgery with diprivin anesthesia while taking cholestyramine?
ANSWER: Cholestyramine is not absorbed and will not bind to anesthetic agents.
5/ Animals with mold illness
QUESTION: Do dogs or other animals have mold illness?
There is no question that humans are not the only animals with inflammatory response syndromes. I have collaborated with veterinarians in the past looking at creatures as
diverse as hawksbill and green turtles; race horses and riding mares; horses with Sarcocystis and Lyme; dogs, cats, pelicans; and many more. The difficulty a veterinarian faces is how to access the laboratory studies needed to confirm the diagnosis.
6/ Anti-inflammatory pathways in workplace disputes; Asking my local doctor to run the blood tests.
QUESTION: I have been working in a trailer with leaky roof and visible mold for the past seven months. An outside agency has suggested the building be vacated but yet my employer continues to require me to attend work in this building. I have multiple health symptoms. What should I do?
ANSWER: I think the first order of business is to have you collect a sample of dust from your trailer to run an ERMI on it to confirm that this is a water-damaged building. Please note that the EPA and CDC would say mere presence of a leak or visible mold was enough and
you didn’t need to have environmental sampling done. In contrast to that opinion, one that always loses in court, is the reality that if your employer has ignored reasonable informed opinion to vacate the building, you are going to need additional evidence to vacate on your own. All employers have a clear duty to provide a safe workplace. It is also in your best interest to begin the proper diagnosis pathways for treatment and proof of physical effects from the moldy environment. Mold allergies and CIRS/mold illness are two separate possibilities to look into.
You can learn more about getting started on the Shoemaker Protocol diagnosis pathway here. [link to Shoemaker Protocol™ quick start blog]
I think it reasonable to sit down with your employer once you have unmistakable evidence of contamination and inform the employer of your adverse health effects. If your employer is unwilling to assist you, you have the option of taking the physician order sheet to your doctor together with the 2010 Expert Treating Physicians Consensus Report (available as a free download on this site) together with the paper from Health (also a free download) to a local doctor with the request that labs be done. If the physician refuses, then you also have the option to contact one of the Shoemaker Protocol™ certified physicians. Their contact information is on the website.
7/ Anti-inflammatory pathways, muscles
QUESTION: Do muscles act as an endocrine gland to decrease inflammation?
ANSWER: The important regulators of inflammation remain the neuropeptides, MSH and VIP. These hormones will have a variety of effects on metabolic pathways and muscle; but muscle itself is not an endocrine gland. ACTH and cortisol are important mediators of
inflammation as well, though under regulation of MSH and VIP, among others, but muscle effects are due to other hormones, including ACTH and cortisol.
8/ Aromatase (see androgens)
QUESTION: How do aromatase and low MSH fit into fertility issues?
ANSWER: If we have up regulated aromatase due to inflammatory responses in CIRS, and this is incredibly common, we will see enhanced conversion of testosterone to estrone and then
to estradiol. Such disruption of normal androgens can have fertility effects both on me and women.
MSH has a significant role in regulation of LH and FSH, the gonadotrophins that regulate production of sex steroids. If there is evidence of abnormalities of FSH or LH, correction
of MSH is a desired part of treatment.
9/ Aspergillus in sinuses; chronic bronchitis
QUESTION: I am diagnosed with having Aspergillus and Pseudomonas in my sinuses that are reportedly the triggers for my chronic bronchitis. I have read that UV light will be of benefit in eradicating these organisms. Do you know of a mechanism to deliver UV light to sinus conditions?
ANSWER: First, I hope that your culture was done of material obtained by sinus drainage and not from nasal aspiration. Obtaining material from sinuses is difficult; children often are given the inviting prospect of having sinus puncture done at the bed side. I cringe even
talking about this. Endoscopy in adults can help to obtain pure sinus materials for staining, PCR and culture.
There are a variety of fungi found in sinuses that can create a chronic rhinosinusitis (CRS) as work from David Sherris and his colleagues (who were at Mayo but now are at the State University of New York at Buffalo) have shown. Unfortunately, control patients in the early Mayo studies also had fungi found in sinuses. They key was to identify
interleukin 13 and IL-17 in sinuses related to colonization (not infection) from particular non toxin-forming species. Pseudomonads are gram negative bacteria that can be a very dangerous pathogen if in blood, soft tissue or lung. A study done years ago looking at
nurses new to working in the ICU showed that they picked up nasal colonization of gram negative rods, including Pseudomonas, within one month of occupational exposure.
What this means is that you need to be very careful saying that you have sinus infection with Pseudomonas versus simple nasal colonization. Similarly, finding a fungus in a nasal swab does not equate to having a fungal sinusitis. Thirdly, having fungi found
inside sinuses does not necessarily convert over to a source of an ongoing fungal infection requiring antibiotics, at least according to the Mayo and SUNY data.
