[continued from previous message]
Here is a case of someone who was brought to me about a year ago with severely agitated depression.
She was very reactive during the monsoons. There was some thunder, and she reacted as if a gun had been shot off next to her head and couldn’t stop trembling for about 10 minutes.
Lightning Smaller
If she had had insurance of any sort of financial resources, I would have hospitalized her. She was that severely sick. Unfortunately, that wasn’t available.
I got the history that this severe anxiety and depression had started about 2 1/2 years ago, around the time of menopause. She also at that time had lost her home in California with the financial crisis. And she also had found out that her husband had a
terminal illness related to the lungs.
She had never been depressed or anxious before, in fact had been quite the opposite. But there was a family history of anxiety and depression. She had been treated in California by several psychiatrists for hormones and for the psychiatric illness,
without any improvement.
She had had severe GI pain. When they investigated, they blamed it on diverticulitis. Surgeons wanted to remove a foot of her colon. The family didn’t have the money and the patient didn’t want that done, so they refused the surgery. That was
interesting to me, because usually when surgeons want to remove a foot of your colon, you don’t recover without any sequelae and then function normally for the next year.
They moved to Arizona to be with family and the husband became the full-time caretaker of the wife. He had to be with her day and night, watching her. She did feel suicidal. She couldn’t function. She’d be up and pacing all day, severely anxious and
really not capable of doing anything else.
I was seen as the last resort, which unfortunately is what happens in integrated psychiatry since meds haven’t helped.
I ended up changing the psychiatric meds, which led to a partial improvement in the first month or so. The family was very happy. But unfortunately, that improvement stalled and I spent the next six months just switching meds and adding supplements
without much more improvement. We didn’t have to hospitalize her, but there was very little quality of life for her or for the husband.
Then again in summer, she worsened considerably. The depression and anxiety became much more unmanageable.
She had a colonoscopy that showed no problems — no cancer, no necrosis. That was again a little puzzling and interesting to me.
Out of desperation, I started to ask about mold. If people are very psychiatrically ill and you start asking about mold, they have a hard time believing it. Sometimes I get a little cautious about bringing it up, because it’s so out there to so many
people.
But after a year of treatment, I started asking about mold. That’s because mold illness in Arizona is actually worse in the summer due to our monsoons and swamp coolers and leaking roofs and stuff like that.
The husband remembered that at about the same time that his wife became very ill, he had found extensive black mold in the garage due to a leak in the kitchen sink above. The house was in disrepair because of financial crisis. He had done the remediation
himself without any precautions before doing a short sale. He felt that the mold had been there for a few years because the house was a fixer-upper that they were fixing up to be their dream house.
So he got interested because he has an alpha antitrypsin deficiency that can lead to lung problems. He knew that he shouldn’t be exposed to mold. He became very interested and read Surviving Mold. He had his wife do the visual contrast tests and she
failed.
I started cholestyramine. They didn’t have money really for insurance, but I got a haplotype that showed that she did have a mold gene and a low MSH gene.
I saw her a month later. This was the first time she had ever been able to talk to me without tears or agitation or having to be forced to talk. She was actually talking freely, talking about her experience. She told me that she was very tired from
cholestyramine, but that she had actually had waves of feeling herself again.
Interestingly enough, the husband at the VA had a CT scan which showed in his lungs sarcoidosis and possible fungal balls. So he was fairly grateful to have learned about mold too.
I’m sharing this case just to show that I did not initially pick up symptoms of mold because the psychiatric presentation was so dramatic that I went immediately to psychiatric meds without talking about mold. Obviously if I didn’t ask about mold,
there are very few psychiatrists who would have asked her.
It does now look like this was contributing. The CSM was the first treatment where she got periods of time when she was feeling like herself.
I assumed this was due to family stressors and the onset of menopause and traumatic life events. I was wrong.
I will point out that her response to SSRI’s was typical of the mold patient in that they made her worse, agitated her more, didn’t work really at all.
Treatment
I’d like to make it obvious. I am not against using allopathic meds. If somebody is feeling very depressed or anxious, I’m going to do whatever I can do to alleviate suffering.
I will not tell people to get off their meds when I diagnose mold illness. I suggest that they work with me to treat it and gradually go off meds so that we don’t have any exacerbations of symptoms of depression.
Mold treatments that I use that are pretty easily available are, of course, the whole Shoemaker protocol.
Fish Oil
Fish Oil
Another supplement that Dr. Shoemaker recommends highly for inflammation is fish oil. There’s actually a large psychiatric literature that fish oil helps, to the extent that even the American Psychiatric Association endorses the use of fish oil in
psychiatric illness. It’s safe and effective. Fish oil is not something that you would think of, but in some studies a three-month course of fish oil seemed to be actually as effective as drugs in cutting the rate of psychotic illness and schizophrenia,
by almost 25%. (18)
You have to understand that in your brain, you have neurons that are your electrical system. Neurons are surrounded by a myelin sheath, which is your insulation for nerve wires. That myelin sheath is a fatty substance that is highly improved by adding
the EPA, DHA and other cholines. It’s called the phospholipid bilayer cushion. That’s what we believe fish oil may be doing.
Other things that fish oil has been shown to do is that it allows serotonin and dopamine, your neurotransmitters, to bind to receptors. It down regulates cortisol, which is very high in stress and is the response from the adrenals before adrenal fatigue
sets in. There’s no evidence that it decreases cortisol, so don’t be afraid to use it if you have low cortisol.
It down regulates inflammatory cytokines. It actually helps increase thyroid hormone transfer to the brain.
There’s a pretty good literature on Omega-3’s in bipolar illness. I often find it almost diagnostic when I give people a liquid fish oil, pharmaceutical grade, and people with bipolar illness will guzzle it when they’re not feeling well and feel
that they can almost regulate their illness by using fish oil.
Salmon Salad
Diet
Very, very important is diet. I am very big on the anti-inflammatory diet, meaning anti-inflammatory for the brain.
There’s a study that looks at whether Alzheimer’s Disease can be a form of Type-3 Diabetes. Alzheimer’s may be very strongly linked to inflammation from sugars. (19)
The type of diet that I recommend is one that is low in sugars. Low in processed sugars and also low in carbs, because carbs are broken down to simple sugars. It may be Dr. Shoemaker’s amylose-free, which has you off most grains and amylose.
You can call it the ketogenic diet. The ketogenic diet is one that switches you over from burning carbs to burning fat.
That diet has been used for almost 100 years to treat epilepsy in children. It really does work. We wouldn’t be doing it for 100 years if it didn’t. Johns Hopkins is actually at the forefront of doing that for the last 100 years.
The ketogenic diet is probably the one that is best for the brain. It’s also known as the Paleo diet. The goal is to start eliminating sugars and simple carbs from your diet.
If you want to read a recent book, it would be Dr. Perlmutter’s book “Grain Brain” and all of his work on the topic of carbohydrate excess on brain function. You also can look on my blog in the article about “Ketogenic Resources” and then just
start to follow all the links about the ketogenic diet. (20)
I’m also a very big believer in eliminating food sensitivities such as gluten and dairy. Again, those contribute to inflammation including probably neuroinflammation.
Gluten sensitivity in celiac has been known for a long time to cause something called gluten ataxia, which is balance. That is just one study that shows that gluten sensitivity can affect the brain.
I tell most people to get off gluten and dairy initially. Many people do feel better. For others, the benefits may not be shown for many months. Or they may find that when they start to do gluten or dairy again, things get worse for them. This is a
fairly simple trial that everyone suffering from some kind of chronic inflammatory illness should be trying.
Again, I’m mentioning the schizophrenia and the anti-gliadin antibodies which is pretty impressive actually.
Bipolar illness is very linked to epileptic illness. They use the same drugs to treat them and they are effective in bipolar illness.
The ketogenic diet is effective in epilepsy in children. There are some small studies showing that based on that reasoning, the ketogenic diet might help bipolar brains.
There are some small studies showing that to be true. It’s something that I do recommend for people with bipolar illness, especially when people are having a hard time trying to control it.
So diet to me is extremely important. When you have something like Chronic Inflammatory Response Syndrome affecting so many areas of your life, there is no magic bullet here. The treatment works but it can be slow. Doing the diet changes can
significantly help decrease inflammation throughout the body.
Curcumin
Supplements
A natural substance that you can take that are effective for the brain would be magnesium. Many Americans are very deficient in magnesium.
A number of cases have been documented showing rapid recovery from depression when magnesium was supplemented. (21)
Magnesium deficiency is linked to an increased risk for stroke. It’s linked to glutamate excitability. Magnesium does help decrease glutamate in the brain. Glutamate is highly associated with anxiety.
I recommend magnesium for anyone with problems with insomnia or anxiety. For hypertension, it’s excellent. It’s something that should be tried in hypertension.
We also use it a lot when people are taking cholestyramine, which is highly constipating. We have patients mix powdered magnesium citrate directly with the cholestyramine. We find that solves most people’s problems with constipation.
Another effective substance is tumeric. There’s one study showing that 1000 mg of tumeric taken over six weeks was as effective as Prozac in depression. (22) To me, since tumeric is highly anti-inflammatory, that’s another study suggesting that for
many people, depression is a condition of inflammation.
Probiotics are very very useful. MSH, which is low in many people, is going to mediate the tight junctions between cells and contribute to leaky gut. There’s a strong connection between pathogenic gut, bacteria and anxiety. (23, 24) I have certainly
seen a number of times that adding probiotics can help anxiety and depression.
Vitamin D is highly linked in many studies with depression and anxiety. (25) It is, of course, linked with the immune system. It can improve the immune system and is cancer protective. Levels are easily measured. I think that Dr. Shoemaker showed low
Vitamin D levels in patients and that those levels improves with VIP without supplementation.
When I measure low Vitamin D levels, I will always encourage people to get on Vitamin D. 5000 is my usual dosage. For people with very low levels, we may go as high as 10,000. With some people, we will just use 1,000. And yes, this is even in sunny
Tucson. Studies have shown that 70% of people here in Tucson have Vitamin D deficiencies. There’s more to Vitamin D than just the sun.
There are a couple of studies linking Vitamin D and depression.
Mother And Children Prepare A meal,mealtime Together
Selfish vs. Eudaimonic Happiness
There are a number of studies linking happiness — psychological states and behaviors — at the genetic level with inflammation. (26) This research is known of as the field of epigenetics. It’s showing that it’s possible to alter the expression of
inflammation at the genetic level. These are not just psychological changes — it actually showed decreased expression of proteins responsible for inflammation.
Psychological researchers have differentiated between different types of happiness. There’s a happiness that is known as more selfish happiness. You might think of that as coming home, watching a TV program you like, having some alcohol, eating some
food, maybe doing something else associated with pleasure. Those things make you happy, but do not necessarily contribute to the meaning of life or help other people. That’s considered more selfish happiness.
Buying cars or having nice clothing perhaps would be considered more hedonic happiness.
Eudaimonic happiness is associated with having a sense of meaning and purpose in life. That can be different in everybody. That could be taking care of your family, taking care of your children. That would certainly be noble purpose. It could be social
happiness — being involved in groups with other people, communicating with other people, feeling that your experience helps other people. That would be associated with more eudaimonic happiness.
You don’t have to be a Mother Teresa, which is the first thing that most people will think about with eudaimonic happiness. But again, it’s having a sense of meaning and purpose to your life that differs across people but is a feeling that people
have. That has been shown to decrease the expression of the pro-inflammatory genes and actually increase the expression of genes responsible for killing viruses and bacteria directly.
Nobody knows exactly why this happens, but it probably is linked somehow to the survival of the species and survival of us as a group, as opposed to individual survival.
I will have to say in my practice that people who have some meaning in their life — who are linked to family or linked to church or linked to work that they feel is meaningful — do sometimes do better than people who are very isolated and who have
lost feeling that what they do matters very much in the world.
Other non-pharmacological things that may help with things like marrow plasticity (which means getting your brain to grow new brain cells) or parasympathetic output (which is linked to relaxation) would be mindfulness meditation. There’s a lot of
research now on the benefits of mindfulness meditation or even mindfulness psychotherapy. (27)
Recovery
In my practice, treating biotoxin illness for several years, I’d say that a large percentage of the patients that I see who are complaining initially about depression and anxiety and insomnia — when we start the appropriate treatments with the
Shoemaker protocol, their problems just gradually resolve over 2-4 months. It just becomes a non-issue. In fact, sometimes we have to go back to the initial notes and remind people that they first came to me because they were complaining about depression
or anxiety.
I would say that about 30% are going to need more intensive supplemental or allopathic intervention. Again, I am not opposed at all to using benzodiazapines or SSRI’s or stronger meds if they are needed.
I think therapy or support can be very helpful. I often refer people to a psychologist who is very familiar with mold illness.
Patients find it very helpful that they can talk to someone who doesn’t think they’re crazy when they start talking about their mold treatment or when they link re-exposure to psychiatric symptoms. I hope there are more and more psychologists who
will be available to do that. Or coaches who have experience. It is extremely helpful for people going through this.
There are about 10% of people that I see who have what I would call intense psychiatric processes going along, such as severe agitation, depression or psychosis. They may require antipsychotics or even electroconvulsive therapy. Although it sounds severe,
when there is severe suicidal ideation or when people aren’t eating — when there’s a threat to life — what’s needed needs to be done.
Thank you for letting me share what is for me exciting and interesting information.
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References:
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(2) Shenassa ED, Daskalakis C, Liebhaber A, Braubach M, Brown M. Dampness and mold in the home and depression: an examination of mold-related illness and perceived control of oneʼs home as possible depression pathways. Am J Public Health. 2007 Oct; 97(
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(9) Tatiana Falcone T, Carlton E, Franco K, Janigro D. Inflammation, psychosis and the brain. Psychiatric Times 2009; 26.
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(11) Cascella NG, Santora D, Gregory P, Kelly DL, Fasano A, Eaton WW. Increased prevalence of transglutaminase 6 antibodies in sera from schizophrenia patients. Schizophr Bull. 2013 Jul; 39(4):867-71.
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(13) Gordon WA, Cantor JB, Johanning E, Charatz HJ, Ashman TA, Breeze JL, Haddad L, Abramowitz S. Cognitive impairment associated with toxigenic fungal exposure: a replication and extension of previous findings. Appl Neuropsychol. 2004;11(2): 65-74.
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(15) Jedrychowski W, Maugeri U, Perera F, Stigter L, Jankowski J, Butscher M, Mroz E, Flak E, Skarupa A, Sowa A. Cognitive function of 6-year-old children exposed to mold-contaminated homes in early postnatal period. Prospective birth cohort study in
Poland. Physiol Behav. 2011 Oct 24: 104(5):989-95.
(16) Swardfager W, Lanctot K, Rothenburg L, Wong A, Cappell J, Hermann N. A metaanalysis of cytokines in Alzheimerʼs disease. Biol Psychiatry. 2010; 68:93041.
(17)
http://www.survivingmold.com/diagnosis/neuroquant
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Psychiatry. 2010 Feb; 67(2):146-54.
(19) Accardi G, Caruso C, Colonna-Romano G, Camarda C, Monastero R, Candore G. Can Alzheimer disease be a form of type 3 diabetes? Rejuvenation Res. 2012 Apr; 15(2):217-21.
(20)
http://mypassion4health.blogspot.com/2013/09/ketogenic-diet-resources.html
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(22) Braidy N, Grant R, Adams S, Guillermin GJ. Neuroprotective effects of naturally occurring polyphenols on quinolinic acid-induced excitotoxicity in human neurons. FEBS J. 2010 Jan; 277(2):368-82.
(23) Messaoudi M et al. Beneficial psychological effects of a probiotic formulation (lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in healthy human volunteers. Gut Microbes. 2011; 2, 256-261.
(24) Benton D et al. Impact of consuming a milk drink containing a probiotic on mood and cognition. Eur J. Clin Nutr. 2007; 61, 355-361.
(25) Jorde R, Sneve M, Figenschau Y, Svartberg J, Waterloo K. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: a randomized double blind trial. J Intern Med. 2008 Dec; 264(6):599-609.
(26) Fredrickson BL, Grewen KM, Coffrey KA, Algoe SB, Firestine AM, Arevalo JM, Ma J, Cole SW. A functional genomic perspective on human well-being. Proc Nat Acad Sci USA. 2013 Aug 13;110(33):13684-9.
(27) Pace TW, Negi LT, Adame DD et al. Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology. 2009; 34: 87-98.
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