Mycotoxins, Lyme disease, Mold

Untangling the Lyme/Mold Conundrum

By Nicola McFadzean Ducharme, ND

Chronic Lyme disease and mycotoxin illness are rapidly becoming more and more intertwined, with many patients suffering greatly from both maladies. It gets incredibly difficult to sort out what is causing what in terms of a patient’s health picture, given the overlap of symptomatology. For patients it is confusing, and for health practitioners it can also make navigating treatment planning very difficult.

The purpose of this article is to highlight some of the commonalities and distinctions in terms of both testing and treatment. We can utilize testing to evaluate which stressors are present, try to sort through which ones are having the greatest impact, and what the secondary effects on the body systems are. That can help guide treatment choices.

Having said that, from a clinical standpoint, I have found in my clinical practice that rather than viewing these issues as two totally separate things to be dealt with one at a time, it helps to look at the whole person and find the common traits that come from both issues and addressing those. Yes, there are differences, of course—Lyme disease involves bacteria, mycotoxins are from mold exposure—and so of course there will be specific treatments that are needed for each. But in my experience, looking for treatment options that help with both things at the same time provides a better outcome for patients and is less overwhelming for them.

Some practitioners believe that you can’t treat mold toxin-illness until Lyme disease is treated. Others say that you can’t treat Lyme until mold is dealt with. To me, in the reality of how these two issues show up in the body, it’s simply not as black and white as that. I tend to try to chip away at both things, gradually and systematically, on the premise that every stressor, be it a pathogen or a toxin, is going to be impacting that individual’s health. We cannot separate them out. So where do we start?

A patient comes to my office. They complain of joint pain, headaches, foggy brain, pins and needles in their hands and feet, constipation, abdominal pain, dizziness, and terrible fatigue.

Is it Lyme? Could be. Is it mold toxicity? Could be. Is there something else going on? Possibly.

Obviously, we take a thorough history since clinical presentation is such a big part of the Lyme diagnosis, but since we’re talking labs right now, we’ll just assume that clinical presentation has been gathered and taken into account.

Also, most patients with chronic complex illness have been through the gamut of doctors before they get to our clinic and have had an extensive work up for all the other things that could be going on—autoimmune markers checked, MRI’s done, ultrasounds performed. They may even come with a previous diagnosis that reflects one of the many things that Lyme disease can mimic. Therefore, for the purposes of this article I am keeping our differential diagnosis to Lyme disease and mycotoxin illness.

Level One: The Basics

If a patient has not had standard bloodwork for a few months, I will ask for a panel of labs to make sure there aren’t any imbalances that we need to correct, any causes of fatigue that might be contributing such as low iron or ferritin. These labs are helpful to get a baseline and to show how to fine-tune treatment. The difference here is that if they all come back normal, we do not tell the patient that there’s nothing wrong with them and it must all be in their head! These basic labs are more an evaluation of “how is your body coping with all of this.”

Labs I might run include the following:

• Complete blood count

• Comprehensive metabolic panel

• Lipid panel

• Serum iron

• Ferritin

• B12 and folate

• Vitamin D

• Hemoglobin A1C

• Magnesium

• Thyroid (TSH, free T3, free T4, reverse T3, anti-TPO, anti-thyroglobulin

• Reproductive hormones – estrogen, progesterone, testosterone (free and total)

• Cortisol (will run that through a salivary panel with morning, noon, afternoon and evening collections to assess the circadian rhythm)

• C-reactive protein (CRP)

• Erythrocyte sedimentation rate (ESR).

Surprisingly, despite the massive inflammation in these chronically ill patients, CRP and ESR are frequently within normal range.

Getting a little more in depth on opportunistic infections and other underlying infections, I might also run IgG and IgM antibodies to Chlamydia pneumonia, Mycoplasma pneumonia, Epstein-Barr virus, cytomegalovirus, HHV-6, and Candida albicans. Those labs can all be run through large commercial labs such as Quest and Labcorp.

Level Two: Indicators of Neuro-Inflammation and Immune Dysregulation

Dr. Ritchie Shoemaker¹ has been a pioneer in the field of mycotoxin illness and chronic inflammatory response syndrome (CIRS). In developing his work, he compiled a panel of lab markers, which are indicators of mycotoxin illness. I find these markers to be useful; however, I would argue that they are not only influenced by mycotoxins alone, but by biotoxins, which can be created by mold or by pathogens in the body. Mast cell activation syndrome (which may be more of a result than a cause) can also alter some of these results.

Therefore, in my opinion they are better used as tools to assess and evaluate than to actually diagnose. These markers can also provide a good baseline to be able to retest later and quantify progress on the treatment given.

While each marker has its own unique actions, they all have one thing in common—they influence immune activity and inflammatory processes in the body. Some of these markers are outlined below.

C3a and C4a are part of the complement system, which are proteins that travel through the bloodstream, and play a significant role in immune function and inflammatory responses. Elevations can be a sign of an overactive immune system that can’t regulate itself.

TGF-beta is a protein that regulates cell differentiation, proliferation, and apoptosis (cell death); it is also an indicator of prolonged inflammation.

MMP-9 is involved in allergic and non-allergic inflammatory response. When MMP-9 is in balance, it aids in regeneration and remodeling of tissue. However, when it is out of balance it sets up an inflammatory cascade of cytokines and chemokines. Those tissues then have higher levels of histamine, which is why MMP-9 is also used to evaluate MCAS.

MSH is a hormone called a neuropeptide that controls other hormones, as well as immune response and inflammation. MSH is typically low in biotoxin illness, which means it can’t have its normal control on inflammation. Without sufficient MSH, individuals are more susceptible to sleep issues and chronic pain due to reduced endorphin production.

VIP is a neuro-regulatory hormone that regulates peripheral cytokine responses and inflammation in the body. If we don’t have sufficient VIP, we cannot adequately regulate inflammation in the body.

HLA-DR genes. Looking at certain genotypes can help emphasize an individual’s susceptibilities. According to Dr. Shoemaker’s work, approximately 26% of the population are genetically susceptible to mold toxin illness.²

VCS test is not a lab test as much as a self-guided assessment that one can take online. The Visual Contrast Sensitivity test is a reflection of neurological function and the potential damage that biotoxins have done to neurons.

NeuroQuant EEG. I have very limited personal experience with NeuroQuant EEG, however, it may be a useful tool in distinguishing the impact of Lyme versus mold on the human brain. One of the challenges of this modality is cost, access and accurate interpretation.

CD-57. I include this in the “indicators” category. CD-57 is a cluster designation marker that is theorized to be suppressed in chronic Lyme patients. I do measure it as a guide; however, it is not a marker that I lean heavily on as I have concerns about reliability of the test.

Level Three: Getting Specific

Here is where the rubber hits the road, and where I put most of my focus with my chronic, complex patients in assessing the underlying causes of their health issues.

While general/basic markers of health are important to have and while the indicators listed above can provide helpful information, I am a firm believer in being as specific as possible in testing. Therefore, the following tests are the ones I choose as a priority in assessing my patients.

Mycotoxins. For assessing mycotoxins, I am a big fan of doing a direct urine mycotoxin test. If mycotoxins measure high in the urine, the patient has mycotoxins. To me it’s simple, its direct, and its quantifiable. It’s not perfect, of course, if a patient doesn’t detoxify well, the output may not be truly representative of their body stores, but it’s good enough in my opinion to be the most useful assessment for mycotoxins.

Now there are many questions that come from a positive result. Where did this exposure come from? Are they still being exposed? Have they had their current home or workplace evaluated? Do they need to move? Do they need to throw away all their belongings? The rabbit hole of mold illness is deep and difficult to navigate.

I mostly use Great Plains Laboratory’s urine mycotox panel. I was always happy with Real Time Labs, but the price point made it prohibitive for many patients. Great Plains Lab has always offered great testing at a reasonable price, and their panel has made mycotoxin testing possible for many of my patients.

I am grateful to Neil Nathan and his book Toxic³ for his suggestion to provoke the urine mycotoxin test. He suggests using glutathione 500 mg twice daily for a week before (if the detoxification effect of this is too strong, patients can stop taking the glutathione and do the collection the following day) or use an infra-red sauna prior to collection.

I do think that MARCONS testing is valuable here too. Aligned with the work of Dr. Brewer and Dr. Nathan, I am seeing the significance of mold and fungal colonization in the sinuses and have responded by using more nystatin and amphotericin B nasal spray, both with EDTA to help break down biofilm. If a MARCONS swab comes back positive, then I would start with BEG spray to try to eradicate bacterial infection before moving on to antifungals, then move on from there to VIP spray, which is more for neurological healing rather than being antifungal or bacterial. If MARCONS negative I move directly to nystatin/amphotericin B with EDTA as a starting point.

Lyme disease. In my opinion, IGeneX is still the gold-standard for Lyme testing, and I utilize their testing extensively. I believe it’s just as important to assess co-infections as Borreliosis itself, so I recommend that patients get a panel that at least includes the Borrelia IFA, and IgM and IgG Immunoblots, plus testing for tick-borne relapsing fever. I have seen several cases now where the Borrelia Western blots came back negative, but the tick-borne relapsing fever came back positive, so I am appreciating the expansion in strains of Borrelia testing that are becoming available to us.

From a co-infection standpoint, Babesia and Bartonella have always been the ones I’ve kept the closest watch on, mostly because Ehrlichia and Rickettsia tends to respond to the same treatments as the Borrelia itself. Bartonella is a bacterium, as is Borrelia, however its treatment path is fairly distinct. Babesia, being a protozoon, requires a different set of medications and herbs altogether. For that reason, these two are highest on my radar.

Personally, I opt for the antibody tests and the FISH tests for co-infections. As with the Lyme panels, I never felt the PCR tests were sensitive enough to warrant the extra expense.

When urine PCR testing became available, it appeared to be a good, cost-effective, comprehensive option to cover Borrelia and co-infections. I have had some concerns about sensitivity of the test but I will run it in conjunction with IGeneX Borreliosis testing as a more cost-effective option than the full Lyme/co-infection panel.

For new patients, I still tend towards the IGeneX panels using IFA and Western blots. If finances are limited, I might choose the Lyme/TBRF panel 1 (LTP1), along with the new urine PCR panel (TBD7). If finances are not a major consideration, I’ll opt for the Tick-borne disease panel 1 (TBD1), as well as the urine PCR just to utilize the different types of testing to maximize the chance of getting helpful information.

Where I think the urine PCR testing is also useful is in evaluating a patient who is nearing the end of treatment. For some, Western blots were always negative or indeterminate at best, so when we go to repeat them during or at the end of treatment, what change are we expecting to see?

If we have high antibody responses on the IFA test, multiple bands on Western blot, positive antibodies for co-infections…they can all be repeated and see change. But what about the many people who had “meh” test results. Is there a point in repeating an indeterminate IgM Western blot? What “before” and “after” are we hoping to achieve? And if IgG is positive to start, can we expect that to turn to negative, or not, since memory cells may stay active for a decade to a previous infection?

Here is where I think the urine PCR testing has a place. If PCR positive, then we know there is some level of ongoing infection. If negative, it doesn’t guarantee it, but it’s a good sign.

The bottom line is, I order Lyme/co-infection testing to try to clarify the chronic infection situation. IGeneX is still my preferred lab and I will order a combination of blood and urine testing, depending on the patient and their needs. Coupled with the urine mycotoxin panel from Great Plains, that to me offers the most succinct way to evaluate those two issues.

Implications for Treating Lyme/Mold-Related Illness

I am a proponent of trying to be as specific as possible in the testing we do, to identify as clearly as possible the role of Lyme versus mold in a patient’s situation. Obviously, each one is going to have its own specifics of treatment, however, I thought it might be helpful to highlight some of the commonalities between the two. For people dealing with both issues, this may help to feel less overwhelmed and more streamlined in their approach. For this conversation, let’s think about Lyme and mold toxicity both as biotoxin illnesses that trigger massive immune reactions, that then trigger systemic inflammation and chemical mediators of inflammation including cytokines and chemokines.

Toxicity. Mycotoxin illness is clearly a toxic issue. Mold spores give off toxins that are inhaled into the body and settle there. If you are one of the unlucky 25% that can’t detoxify mold properly, those toxins can stay for years, until something is done to get them out. Lyme has a strong toxic element too – any antimicrobial therapy, killing the bugs, causes them to release toxins into one’s body as well, which then have to be detoxified. This is what Lyme patients identify as a Herxheimer reaction. Therefore, addressing detoxification in the body through methylation support, liver/kidney support, blood cleansers, opening up pathways of elimination (skin, lungs, kidneys, bowels) is key for both situations. I tend to use a combination of herbal tinctures and glutathione for detoxification, as well as encouraging patients to do home-based modalities such as Epsom salts baths, infrared sauna, and coffee enemas.

Inflammation. In the previous section on markers of neuro-inflammation and immune dysregulation, we saw that there are many different indicators that reflect the inflammatory cascade that many of these stressors on the body can create. Massive inflammation in the body and neuro-inflammation occur both in Lyme disease and mycotoxin illness. Therefore, the common thread of working to support healthy immune function while dampening inflammation in the body is a valuable approach. One’s diet can play a big role in that: avoiding gluten, dairy and other inflammatory foods, including saturated fats, and eating lean proteins, healthy fats, and vegetables. There are many herbs that help calm the inflammatory response, such as curcumin, white willow, and green tea. I love Cytoquel by Researched Nutritionals. Proteolytic enzymes can be helpful as well; InflaQuell (also by Researched Nutritionals) is a great blend. When taken on an empty stomach, it can help to break down the products of inflammation in the body.

Immune regulation is somewhat linked with inflammation since immune responses create inflammation. But separate from reducing inflammation, it’s also important to strengthen a health immune response while minimizing the possibility of an autoimmune situation being triggered. I utilize Transfer Factors, both general—such as Transfer Factor Multi-immune—and targeted, with TF L-Plus and TF Enviro, to cover both Lyme and mycotoxins. They strengthen immune response and enhance signaling and communication within the immune system.

If I see any indicators of autoimmunity (thyroid antibodies, positive ANA etc), I will suggest low dose naltrexone for its ability to help balance the immune response through upregulation of enkephalins (immune-mediating chemicals). Through its ability to boost endorphins it can be helpful for pain, mood balance, sleep and energy, which are things that the majority of Lyme/mold patients struggle with.

Gut Health. I would estimate that 80% of my Lyme/mold patients have fairly significant digestive issues. Both conditions can create gastrointestinal symptoms, or they may be a slightly separate phenomenon. Either way, if one’s gut isn’t functioning well, it can hamper treatment overall. Remember, too, that the gastrointestinal tract has its own nervous system and its own immune system so it’s a vital system to have functioning well.

Anything that causes imbalance and inflammation in the gut can lead to a condition called leaky gut, where the junctions between the cells in the small intestine open up and allow larger-than-normal food particles into the bloodstream. The immune system reacts to these as a threat and will mount an immune response, leading to, you guessed it, inflammation. The chemicals of inflammation can travel through the bloodstream and cross the blood-brain barrier, causing even more issues in the central nervous system.

Treating the gut is also important to be able to tolerate various treatments for Lyme and mold. We can’t give antibiotics to a person who has massive gastritis or dysbiosis; we might have trouble getting any binders, especially cholestyramine, into a patient with ongoing constipation.

Candida overgrowth. Another part of the discussion about gut health involves Candida and other yeast overgrowth. I have found my Lyme patients have a greater propensity to Candida overgrowth, whether or not they are taking antibiotics. We are also paying more attention now, thanks to the work of Dr. Brewer and Dr. Nathan, to yeast and fungal colonization in the sinuses that ties into the mycotoxin picture.

I like to use a very direct test to evaluate for Candida as well – the urine Microbial Organic Acid test from Great Plains Lab. It measures metabolites of yeast and gives a clear, quantified report that can be used as a baseline for monitoring treatment.

Other non-prescription things that can be useful as nasal sprays are colloidal silver, and XClear. There are many great antifungal herbs (my favorite blends are Biocidin and Citricare), and we also have prescription antifungals such as nystatin, fluconazole, and itraconazole. I use all of the above in both my Lyme and mold patients.

Oxidative stress, aka free radical damage, occurs in all of us in each and every cell, but toxins and infections are going to accelerate it. High levels of oxidative stress have been linked to a myriad of chronic health conditions. We can help counter oxidative stress using nutrigenomics. I use an NRF2 activator that is a combination of five herbs in very specific ratios and functions to bring down oxidative stress. I have seen this be helpful in both my Lyme and mold (and combinations thereof) patients in enhancing their overall baseline of health.

Mitochondrial dysfunction.The mitochondria are the powerhouses of our cells that produce ATP, or energy. Mitochondrial dysfunction also plays a big role in chronic health conditions. We can support mitochondrial repair with agents such as phosphatidylcholine, Coq10, ALA, acetyl-L-carnitine, and glutathione. I use an Nrf1 activator that contains a combination of the key nutrients.

Limbic system dysfunction.If you are an individual that just looks at a herb and gets a negative side effect, you are reactive to everything, including foods, chemicals, and EMFs, and are trying to figure out how you’ll tolerate the treatment you need when everything makes you sick, you might want to consider limbic system dysfunction getting in the way.

The premise of limbic system dysfunction is that the part of the brain called the limbic system gets “stuck” – the wiring all gets tangled, neurons are stuck in negative pathways, and as a result its putting out signals to the rest of the body that create disordered function in the body.

Annie Hopper developed a program called Dynamic Neural Retraining Program,⁴ that helps people address limbic system dysfunction. It is a step-by-step system, based on neuroplasticity, which means that we can indeed rewire our brains in healthier patterns with healthier signals. This leads to healthier physiological responses in the body as a whole.

I have seen this program benefit many people. It can be done from your own home and can help with Lyme disease, mycotoxin illness, EMF sensitivity, multiple chemical sensitivities, and more. It also helps to release prior trauma, which Annie believes is a significant piece of causing the dysfunction in the first place.

Conclusion

It used to be that a complex Lyme patient was that way because of multiple co-infections; now it’s a tangled web of Lyme and co-infections, opportunistic infections (such as Candida overgrowth), mycotoxins, heavy metals, mast cell activation syndrome, to name a few.

Trying to separate each individual stressor out has its challenges, including the accuracy of testing, genetic variances in each individual, responses to treatment etc. It also can be incredibly overwhelming for the patient. The approach of finding commonalities in physiological responses and processes within the body can make treatment planning easier, less overwhelming, and more in line with treating the whole person.

While I have covered quite a few different topics in this article, I want you to take away two key messages. One is, get as specific and direct testing as you can to evaluate what’s going on in the body. The second is, if you don’t know where to start or feel overwhelmed with treatment, go back to basics. Toxicity and inflammation are the most important common threads. They are the key pieces and are shared jointly between Lyme and mold toxicity.

TOXICITY…INFLAMMATION…TOXICITY…INFLAMMATION…TOXICITY

Remember that at the end of the day, there is an interconnection between the “terrain” (which is the body), and outside agents such as Lyme bacteria or mold toxins. The more you can do to make the terrain healthier, through diet, positive thought processes, lifestyle choices, clean food/water/air, detox modalities, herbs and supplements to balance immune function, and so on, the best chance the body has to deal with the offending agent.

Lyme and mold might feel like a double whammy, so that’s why it’s important to keep remembering the commonalities. Ask the patient to think of it this way: that you’re working on strengthening your own health; you happen to have a couple of different sources of biotoxins, but they do similar things in your body, and therefore many interventions will help with both. Focus on those interventions as the core of your protocol and build from there.

References

1. www.survivingmold.com.

2. https://www.survivingmold.com/diagnosis/lab-tests

3. Nathan N. Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illness. Victory Belt Publishing, 2018.

4. www.retrainingthebrain.com

Nicola McFadzean Ducharme, ND, is a licensed naturopathic doctor and is the founder and medical director of RestorMedicine. She consults with patients around the world, blending conventional and integrative approaches to treating Lyme and other tick-borne illnesses.

She has authored several books on the subject, including the best-selling The Lyme Diet, The Beginners Guide to Lyme Disease, Lyme Disease in Australia, and Lyme Brain. She has also been a chapter contributor in two of Connie Strasheim’s books, Insights Into Lyme Disease Treatment, and New Paradigms in Lyme Disease.

Dr. Nicola has developed two online training programs for Lyme disease – Lyme-Ed for Patients and Lyme-Ed for Practitioners.

She can be contacted through her practice www.restormedicine.com or www.drnicoladucharme.com. Her courses can be found at www.lyme-ed.com.