Lyme and Mold: Possible Root Causes of IBS, Dysbiosis and Other Gut Issues

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm going to be talking with Dr. Diane Mueller, a naturopathic doctor, doctor of acupuncture, and a survivor of IBS, Lyme disease, and mold illness. Dr. Mueller is passionate about bringing research, understanding, and compassion to those with these diseases. She's co-authored a book which is to be released in May 2021 called Use Your Mind to Heal Your Mold and Lyme. Her practice, the Medicine with Heart Clinic, treats patients around the country. She also co-owns an online functional medicine school called the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine. But before we start, if you haven't yet, pop over to my website, HighDesertHealthCoaching.com, to pick up my free new ebooklet called Finding Your Root Cause Through Stool and Organic Acids Testing. And if you haven't yet followed or subscribed to the show, be sure to do that so you don't miss an episode. And please share it with a friend who you know has gut health issues, or in your favorite gut health Facebook group if you haven't seen it mentioned there. And now on to the show. Welcome, Diane.

Thank you so much, Lindsey. I'm so excited to be here.

Yeah, thanks so much for coming on the podcast.

My pleasure.

So it seems like a lot of these podcasts and summit interviews always start with this long illness history from their guests, and I don't want to spend too much time talking about that, but it's 2021 now. And so I'm just curious what years you were dealing with IBS and Lyme and mold illness. Was that all at the same time or one at a time?

The IBS was actually the start of it. The IBS actually started in childhood, so that was back in the '80s. And then I started having symptoms in the late '90s, early 2000s that later led to me realizing those symptoms were basically connected to Lyme and mold, but they kind of worsened throughout like 2000 to 2010, and it was 2011 when I actually realized what was going on from that standpoint.

Okay, and so is having gone through that what got you into becoming a naturopathic doctor?

The IBS part was so— because I had gone through all the classic things as so many people do with IBS around all of the standard, you know, conventional tests that everything was normal. So that's kind of what drove me into learning naturopathic medicine and acupuncture. And it was actually when I was in medical school for that that was driven by the IBS that— and I think it was like maybe the stress of medical school that started making some of the symptoms of Lyme and mold really start exacerbating. That's when I really started going downhill, was actually when I was in school.

That's sort of ironic, right? You're learning how to treat these things while you're simultaneously succumbing to them. Yeah.

I mean, it's, you know, in some ways it's, I guess, a good way to learn. I'm a kinesthetic learner, so, you know, maybe that's why this happened to me, is so I could learn.

Right, right. No, I think that's how a lot of us get into all this.

Yes.

So do you have a sense of which So you say the IBS came first, but do you think of that as like your root cause or what? Obviously there was a root cause to the IBS. What was it for you?

For me, I mean, one of the big things that it was was small intestinal bacteria overgrowth for sure. And I think the onset of that was when I was young, we took a family vacation and I was at a restaurant and had drank some really soured milk. And I had really insane food poisoning that took me down. The way my mom describes it is I wasn't normal for almost a whole week after. Mm-hmm. And, you know, and now we know of course that food poisoning is so often that instigator through the CBT toxin release that I think that's what basically caused, you know, my migrating motor complex to shut down and the progression of SIBO from there.

Mm-hmm. Have you ever done the IBS-Smart test?

I have done the one that is offered by Vibrant Wellness.

Oh, okay.

Yeah.

Does it, does it test the anti-CDTB?

It does. Yeah.

Antibodies.

Yep. Exactly.

Anti-vinculin.

Correct. Exactly. It's basically the same test. It's just different company.

Got it. Okay. And so yours were positive?

Mine were positive. Yeah.

Okay. So now then the Lyme and the mold, did they You just assume you got those sort of along the way, but the stress was what made you more susceptible to them then? Yeah.

So basically I did grow up in the Northern Virginia area. We used to camp a lot in the Appalachians and my sister had Lyme disease when she was young. She had the classic bullseye rash, that sort of thing. And it— and that was when she got sick was right when people were actually realizing that Lyme disease was a real thing. So I know I was definitely in some very, you know, heavy Lyme areas. So my suspicion is I could have caught it back then. And like so many people, like it can look like the flu and it goes dormant. And so my suspicion is that medical school and stress made it really come out of dormancy. Some of the things I was having prior to that was I would just wake up sometimes prior to medical school and have these days that were just really, really off. Like, I couldn't think, everything would get cloudy, and I started having some joint swelling to the point where I actually had to have elbow surgery to work on some of the swelling.

Wow.

So those were some of the early symptoms that started coming on. And then when I got into school, I think the stress of that, and then I was living in a moldy environment. So I think all of those things kind of converged. I was still at that point still had SIBO. So it's just kind of a perfect storm.

Mm, got it. Okay. So let's talk a little bit about how Lyme, and let's talk about the classic Lyme first, the Borrelia burgdorferi. How do you say it?

Burgdorferi.

Yep. Burgdorferi. Okay. How that might manifest in the gut.

Yeah, it's such an important thing. So basically what has been shown in research is that on those positive with Lyme, the cardiac vagal tone, which is basically just a, a way of monitoring the impulse of the vagal term on respiration, the vagal tone on respiration, but it really is telling us— the test is really telling us about the vagal nerve functioning in general. So what this study found is that those with Lyme through through this testing mechanism, the vagal nerve was actually downregulated, which is, as you and I know, means this turned down, not functioning as well. And that vagal nerve runs so much of digestion from anything from peristalsis, the movement of food through the intestinal tract, and proper stomach acid secretion, proper bile secretion, proper pancreatic enzyme secretion, all these different things. So when Lyme starts to attack the vagal nerve, we can actually see a problem in the digestive tract because none of these digestive functions are getting the proper signal.

And so have you read or do you know about Stephen Porges, his work?

Oh yeah.

Yeah. Yeah.

The polyvagal theory.

Polyvagal theory. Right. Right. Right. So what vagal state would you be in typically?

4 if you have Lyme.

Yeah.

I'm trying to actually remember the third system.

The dorsal? Well, there's the dorsal and ventral. I can't remember which one's the bad one.

Yeah, you know, I'd have to— I went and read that theory so long ago, I'd have to go back and I think reread that to be able to properly answer that question.

But it's— you had the fight or flight, and this adds on the freeze, right? And to some extent, a frozen vagal nerve would mean you've got slow digestion.

And yeah, yeah, I think that's a great way of looking at it.

Yeah, okay. Anyway, so what about the Lyme co-infections? Do they manifest the same way in the gut impacting the vagus nerve?

It's slight— slightly different in mechanism but same potential impact. So like Bartonella, for example, that co-infection, the mechanism that is thought to be happening is Bartonella basically will cause an increase in our white blood cell, the CD34 white blood cell. And basically when that is upregulated, what happens is that will be seen with like a catecholamine dominant. So we see like norepinephrine and epinephrine, adrenaline essentially, increase. And when those things increase, then, you know, we move into more of that fight or flight type of situation. So it's really— it's the same thing can happen through like a turning down of the vagal nerve, but it's through this, it's through this backdoor mechanism of increasing the fight or flight due to the way our white blood cells are responding.

Okay. And so how many different Lyme co-infections are there? Can you just briefly go through those?

The question is probably in some ways not totally possible to answer because I think we're still learning so much about all of these different things, all these different microorganisms that insects are containing. So the thing is, you know, it's like when people get bitten by an insect, it's just like whatever cocktail of that insect has as far as microorganisms, get basically inserted in somebody's body. It's so unspecific. So I think the— I can answer that in like the most common ones that we see in clinical practice. And, you know, these ticks, these insects are always picking up new things. So I think there's always going to be that new, say, microorganism on the, on the scene that we haven't seen before.

So what are the most common ones then?

Yeah, the most common ones are gonna be Bartonella, Babesia, Ehrlichia, Anaplasma, Rocky Mountain spotted fever. So I would say those are like the super top ones. And then we, you know, have other things like dengue fever, for example, that can also be a, a concern. But the top ones for sure are gonna be the Babesia, Bartonella, Ehrlichia, Anaplasma, and Rocky Mountain spotted fever.

Okay. And if you go to your doctor to get tested for Lyme, How likely is it that they're gonna test you for those other things? And is their test even worthwhile, or do you need to go to see a, a naturopath or a functional medicine doctor to order a good quality test?

Oh, I'm so glad you're asking this. The challenge with what's— how, how these things are being tested for in conventional medicine is typically they are like Lyme, for example. Borrelia is first screened for in conventional medicine with an ELISA test. An ELISA test has been shown to have a high rate of false negatives. And so it was super weird about how it's set up because the Western blot is a different testing mechanism and the Western blot has been shown to be much more accurate for diagnosing Lyme than the ELISA. But yet the ELISA is what people start with and they only get the Western blot if the ELISA is positive.

Is this an insurance thing? Like the insurance companies won't pay for the Western blot because it's more expensive?

Correct. Exactly. Exactly. And so that's the challenging thing with going to a conventional doc. And so many people, even if they request test this and they hear this information, they're like, let's go get tested. They hit this roadblock and they think they're fine when they're not because of a bad test. So it's definitely important to go to somebody that's Lyme literate, that really knows Lyme, to get a test from them. And Western blot's definitely a decent test, but there's also problems with it. And some of the problems are like what, what the Western blot essentially is. It's basically where they are kind of taking little tiny pieces of protein pieces of the Lyme bacteria and basically seeing if we have an antibody response. They're looking to say, is our immune system reacting to certain proteins? And the proteins are ones that are seen in the Lyme bacteria. And the problem with this is how this test is interpreted is basically says, okay, well, your immune system has to react in 3 to 5 different ways to these particular protein pieces. And why that is oftentimes an inaccurate way of interpreting things is because some of these protein pieces are so specific to Lyme that there's really not gonna be other microorganisms that would actually cause our immune system to react in this way. So, the idea is why do we have to have 3 to 5 different ways of reacting when, you know, if it's super— if this test is super specific to Lyme, one of these elevations should be a sign that there is Lyme present. So, I know that's kind of heady information, but the point of that is, Even with the Western blot test, it's really important to go to a, a Lyme literate doc that kind of understands like how to extrapolate and understand the material so that it's truly being interpreted correctly, because it can be interpreted incorrectly quite a bit.

Right. So it sounds like you could even look at your own Lyme test from a traditional doctor if it were a Western blot and see if you get one positive. I should probably consider myself as having Lyme and see somebody who can help me with this since my doctor probably will tell me I'm negative.

Correct. Exactly. And there are some of those protein pieces that are very nonspecific, meaning there's some protein components of Lyme that, say, viruses have as well. So those things that are like nonspecific, those we kind of ignore if it's just one, or not ignore, but we understand the whole picture. But if the protein pieces that are like, this is really just Lyme that has these pieces, so if our immune system's reacting, that part of the test is super important to interpret correctly. And then the, the PCR test has really come a long way too. The PCR test, which is really looking at the DNA, you know, for the DNA of the bacteria, that's also a super useful test to do in combination with the Western blot, just as a check and balance.

Okay. And then is this a stool test or what kind of PCR?

No, this is, this is a blood test. Yeah.

Okay.

So, you know, being a gut podcast, I'm sure your listeners are really used to hearing about PCR in stool tests. So it's, it's a similar mechanism of looking for the DNA and microorganisms, but instead of looking for them in the stool, we're looking for them in the blood because that's going to be a more likely place where we're going to find the DNA for Lyme.

Yeah, I'm not actually sure how much my listeners know about PCR tests, but, but I, I mention often the GI-MAP and that's a PCR test where you're basically just matching the DNA to the organisms you're looking for. Is that, that more or less?

Yeah, that's a simple way of explaining it. I love it. Yeah. And that's a great test. We use that test too.

Right. Okay. And what about the co-infections for Lyme? If you see your doctor, are they going to test for the co-infections or not that either?

They are probably going to think that you are reading too much online if you ask for the co-infections, honestly. And every once in a while I do find somebody, you know, a conventional doc who's really educated in this. But most of the time, one of the biggest problems beyond even the insurance world that I find around insurance not covering and doctors not wanting to order things they don't cover, one One of the things that I have seen come up quite a bit when talking to conventional docs is that people don't like to order things that they don't know how to interpret and treat. So oftentimes, like, a no can even be coming from a place of, well, if the doctor orders it and doesn't know how to treat it, then they're assuming in some way some level of responsibility and they don't know what to do from there. So it's almost like there's some resistance to even going down that road.

So maybe you could just say, hey, my, you know, my functional doctor wants me to get these tests and they'll handle it when they get the results and they might have a better chance, or my naturopath.

Yeah, absolutely. I mean, I still see people get shut down, but having that approach of letting them know that, okay, doc, you're not responsible for this information. I have a plan. Can you just help me? And some docs definitely will. It's definitely from a testing perspective, what you're asking for is— I would ask for like whatever the microorganism is. So if we're saying Bartonella or Babesia or any of these others I mentioned, then they would typically want to ask for both an IgM and IgG antibody as well as the PCR. So it's essentially 3 different markers for any of these microorganisms, the coinfections that you would be wanting.

Okay. And so If you find somebody who's got simultaneously the gut issues and then the Lyme, which do you deal with first?

It's definitely dependent, but one of the things that's super important to realize is oftentimes starting with the gut can keep us— we can move further faster. One of the things that's really interesting is that E. coli, one of the microorganisms that's Some cases shown to overgrow in SIBO and also seen with chronic UTIs. So, you know, we know how common E. coli is, and E. coli will actually change a protein in the liver. It's a transport protein, and that transport protein's job is to basically help move toxins out of the liver so our body can excrete them in the stool. And so E. coli will actually block— not even E. coli itself, it's the toxins, the endotoxins from E. coli will block that transport protein. So what that means is somebody that has, say, like a SIBO infection, for example, but also Lyme and mold, that SIBO overgrowth, I should say, is actually preventing the Lyme and mold toxins from moving out of the body. So definitely, you know, if there's SIBO— SIBO is a case where it is often better to start with the gut. One of the exceptions though there, I would say, is if somebody is in a moldy home. The moldy home tends to cause so many problems that if people have the ability to prioritize all of their focus on getting into a safe space in that situation, I usually say that's most top priority, but we definitely have to get the gut working as fast as possible.

Got it. Okay. And so how do you end up treating Lyme and its co-infections?

So in our practice, we use predominantly herbal medicine. A lot of people are really into treating Lyme with doxycycline and your triple antibiotic therapy. And there's so many problems, as I know you and I know about the gut and really the microbiome of the whole body. And what's also interesting is the main drug, doxy, is the main drug on the scene for treating Lyme. And it has actually been shown, there's multiple studies showing this, that doxy will actually cause Lyme to convert from its most active form and it'll convert the form into Lyme where it's more in like its dormant state. So the challenge with that is people can go, they can take doxy and they can feel a little bit better because they're getting the Lyme out of their blood and out of the system, the active form, but then they're just moving it into hiding. So they're not actually clearing it. They're just putting into hiding so that when somebody's stressed, then the Lyme will essentially come out of hiding. So that— I really don't like to use doxy. And then the triple antibiotic therapy is so intense. I've seen people come into my clinic that have seen other practices that have been on IV triple antibiotics, sometimes even up to 5 years. I've seen—

yeah. How do you do an IV antibiotic for 5 years? They have to put a line into you.

Yeah, they have a PICC line.

Wow.

Yeah, exactly. And these are the sickest people I've ever seen, are the people that have had that type of level of antibiotics. And I'm sure it's no surprise to your listeners after the work that you do on teaching them about the gut and the health of the gut and the microbiome, because it really just destroys us. And with all we know about like the gut and the microbiome and its effect on our immune system, Destroying that is not gonna help us eradicate these infections. So I find herbal medicine to be a much safer approach and incredibly effective. It works so well.

And are there particular herbs that are good for Lyme then, or particular nutraceuticals?

There's definitely particular herbs, and some of it is also about the way the herbs are prescribed. So one of the things we really want to be careful with whether it's herbs or pharmaceuticals, we really want to be careful with preventing the Borrelia, the Lyme, from burrowing deep into our tissues or from changing from its active form into one of its hiding forms. And so there's a couple different ways we can do that. One is through pulsation, which basically means that we are going through a period where we are, say, on the herbs and then off the herbs. So we might say, take an herbal protocol for 5 days, take 2 days off. And, you know, during those 2 days we might be doing some gut work or some adrenal work, something that's strengthening the body, and we kind of rotate that way. The other way to really prevent the Lyme from going deeper is by rotating through our therapies. So when we rotate, we might do an herbal protocol for, say, a month and then switch to another herbal protocol for a month, switch to a third, and and then rotate that way, always on that 5:2 pattern. You're rotating the different types of herbs. It doesn't seem to need to do the 5:2 pattern. The 5:2 pattern is really if you're just sticking with the same protocol. You either stick with the same protocol and rotate on and off, or you stay on the herbs but you just rotate through what the herbs are. Does that make sense? Yeah, yeah.

And so which herbs are good for Lyme?

So one of the most important ones that we feel at this point is an herb called Cryptolepis. So Cryptolepis is really amazing. It kills Lyme in all of its different states. And there's one particular, like, state, dormant state called the persister state. And what's interesting is this persister state is a state of Lyme that just does not respond to antibiotics. It's not antibiotic resistant because antibiotic resistant bacteria have actually changed their DNA to allow them to become resistant. It's thought to be caused by a genetic mutation in Lyme that just spontaneously makes the Lyme resistant without having a gene against the antimicrobial agent. So the idea with this is Cryptolepis has been shown to kill those types of cells where it's oftentimes in laboratory studies, they'll do these studies where they're putting these various different killers, these different antimicrobial agents against Borrelia and it'll look like Borrelia's dead and then they'll check the petri dish like a week or two later and all of a sudden all these new cells have sprung up. And so Cryptolepis has been the herb that's performed so well with up to 21 days is how long the study has gone on for. With Cryptolepis and at 21-day mark, there's no Borrelia. And that's been the only thing that's performed that well from, from an herbal or from a pharmaceutical standpoint. The study that looked at that compared several different pharmaceuticals that are being used on the scene for the same reason. And Cryptolepis outperformed all of the herbs and all of the pharmaceuticals.

Cool. And so I probably should have asked this ages ago, but what are the symptoms that somebody might have Lyme or Lyme co-infection?

Yeah, it's a great question. So one of the most common things we see is migrating pain. So pain that can be in the hip and then the shoulder and then the elbow. So pain that it's usually somebody's in pain most of the time, but it moves in location and severity. So that's one of the most common things. But chronic fatigue's really common. Gut problems are really common, especially if, you know, since we're talking about gut. From a gut perspective, I would really be thinking about Lyme are times they've done the GI map, they've done the SIBO, they came back and they're hydrogen and methane negative and their GI map looks good and their microbiome's healthy. And what else is causing this? And trying to figure out what else is driving it. Try different diets, you know, all the basic things have been done. So from a gut perspective, that's definitely when I would start saying like, okay, we've taken care of all of these really great tests. And we still have symptoms, now we should start looking at what else could be, say, attacking the vagal nerve, could be causing some of this inflammatory process. So that's from a gut perspective when it's really important. And then other symptoms to look out for are things like agitation, anxiety, quick to overwhelm, quick to anger. Sometimes people will wake up in panic, wake up in anxiety. So kind of waking up at the middle of the night, like a classic, a very, very textbook Borrelia person is gonna wake up with anxiety around the 3:00 AM time period. But of course it can be whenever. So there's a lot of other symptoms, but those are some of the, the ones that are the most common. The other thing to really think about and when to consider Borrelia and Lyme is when there's been, you know, maybe the gut's been looked at, the adrenals have been looked at, maybe metals have been looked at when there's been a lot of other things that have been looked at and it's like, gosh, what else is causing such a widespread symptom picture where somebody's not getting better? Then we definitely wanna be thinking about Borrelia.

Okay. And in terms of the moving pain, is that typically moving between joints or could it be in your digestive system too?

It could be anywhere, honestly. Like the most classic thing is for sure between joints, but it can definitely be in the muscles. There can be fibro-like pain. It can be in the gut. If pain's involved, we do wanna have Lyme in the back of our mind as a possibility and pain anywhere, you know, headaches, anything like that.

Okay. Got it. And so how long typically are these herbal protocols then for Lyme?

The average person is on herbs for Lyme for a year. So, and then as far as total treatment, it really just depends upon, you know, when we do functional medicine lab tests, it depends upon how many different those things we find come up on the labs.

And so assuming that you've already worked on the gut and the Lyme and a year goes by, they can get off the medication, do people tend to then not have the gut issues reappear?

Yeah. I mean, I do see that some people still have to be on certain diets. One of the things I have found is that for people that have chronic SIBO, for example, where it's just like, gosh, you treat, goes away, it seems like it's gone. I do Migrating Motor Complex work for 6 months, they're great. And then a year or two later, I just find that some people do have a tendency for it still to recur. So there are certain people that I have found that, wow, if we can just keep them on certain diets, it can really be helpful. But it definitely, I've absolutely seen this really change the picture for people with GI in a permanent way.

And what do you like for the Migrating Motor Complex?

For the migrating motor complex, we're using things like 5-HTP, we're using ginger, we're doing low-dose naltrexone. I really do like the low-dose naltrexone quite a bit. I've seen some really positive things with it. Done a little bit of low-dose erythromycin, but haven't used that one quite as much.

Yeah, that one kind of scares me cuz it's an antibiotic.

Exactly. Like even in low dose, it's definitely— it scares me too.

Excuse this brief interruption, but I wanted to remind you that if you've been struggling with IBD or IBS, reflux, gastritis, SIBO, dysbiosis, Candida, or another gut health issue, that's my specialty. I work with clients not just here in Tucson, Arizona, where I live, but virtually on video chat, and I offer single appointments as well as 5-session gut health programs for people with tougher issues who will likely require testing and longer-term follow-up as well as 12-week programs for weight loss or reversing autoimmune disease. So if you think a 5-session or longer course of health coaching might help you meet your health goals, you can set up a free 30-minute breakthrough session with me to talk about what you've been going through and hear what health coaching involves. So, uh, you can find the link in the show notes. Now back to the show. Okay, so we've talked a lot about Lyme. Let's move on to mold. I have a client right now who has very serious mold illness, so I'm eager to hear more about it and how it interacts with the digestive system. Lindsey Parsons. So first, let me just ask, is mold usually environmental, like you're in a moldy house or workplace, or is it sometimes coming from food or other sources?

Well, it certainly can come from food and other sources, but if people are truly having mold illness, is really an issue where we have a genetic anomaly where our body is not able to properly, say, recognize the toxin from mold. And because we can't recognize the toxin because of our immune genetic issue, we can't eliminate it. Yes, it comes from buildings. We can have it from food, but I've never seen somebody where it's, oh, eating some peanuts is the reason they have mold illness. Somebody with mold illness should certainly avoid peanuts, but it's more around, hey, the mold toxin level is so high that our body can't eliminate it.

And what portion of the population has that genetic anomaly?

24%. But the thing with that is, is that not everybody has their gene activated. So just because there's 24% that have it, of course the gene has to be activated. So not all 24% are in this situation where they could react this way because some of them will not have an activated gene.

And what might activate that gene?

So typically what we see from what in— activates genes is usually in research we call it the environmental trigger. So usually it's going to be things like viruses have been studied quite a bit for activating genes. Toxins, pollutants in the air, stress, mindset. So if we're, you know, we're creating an internal stress response because of our internal dialogue, that could be enough to, to activate it. Infections in the gut, our diet, you know, poor dietary choices. Any of these types of things can potentially activate the gene.

Okay. And once it's activated, can you deactivate it?

It's a big question in research right now. The way research is looking at the epigenetic, the things that are actually triggering genes is really to see a couple different things. So the way it's been described to me and the way I can best help people understand this is it's almost like you can imagine that if our, our genetic code was, say, like, in your arm, and then there's sleeve, right? So your arm is covered. So there's certain things that are going to basically pull open the sleeve, which is essentially allowing the gene to express. So one of the things that we have seen to pull down the, the sleeve and essentially cover up the gene are basically methyl donors. So by giving things like SAMe or choline or creatine, these things that have been shown to help with methylation, that's definitely something that we see is, okay, well that provides that sleeve, covers up the gene, and can help potentially with lowering that epigenetic expression. This is still a little bit theoretical in research, still like this unknown area of, you know, how much is this truly able to be turned off? The other thing that is showing promise right now is meditation. So those are the two things that I've seen that are showing the most promise, although we still need more studies to really say, okay, conclusively this is happening.

Okay. So I found it interesting that you mentioned choline, SAMe, and what was the third one?

Creatine.

Creatine. Mm-hmm. As methyl donors.

Well, SAMe is a methyl donor and then choline and creatine will basically help to clear methyl donors. So they'll help prevent methylation from being used to create them. And so then methyl donors can be more available for something else, especially creatine. It takes a lot of methyl donors to make creatine. So then if we give creatine, we don't have to use those methyl donors for that. So then we can use the methyl donor someplace else.

Okay, because when I think about methylation, I always think about methylfolate and methylcobalamin, B12.

You know what's so interesting about that? There's a really cool study that looks at methylcholine or methylcobalamin and methylfolate, and what that study showed is that even though there is a methyl group attached to those things, from like how many methyl donors those types of molecules can do compared to say like a SAMe or compared to creatine, it is so much less. Even though we do know, of course, people with, you know, MTHFR problems, and sometimes if we give 'em, you know, too much methylfolate or too much methylcobalamin, the right amount is good, the wrong amount is a problem. And even though, so there is something happening there, the amount of donation from a methylation perspective of those nutrients is so much less than these things I mentioned.

Hmm.

And that study was really exciting to me to find because it's definitely not what I think a lot of us were thinking about methylfolate and methylcobalamin for some time.

Hmm. Yeah. Okay. So tell me, how does mold impact the digestive system?

One of the things that mold has a tendency to do from a symptomatic perspective is a lot of people feel very, very nauseated with mold. So there's a lot of that. And we do know that mold can cause a lot of neuroinflammation. And we do see that mold for a lot of people can also cause sympathetic dominance. So from that standpoint, again, bringing us back to the need for parasympathetic control, that's a big thing. But, you know, one of the things that I know you and I had talked just super briefly about prior to this was the idea of, you know, mast cell activation, histamine intolerance, these types of things. And many people with mold will wind up having histamine intolerance because mold will tend to create a lot of histamine in the body. And we actually see that histamine, when it is not broken down, can actually cause intestinal permeability. So when we're talking about leaky gut and we're talking about leaky gut even leading to autoimmunity and the inflammation seen with intestinal permeability, that can be connected to histamine and that can be connected to mold.

Okay. Now I'm sure people are familiar with antihistamines, so they probably know what histamine is likely, but just talk a little bit about how that looks in practice?

Yeah, absolutely. So, you know, histamine is the molecule that gets released, but basically it gets released when we encounter something that is, say, bothersome to our body. Our body responds with this release of this molecule called histamine, and classically allergy symptoms come from the histamine, which is why antihistamines work. And so basically with histamine intolerance, essentially what we're saying there is we're saying what happens when we encounter, say, histamine in in our environment or histamine in our food. A lot of foods have histamine. And what classically happens there is our body releases a couple enzymes, one that comes from the gut, one that comes from the liver. And what happens is when we encounter histamine, those enzymes go up and the enzymes will break down histamine. And if the enzyme levels are high enough, then the histamine basically goes away and we don't even realize this happening. We don't have symptoms and all of this. So allergies, or the idea of histamine intolerance, is basically when the imbalance happens between the amount of histamine coming in and the amount of histamine going out, either due to too high of a histamine load or due to too low of the amount of enzymes that are actually designed to break down that histamine. And so that imbalance is where this histamine intolerance can come into play, and that can manifest in symptoms that are classic histamine type of symptoms, like the runny nose, the, you know, itchy eyes, those types of things. But it can manifest in skin rashes, it can manifest in intestinal permeability, it can manifest in headaches and migraines and fatigue. So many things that are non-classic allergy related that oftentimes we, without testing, we don't even realize this was going on.

And would these reactions, if they were related to too much histamine in food or our inability to break down that histamine, would they happen right after we eat a food with— that's high in histamine?

They can, but usually if it's gonna be just from a food that's high in histamine, unless we're gorging on that food for many days, the enzyme should be high enough to break down our histamine from food. So if it's truly just from food, then either— either one of two things. Either there's such a strong reaction to the food that the histamine level is like super, super high and over the top, or if it's a more mild reaction, then it's usually due to a deficiency in those enzymes and that underlying problem of those two enzymes not being high enough to break down the histamine that's in food.

And is that what mold does to you then?

People can have a histamine type of reaction to mold. That's one possibility. There's a lot of things that happen with mold illness. So people have headaches and migraines and all sorts of different symptoms. But one thing, one way, one of many ways that mold can affect the body, people can have a histamine reaction to it. And that histamine reaction can basically then cause that process that I just described. But I wanna make sure I'm being very clear that this is only one of many different ways that mold can affect the body. It's just how it's related to the digestive system.

Yeah, no, I'm interested because I do have this client in particular who's having this combo of symptoms where she's got the mold and all of the accompanying symptoms and then definitely is dealing with histamine intolerance and inability to eat the vast majority of foods. Mm-hmm.

Mm-hmm. Yeah, I would definitely be looking at mold.

Yeah, no, there's no question it's mold. That's at the base of it all.

Yeah.

Yeah. So I guess there's a good question. If the person cannot get out of the mold right now, is it still worth going in and starting to treat it?

I have tried that so many times because I want that to work and I have been pretty underwhelmed with the results. Every colleague that I've talked to that treats mold has had the same, you know, the same clinical results. Around it not making a huge difference. So minor differences, sometimes I've seen small, very small changes, but unfortunately getting out of that place seems to be essential.

Right. Okay. So say you're able to get out of the place, but you know, the residual mold in your system is still debilitating and your digestive system is essentially feels dysfunctional. It feels like you're not absorbing your nutrients and sort of like both systems are shot, where do you start?

So I do like to start people as soon as we get them out of the moldy place. Two of the nutrients I tend to start them on right away, even if we're not ready for a full detox. So oftentimes, like I said, if like where you're talking about where the digestive system is shot and there's a problem there, oftentimes it is valuable to really go after that as one of our priorities. And in a mold situation, say we had H. pylori show up, and let's say we have Blastocystis hominis come up on the GI map. And so in that situation, we would definitely want to prioritize doing those. But in a mold situation, I would absolutely, as soon as they're out of the moldy house, get started on opening up some of the detox pathways and binding the mold. So one of the nutrients that I've seen to be just phenomenal for working with mold illness is choline. So putting people on a fairly high dose of choline, usually 4 grams, 2 to 3 times a day, mm-hmm, is a pretty solid choline dose. And then starting people on binders to actually grab onto the toxins and get rid of them. And of course, if somebody has a tendency with a GI issue for chronic constipation, I will tend to still put them on binders cuz it can help their overarching symptoms. But then I usually do something like a citrate, or sometimes even I use a Chinese herb that is Da Huang, which is essentially a rhubarb extract that is a bowel mover. So I will use something if they're constipated. I will still give them a binder to get the mold out, but then also I will temporarily put them on some sort of bowel mover to make sure that we are not trying to get things out and basically have our plumbing gunked up.

And do you do binders between meals the way you would like with a gut protocol?

Correct. Yep.

Okay. And so are the binders specific to the kinds of mold that the people have, or are there some good general binders?

I usually put people on a pretty broad binder spectrum because people do tend to have quite a few molds, and there's enough other environmental toxins and metals and, you know, glyphosates, all sorts of different things that people tend to have in their body. So I usually just like to put them on a broad spectrum thing. So it can be a combination of things like chlorella works really, really well. The thing with chlorella is the chlorella is an amazing mold binder. It has, if you don't get it from a quality source, it actually is contaminated with metals. So there's a brand that I have vetted that we use. It's called Prime. No financial interest in them. This is just purely, this is a good, good company. And so, they have a really, really great chlorella that we use. So, and the other thing that in giving chlorella that's super interesting, most binders, if you start giving people too many and they're detoxing too fast, then you tend to have to pull back on the binders and give less. Chlorella, the opposite is true. Chlorella, if people are feeling bad, getting them and they're kind of herxing, they're detoxing too quickly, the way to get them off of that usually is to give more chlorella. So that's a really interesting thing about chlorella. So we'll do things like that. We'll use zeolite frequently, fumic, fulvic and fumic acid. So those are some of the common ones we use.

Do you know GI Detox at all?

Yeah, I've used that product in the past.

Yeah, yeah.

It's not one we're using now, but that's just purely from a not wanting to put people on too many things. But the thing about GI Detox is it does have a really blend of a lot of these things in it.

Right, right. And do you recommend certain diet changes then for mold patients?

It's not so specific to molds that I recommend diet changes. I do recommend diet changes, but not tending to be because they have mold. It's more like in combination with other things they have going on. So if somebody has a lot of blood sugar issues, I might put them on keto diet, or if they have a lot of cognitive dysfunction, I might put them on keto. If— for almost everybody comes off gluten for me. I feel like that's clear that for 99% of the population it's probably not the best thing. So most people I take off of that and then it really is going to be more dependent upon like, okay, if they have SIBO or if they have various different infection or very different like GI infections, we would change things. So it's more dependent upon the whole picture. There's not like a mold specific diet we use.

So if a person with mold has been avoiding most foods, at what point can they feel safe to begin to expand their diet?

Definitely doing it in a slow way, but I would say as soon as their symptoms start improving, once they get to about 30% better from their symptom picture, and we use the MSQ, uh, test. So you can just get an MSQ online, the Medical Symptoms Questionnaire.

Yes.

Now it's subjective. So we rate our symptoms, but it's still a way of saying, okay, well, if somebody was reporting a 10 of bothering them and now they're reporting a 4, that's a pretty major difference. So somebody, when they're significantly 30% better, that's a great time to try it. And another time we'll try it is if people are just really starting to feel the impacts of social, you know, the social impacts of not eating normally, if it's starting to become— this burden is increasing and we've done enough progress where we feel like it's safe to try, you know, we might try it earlier just based upon the effects, you know, the, the multidimensional effect that being on a really limited diet can create.

Yeah. Okay. Is there anything that I should have asked about all this that I have failed to ask?

The biggest thing that I would really say that I think is super important for people to understand is it's when we have multiple symptoms, but even if it's just IBS, even if it's just one major organ system in the body, most of the time for most people, there's not only one root cause. And I think that's one of the biggest things that I feel like people can get, you know, stuck on. It's like, what is the reason? And most of the time clinically, I find it's many different reasons. And from a gut perspective, active. I would just, you know, really emphasize for people that having an IBS diagnosis, having an IBD diagnosis, whatever it is, having that diagnosis is really in some ways just the beginning. Like, now we know that there's a problem, and now we have to figure out why. So if somebody's not getting better from doing histamine intolerant type of foods and removing those and working on their histamine load and healing intestinal permeability and taking care of the microorganisms and all these different things, it doesn't mean that those treatments haven't worked. It just means that that is oftentimes only one piece of the puzzle and we need to continue to ask why, why, why, and continue to look deeper. So if you're not getting— if you're somebody listening to this and you've been trying some really great basics and you're frustrated because you're not getting well, it just means there's more to the story and it's time to continue to dig. And mold and Lyme are both great places to dig.

Okay, and so for gut issues in particular, like that recurrent SIBO, you keep treating it, it keeps coming back, that'd be like a big one for looking deeper?

Absolutely, absolutely. That, and I'd say just classically, you know, more of a peristalsis slowing issue, it's another big one. Even if it's not SIBO, if somebody just has a tendency, even a non-SIBO case, to be chronically constipated for an unknown reason, I would have that ping my brain too.

Okay. And you mentioned, I'm not sure now or when we talked earlier about putting people simultaneously on some type of herbal treatments and at the same time probiotics. What probiotics do you like to use?

So we use Therabiotic Complete by Klaire Labs. So that one's really great. And another particular strain that has been pretty exciting is Lactobacillus reuteri. So some of the studies that we've seen on that around H. pylori in particular have been really, really impressive. But we use a lot of Ther-Biotic Complete. We do use a little bit of spore-based products like Bacillus subtilis. So we do, you do use that for some people. Saccharomyces boulardii, which is sort of a probiotic, especially in cases where people have C. diff toxins. Blastocystis hominis is another big one when we would use that particular probiotic or that particular microorganism as well.

And the spore-based, oh, I should say deciding between those different ones. Are you looking at the GI Map and seeing what's high, what's low?

We don't tend to for the replacement, just because even on the GI Map, a pretty good microbiome profile, it's still, you know, it's like then the microbiome research project where we're doing like a larger microbiome profile. We're still learning about all of the different microorganisms that are out there and what they do and what's important. So we are looking at the GI Map to see abnormalities, but the way we tend to feel is like we just want to make sure that we are getting different species in there. And if we're really trying to reset the microbiome, that's where we've really seen like the Elemental Diet that is so useful for SIBO is also so useful— for getting those, if the microbiome is high in some areas and low in some areas, like on the GI Map, we've actually personally clinically had better results by putting people on like a short-term fast or an elemental diet to actually reset the microbiome more so than even a probiotic. As much as I still think probiotics are super important and super helpful, and in no way am I dismissing them, we've just seen that those things have worked really, really well.

Interesting. And so short-term fasts fast, meaning 3 days or how long?

There is actually a fasting mimicking diet. So you might've heard of like Prolon. Have you heard of Prolon?

Absolutely.

That type of diet we did clinically is we made our own version of it, calculating carbs and proteins and fats and so mimicking kind of the macronutrient profile that the research on the fasting mimicking diet found. And so then we basically did that from a from a food perspective so people don't have to buy all these supplements so that we could basically mimic that research but using things like, you know, whole foods. So that's what we'll put people on, but using the same macronutrient profiles as well as the calorie profiles. And so that's been a really great way of helping people get the same benefits from fasting and get through a fast, but maintaining blood sugar, of course, and helping people that don't fast well.

And how many calories is that in a day?

It's a little bit dependent upon body weight and all of that. I have to go back and look at my exact sheets, but it's like a descending thing. I think the first day for most people is around 700, the first day or two, and then it goes to maybe 4 or 5. It's fairly low, but there is still some level of nutrition that goes in there.

How many days does it go on for?

Typically it's 5.

Okay, that's workable. Yeah. Yeah. I'm just thinking in my head, could I do this?

It's, you know, it's definitely not the easiest or the funnest thing for some of us. I'm not somebody that fasts super easily or well, even though I will do it because of the health benefits. But for other people, I've seen people go on it that feel so good. So some people just fast really well.

Oh yeah. My brother-in-law, he did like 39 days. It's insane. But by the time I talked to him, he could barely— it was like a whisper coming out because he was so weak.

But I would imagine—

yeah, he likes fasting for some reason. I guess it's easier than dieting. Yeah, I personally have— I've never made it past— well, let's see, I think I did about 2 and a half days once. And then, and then I did a bone broth fast for 3 days hoping it might impact my sciatica, which it did not. Yeah.

It's worth trying.

Yeah. So, so does that count as a fasting mimicking diet?

I would say like bone broth, I would, I would think so. I've never compared, you know, the macro ratio depends upon that, but I, I would say the potential of that seems very high to me.

Okay. Well, I have definitely kept you long enough. Thank you so much for all this interesting information. Where can people find you?

So people can find me at my clinic, medicinewithheart.com, and What I wanted to also share with your listeners is that my book about Lyme and mold, and I do talk about some of the things that we talked about in here, like some of the relationship with Lyme and mold to the gut, that for the first 2 days that it goes on sale, that I'm gonna give away the ebook for free. So if your listeners are interesting, you— they can go to mw.h.thrivecart.com.

.com/book.

And that website will basically help— will basically be— it's just a— they just put in their email, and if they put in their email, then I will send them an email when that book is going to be given away for free. So right now it's looking like it's going to be on May 24th is when it'll get launched, but that could change a little bit as we move closer. So that's a way that people can, you know, get informed for that exact day if they want the free book. But then, like I said, my clinic is medicinewithheart.com.

Okay, awesome. I will put links to that in the show notes. Wonderful. Well, thank you so much for coming on, and I appreciate you sharing all your knowledge with us.

Thanks so much for having me, and it's been really lovely to be here. So appreciate so much your work and what you're doing in the world.

Thanks. Great interview. I know I had tons more questions, but that was a lot to cover in an hour, so I'll definitely have to have Dr. Mueller back on the podcast to dig deeper, especially into the mold question. So I wanted to let you know that I've begun transcribing the shows and putting that out in blog format, and I send out a newsletter with links to that about a week after the show comes out. So if you'd like to get that in your inbox, visit my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll get a pop-up box soon after you get to the website, or you can visit the newsletter page under the heading Podcast Blog Videos. And if you appreciate the free information I'm giving you, there are some painless ways you could support the show So first, you could buy high-quality vetted supplements in my online FullScript or Wellivate dispensaries. There's a link in the show notes to both of those. And do compare prices if you find the same supplements elsewhere. I also have an affiliate account at iHerb. So if you buy from there and press on my link under the recommended supplements page or through the link in the show notes, I'll get a percentage. You can also connect with me by joining my Gut Healing Facebook group. If you wanna ask a question about gut health or suggest a topic or a guest for the show, and you can also follow my Digestive Health Facebook page or find me on Instagram, Twitter, or Pinterest. All the links are in the show notes. So I guess that's it. Thanks for listening, and here's wishing you all the perfect stool.