Mold in the Military: Identification and Mitigation Strategies

Young soldier was deployed to Afghanistan for two months and came back to find his personal items totally covered with mold. And this is, this is not an uncommon story. This was just a very, I say, emotionally evoking story.

Hello everyone. My name is Kendra Seymour and I'm joined today by my guest, Dr. Brian. He's going to talk to us about mold in the military and he's going to give us some identification and mitigation strategies. So thank you so much, Dr. Brian, for joining us.

Thank you so much for having me. Really appreciate the opportunity to share some perspective and experience from the military side of the house. And now that I'm recently transitioned, this is an excellent opportunity to share some lessons learned.

Yeah, I love that it's so important. You know, our brave men and women in the military, they really deserve those healthier living quarters and circumstances. So I know you're going to provide some great stuff for them that they can turn around and, you know, hopefully start doing today.

All right, good on, on video and audio.

All good.

Perfect. Okay. Well, once again, thank you so much for having me. So I'm a Army family physician that recently transitioned. So currently a veteran, I was a major in the medical corps for the US army and by board certification, I am a family physician, but I do lifestyle and performance medicine. And most recently I've been doing functional medicine based muscle centric medicine with Gabrielle Lyon. So I get the honor and the privilege to be able to work hand in hand with Dr. Gabrielle Lyon and provide care to elite entrepreneurs, elite war fighters, and just in general, awesome population of individuals. So thank you for letting me get to share some of my previous lessons learned and perspective about mold in the military. So this is just a space holder and making sure that we get a quick moment to reflect. I'm going to be sharing with you lessons learned and perspective from the military side of the house. But just a quick moment to honor the men and women that serve. And it is a, it is a family sacrifice to provide a service. So truly, it's the men and women and the families that back them and the generations of these families that that contribute to our health, wellness, safety of the quick disclaimer. The opinions and assertions are my own. They do not represent that of the dod, Department of Defense, or any branch of the military or the military health system in general. No conflicts of interest to express. Once again, I do work with Dr. Gabrielle Lyon, young, medical practice and an educator with the Institute for Muscle Centric Medicine. So today you're going to get once again information about mold in the military context, some strategies to identify and to mitigate. But you're also going to get a small taste of how we think and how we plan for mission sets in the military setting. So on the right, you'll see it says four steps of ipb, which is intelligence preparation of the battlefield. And this is part of composite risk management. So when we think about understanding the context of the battlefield and all of the factors that contribute to decision making and developing and executing in a mission sense in the operational environment, this is just a small glimpse into our thought process and specifically how we identify and mitigate risk. So from our perspective today, we're going to be talking about mold as the risk and we're going to be defining the operational environment or the battlefield environment. We're going to be describing the impact that mold has on both our physiology and military readiness in general. We're going to talk about how you can evaluate the threat of mold in the operational environment. And then we're going to talk about some courses of action or mitigation strategies for that mold in the operational environment. And then just from learning objective standpoint, exactly what I just mentioned here. Part of that mitigation strategy and those courses of action that we'll be talking about will be how to document and some examples of appropriate documentation and where those documents need to land and live, but then also how to build and leverage your team, who's on your team, who can help you make decisions and get some solution options in front of you. And then also from the terms, from, from the perspective of lifestyle and nutrition, where can you start with self care first? And what can you do to really decrease how much of a burden mold exposure is going to have on you? And also how to unravel or reverse some of the burden that the mold exposure may have had on you already. So once again, we're going to start off by defining what is the operational environment. What do I mean when I say that? And where do you find mold in the operational environment in the military context? So typically when people think about military operational environment, they usually think of firing weapons downrange, catching bad guys, putting life at risk, being in degraded living conditions. But I just want to let you know a different maybe way of defining the operational environment. And I'd love you for you to start thinking about it in three main areas. So garrison training and deployed settings. And when I say garrison, I mean home front. So that may be on post or off post. And when I say post, that means a military base. So where the family lives, where the family exists, the lifespace and that is outside of dedicated training pathways and programs. So typically service members can be away from family in dedicated training pathways for weeks to months on end, sometimes even several years in terms of training pathways. And there is a very different set of total stressors and exposures in a defined training program compared to when you're not in that training program. So training is a unique separate environment and then deployed settings. And I already kind of gave you a little bit of a gist of what that means to be in a deployed setting. But typically degraded hygiene conditions, areas of conflict, or even denied areas of access for a variety of reasons, displaced personnel, including the service members that need to be self sufficient and reliant on their own internal equipment, services, resources with limited to no support from the outside. So very different environments. We'll just define it as garrison training and deployed settings. So I'll start off by talking about in garrison or on post or military housing in general. Now if you are younger in the profession, especially on the enlisted side, now enlisted versus officers, there is kind of different professional pathways. When we talk about military professional pathways, lower enlisted individuals are required to live on post in barracks. And you can think about that as apartments. And the apartments aren't the highest quality, but by all means they meet the needs and it's comfort, it's safety, and it's living quarters for the younger military professional. So one example of mold exposure in some of these barracks. There was recently some reporting from Fort Bragg and this is just an example. In 2020, one young soldier was deployed to Afghanistan for two months and came back to find his personal items totally covered with mold. And this is, this is not an uncommon story. This was just a, a very, I say emotionally evoking story because these quotes were from his father. His father didn't share his name. He wanted to protect the identity his son. And he's saying he's over there risking his life living in these degraded conditions to come home to this and saying that we need to be able to do better than this. Now the, the response from the command teams and the leadership that were, you know, in charge of his unit and his barriers quarters were saying, you know, we, we rely on you guys to report this for us to move quickly and fix it. But in general, moisture mold issues like this in barracks quarters, it is not uncommon. So when we think of living on post versus living off post, living in barracks versus a house or a townhouse setup in the barracks is a very common concern. Apologies, let me, let me go back can be a very common concern and this is just one example of it. So asking about mold exposure, there may be very notable exposures such as this one. Now families, when you're married and as you as you continue in your military professional career, you can get housing dedicated housing on post and dedicated housing on post tends to be older buildings and there is a known issue for maintenance and moisture issues and mold issues in particular in military housing on post. So it is not uncommon for families to actually be relocated to different housing options on post or even off post because of mold issues. So I've got some pictures that I'm sharing on screen here. Drop down ceiling areas around vents behind some of the washer dryer equipment. We'll talk about how to look in certain areas of the house where moisture may live or where previous leaks may have been an issue. But leaks and moisture are very common commonplace issue. Here's one quote from a family member that was moving onto post excited about getting the housing but this this soldier says right away my wife and both my kids started getting just constantly sick and the non commissioned officer said said to Military.com on the condition of anonymity because he was not author rise to talk to the press. My wife is pregnant and she was sick for about a month and month and a half straight now once again just wanted to tell the the perspective of a single family having a voice. This was another example and this was on military.com now I'll dive into it later but since 2018 mold in the military has been extremely high on the radar. There was a few Reuters articles published that really highlighted the issue of mold and milit housing and the lack of responsiveness to fixing it or addressing it, especially in a permanent fashion or an effective fashion. So since 2018 and those articles there's been high priority that has gone all the way up to Congress and back down to address mold in housing conditions for soldiers and military families in general. All right, now when we're talking about being on post, especially working on post, a lot of the buildings are historical. And what I mean by that is that they've typically been built in the late 1800s, early 1900s and this is where people go to work every day. And if you've been in the military long enough, you've likely had to work in some of the buildings that that are similar to this and that have some degraded maintenance condition issues. So on the top left, Fort Sam Hous just an example of some of the older buildings those were built in the late 1800s early, early 1900s. Bottom left, Fort Benning is infantry, the school for the infantry. And that's another example. I believe that was early 1900s. And then on the, on the right you've got Fort Riley, Kansas. And those are just some examples of where people will report to and stay, report to work daily and stay for, you know, a full 7 to 7 to 3, 8 to 5 job. Mold and military equipment. This is notable because it boils down to how we maintain and upkeep our military equipment. There's a lot of canvas based materials that we use out in the field, once again, integrated conditions and in varying weather conditions. So on the, on the left here we have just a couple examples of tents. Now the, the types of tents have changed over time, but the material is generally the same. And the potential for mold development and mold growth in these, in these tents is always going to be a concern. So how units maintain and upkeep their equipment is always critical to the mission. But it's definitely an opportunity to, to ask, evaluate and dig a little deeper. On the top right is an example of a canvas cover for an open back Humvee. And we've got equipment and vehicles that vary in size and also vary in how often they get checked in the back of the motor pool. So you could have rain that seeps into the back of some canvas covered vehicles and mold develops and nobody truly gets in there and checks it until they take it out on a training exercise or even a mission. And now you've got mold that's been festering in an area that people are continuing to store equipment in because they have no other option. And perhaps it's either just been neglected, overlooked, or they just didn't know how to deal with it. So it's important when you see something, say something, and when doing the preventive, preventive maintenance checks and services that you actually look all the way and consider mold. So this is just an example of mold on the inside of a tent. What it can look like and easy to write off, easy to overlook, but can definitely have an impact on health. So now that we've talked about where you can find it, I want to talk about the effect that it can have on, on physiology and then also on military readiness so that you understand the impact of the individual, but also to the military unit. And it's important to be able to speak to that because once you leverage a commander and a commander's authority to help the soldier and the soldier's family, things get moving very quickly. So if you can speak to what motivates them and what they get essentially kind of graded or judged on. Military commanders careers are sometimes made and sometimes, sometimes hampered by their readiness metrics. So we'll talk about what that means in addition to how mold impacts the individual. So when you talk about mold and the burden of mold related diseases or illnesses, there's a dogma and a way of thinking about it. So first off, the toxic potency or the potency of the type of mold and the mycotoxins that you're getting exposed to, plus the cumulative exposure, the cumulative time and the proximity that you've had, determines your dose. And your dose can be the same as the person standing next to you. But your susceptibility to the injury or the illness from mycotoxins can be very different. And typically those are the individual factors of your ability to biotransform or detoxify. Typically phase one and phase two detox, your ability to excrete toxins or mycotoxins. And that's, that's literally just like your hydration status, your ability to have one or two form bowel movements per day and your ability to sweat and even breathe off some of these toxins and their breakdown products. And then also your ability to tolerate the exposure. And what I mean by that is that how tuned up, how keyed up is your immune system already? How prone are you to inflammation and oxidative stress? How much resiliency do you have in the tank that can handle the inflammation, the oxidative stress, and some of these other burdens that the mycotoxins will have on the body? So really this is the unique factors that play into it, why some individuals may be very sensitive and have significant injury or illness compared to others that really don't, even living in the same household or working in the same location. And that can boil down to micronutrient status, gut or intestinal function, microbiome status. Literally across the board, we're going to jump into some of the individual factors, but it's the dose plus the individual factors. So in general, mold has diverse species and they, they can produce spores, they have allergens. They are not self, obviously. So when your immune system sees them, they are allergens. They, they do initiate a response from the immune system. They also produce mycotoxins. Which of the ones in the diagram off to the left here, these are mycotoxins. Some of the most common ones, especially related to moisture and water damage in the household, will be aflatoxin and ochratoxin. And we'll Talk about those. They also produce endotoxins, beta glucans, and microbial volatile organic compounds. Now, these can affect you just by being present in the same environment. They can be aerosolized and present in the air that you breathe. They can get on your skin and absorb or cause inflammation and irritation on the skin. You can consume this with foods. So basically there's a lot of ways you can get exposed and you can get exposed to a variety of the components of the mold. But we will spend some time talking a little bit more specifically about the mycotoxins. And of those I mentioned, the ochratoxin and the aflatoxin is where we'll, we'll spend some time. Definitely talk about those. Now, in general, mycotoxins and the components of mold typically initiate inflammation, oxidative stress systemically in the body through two main mechanisms. One is mediated through the immune system and the other one is mediated through the nerve system and the neurologic system. So in general, with the immune system mediated version, there can be the allergens and IGE mediated response where the allergic components, the proteins that the mold has from the mold components, gets seen by some immune system cells that are doing surveillance. They pick it up and they said this is not self, and they do a histamine mediated inflammatory response. Mast cells degrade, histamine gets released. This is inflammatory and it's vasoactive. So you get swelling, pain, discomfort, redness, and that's the allergen mediated version. There is an immune mediated version where it's initiated by toxins or some of the components attaching to toll like receptors and even interleukin receptors. So there are other ways, but still there is activation of the immune system cells, there is inflammation cascade that happens, and there is typically some histamine release that is associated with that pathway. Now the other pathway is where nerve cells can transmit a signal of distress to other remote locations in the body via neuropeptides and substance P. And it sends these signals and the distant sites then can release this substance P and these neuropeptides. And at a remote site from the initial exposure, and they start releasing histamine from mast cells, initiating inflammation. That's that term neurogenic switching that I just wanted to highlight. So this is why it can be a systemic wide response to a local exposure and why you can get joint pain, myalgia, headaches, and they don't always have to be directly at the site of exposure. They're often histamine mediated, but they can generally be related to inflammation and oxidative stress throughout the body and in response to immune system activity. All right, that was a deep dive on some mechanisms there. I'm sorry, but it's important to understand. So I mentioned aflatoxins and ochratoxins were very common, especially in moisture and water, water exposure to household. So when we start talking about black mold and when I showed those pictures of mold in the military housing or the barracks, this is something we definitely want to focus on, is like, well, what's the impact? What can it do? In total, Just being aware that, hey, aflatoxins and ochratoxins can be carcinogenic. There's a huge area of interest right now and attention being put on carcinogenic exposures in the military operational environment. We're seeing higher rates of cancer development, especially in younger, otherwise healthy individuals. And we're trying to figure out why. Likely multifactorial. But if mold has a role in that process, then we want to know about it and we should be doing something about it. All right, so I mentioned to you already that careers commanders, careers can be made or broken based off of their readiness metrics. And readiness in general in the military context can easily be defined as the ability to train, deploy, fight and win our nation's war and conflicts. So when you think about it and break it down to the ability to train, deploy and fight, if you're missing days from training because of illness or getting medications that are on lists of non deployable medications that require 90 day stabilization periods in order to deploy, you're immediately talking about readiness and you're immediately talking about either an individual or their family unit, or even a group of individuals. Ability to train, deploy and fight. Now, not only is it the ability to train, the ability to deploy, it's performance. So weight gain is easier, weight loss is more difficult, and cognitive and physical performance can be impaired when you've got ongoing exposures to mycotoxins or mold. And then if it's not you, if it's your family members, family hardship and illnesses in the household, I mean, that can lead to medical visits, hospitalizations, and God forbid, but pregnancy related outcomes may be impacted as well. And then that can be mental health issues for not just the family member, but the entire family unit. There is apologies, there is what's called exceptional Family Member Program, efmp. Now, kids with severe allergies, kids with severe asthma, which can easily be worsened or related to ongoing mold exposure, will put a family member on the EFMP list if they have unique needs for specialty care because of the frequency of medical management that's necessary, then that can actually restrict a family's location that they're able to serve at. And that in itself may limit the potential for somebody's career. Now, I'm not trying to talk badly about the program and I don't want anyone to ever hide the need for on, you know, medical care. It is something that's there for a reason and it does fantastic things for service members and their families. But if it was a mold issue that is driving the frequency of need for asthma and allergy care, wouldn't you want to know that? Wouldn't you want to do something about it? Right. So that's part of the total picture. So evaluating the threat. So how do we look for it? How do we think about it? How do we investigate? Now there's an awesome interactive website that is Environmental protection agency, so epa.gov where this house is interactive and you can click different portions of the house and it tells you the risk of moisture, what you can look for, and even mitigation strategy first stop. So really a fantastic resource. But in general, you're going to be looking for parts of the area, parts of the household where you've got condensation, condensation and moisture that sits around. Temperature differentials especially. So exterior windows, exterior doors, you can look around those areas. But areas where condensation will be developing, visible mold, especially black mold. And sometimes it can. It may only look like a slight deformity of a wall and they painted over it. You know, you really just gotta, gotta think hard about, well, why does that look differently than the other portions of the walls? Even if it's a nice fresh coat of paint, moldy odor. Now it's been a while since I've smelled it. I can't exactly describe it for you, but this, you know, this room smells significantly different than the others. And when I walk outside, that smell goes away. So you know, that paired with symptomatology. I apologize, that paired with symptomatology. You know, you should, you should be asking questions and maybe asking someone to come take a look. Poorly maintained air conditioning systems, especially in high humidity areas, coastal regions, and even more so especially when you get power outages. So power outages for significant amounts of time, AC systems are down, you're in a coastal region, there's high humidity. The potential for mold development in those air conditioning systems are high. So asking the questions, initiating inspections, taking a look yourself, these are all opportunities. And then a history of water leakage, exterior interior leaks, Water damage, holes in the roof, roof required repairs multiple times, things like that. All right, so from a clinical patterns and exam finding standpoint, what check engine lights can I look for to see if I should be thinking about this, if this might be part of the problem? Now, since mold has so many mechanisms of action and the ways that it can initiate inflammation, oxidative stress, immune system triggering and almost like allergic type response, then the impact is going to be pretty diverse. And this is why it's, it's kind of hard to think about mold because in 10 to 15 minute appointment slots when you're trying to deal with multiple issues, you may look at these issues or diagnoses independently and with a strategy or an approach that matches a pill to an ill, you may get multiple medications. Instead of an investigation that looks at mold exposure, how common is it for people to have discussions about mold with their primary care docs? Not common. Not common unless they're educated, aware of it, if they suspect it, if they smell something funny, if they see something on the wall or they visibly have seen mold in the house, that's usually been the reason why we've had those discussions. It's not something I always outright ask for, but if I see a constellation of these issues, things like hormonal access issues, things like inflammatory skin related conditions, reactive airway process or even asthma that develops out of nowhere, you know, those are, those are reasons why I'm going to start asking questions and looking deeper and then around cognition, memory, focus, attention, headaches, these are all potential areas where it could be anything. And why shouldn't you ask about mold? We've recently been focusing a lot of attention on heavy metal exposure and munition exposure and industrial chemical or even like fuels. But I think mold needs to be included in that thought process. So this is a yardstick that basically you can assess in a systems based manner, a review of systems and quantify it to see change over time. So a baseline assessment with a medical symptom questionnaire is something that we do in the functional medicine community. It's a great tool. It is not heavy metal specific. So if you were to Google medical symptom questionnaire, you can find it. But typically there's a couple links that say it's toxin or heavy metal specific. It is not, not at all. I did put a link up here. If you are able to get to the PDF and you click it, you can download a version of it, take it yourself and it just gives you an idea of a starting point of systems in these areas. Off to the right and you may see once again broad symptoms, various systems impacted that are inflammatory, oxidative, stress related and perhaps a little more so in like head we talked about headaches, skin, lungs, digestive tract, joints, muscles, weight, energy, mind, emotions. So across the board you can see a pretty significant impact. Now this is just one example of laboratory assessment. Laboratory evaluation. And this is by no means a standard or something that is easily accessible through the military health system. I never got to run these labs on my patients when I was practicing in the military health system. And by all means there's other options. This is just one that I'm familiar with and that we use regularly in our practice. So this is an example from Great Plains lab and they evaluate for the mycotoxins. And of the mycotoxins you can identify red, green, red, yellow, green, and quantify your current burden. Now what's really nice about these studies is that paired with hey, where am I at right now? And which one's at a normal range. It also provides an explanation of where you can find this in your environment, what's the likely source or possible sources, and then they even discuss what treatment strategies or starting points for nutritional strategies could be helpful. So really, this is a fantastic resource. The lab assessment is paired with some further discussion. Where can I find it, what are the sources and what are some initial treatment strategies or what should I be asking for? So I've found this very helpful. Now we're going to talk about courses of action and strategies to mitigate. In general, I'm going to focus on three main things. One is how do I quantify and document, what do I need to document, what does that documentation look like? And then how can I build and leverage my team who can help me address this issue? It's easy to feel overwhelmed, especially if a family member is forward or in a training environment and you're single parenting it and you know who's got time for that. So how do you leverage your team? And then how can I use lifestyle and nutrition to decrease the burden, decrease the chance of this being an issue for me, or start to unravel some of the issues that mold has created. So first off, knowing what to look for in the house or suspecting it is the first part. And then inspect and you can inspect yourself, but be mindful that the dose is going to be different depending upon what, what mold or toxin might be there and how heavy of a burden it might be. So you may ask for professional help and ask a professional to come in and inspect instead of just doing it yourself. But a picture is worth a thousand words and whoever's doing the inspection can and should take some pictures. And if you're able to be present for that inspection, take pictures too, just so you have that and have it available. Make sure there's a report that's created, whether it's something you wrote up with pictures, something the professional wrote up with their inspection findings, and make that available. Scanned into medical records. Recently, especially in special operation forces community, there was a decision made to essentially make records legitimate for understanding exposures if they were scanned into or part of the medical record. So ensuring these records are made into medical record system is extremely important. All right. And we used to do just what's called memorandum for record where you do a memo, a little brief and and you sign it and your commander signs it and it lives in your military folder, your I love me folder, we call it forever. But that is no longer justification or enough to be considered as part of the longitudinal exposure record. It needs to be part of the medical record. And there have been plenty of instances where an inspection was performed apparently by a professional with or without the person being present, but the suspicion being high enough to where like I really don't think that their negative finding results is, is what you know is true or is accurate enough. So you may even need to bring in a second or even pay for a separate consultant as a separate inspection. So you know, don't be afraid if you think it is high suspicion and you're dissatisfied with the quality of the inspection or the findings in total, you may want a second opinion. So for clinical suspicion only, you've got symptoms, you've confirmed presence, maybe you've got some pictures and a report that was initiated either by yourself or by someone that did a full inspection and their findings. This is a note, a way that you can get something drafted up and signed by a physician to scan into the medical record and to help communicate with anyone that you need to start kind of putting the fire under their behind. To whom it may concern. I'm writing this note in support of my patient whom I evaluated in clinic last on date and have been providing care for since. Blank NAIM has been requiring treatment for symptoms that we suspect are related to a mold exposure in their place of either residence or employment. The flares in their symptoms correlate directly with their time spent in this space and have persisted despite trials of multiple medications. The recommended treatment course includes removal of the ongoing exposure which requires your support. Name would be would benefit from relocation either temporarily or permanently, while the space is fully inspected and mitigated. We have scanned all available inspection reports and photos of this space into our medical records and have attached them for your consideration. I appreciate your support and caring for my patient and thank you in advance for any accommodations you are able to make. This is verbiage that just says, we know it's related, we found it, we've got records of it in our records, and here's some records for you to look at, and we need your help. So really, this is one letter that can move a lot of stakeholders to supporting you, because it's saying, we know it, we have evidence of it, and we need your help. So that was just one example. If you have clinical suspicion and some pictures, maybe a report, something scanned into the medical record, if you have lab confirmation, there's a slight tweak that I created, just as an example, that the change here from the last one was that name has been diagnosed with contact exposure to mold, for which we have laboratory confirmation of mycotoxin burden. He or she has been requiring treatment for symptoms related to this exposure and their place in their place of residence or employment. That basically just says, hey, our level of evidence of the connection and the reasoning is just a little bit higher and we've got evidence. So once again, this can be drafted up by a person, any person, and provide it to their physician to say, can you make this yours? Can you put your physi, your signature block, and can you scan this into the medical record and then get a copy of it for yourself and use that to leverage communications to move some stakeholders to action. So when I talk about documentation, it's important also to document responsiveness to reporting. And when I talk about that, it could be email format, it could be text message, but maintaining a log of who you notified, when, what you told them. Because Once again, since 2018, there has been a very high priority, a renewed vigor in addressing mold in the military context. And that is largely focused around housing and military housing, both on post and off post. So command chains and. And command teams in general, if they hear the word mold, they hear the word illness, and they. They understand that someone in the family is having symptoms, they're motivated to act on it immediately. And in General, there, that 2018 and then 2019 efforts I mentioned, that got the attention of Congress and from Congress all the way down, there was a revamping of the military Housing Tenant Bill of Rights and they expanded it from 12 to 15. And by clicking this link or just googling that term, you can see the new tenant Bill of Rights, and it includes the right to speedy response after appropriate notification. They even talked about something called the military Housing Feedback Tool. And I haven't found explicitly what that example is, but once again, renewed attention and vigor. There's been an update to the tenant Bill of Rights, and it's understanding that if you think this is an issue for you, it could be extremely helpful and important to where you understand what you're owed and what you're able to do, building and leverage your team. The tenant Bill of Rights did identify a term specifically called the tenant advocate. So a military tenant advocate is something that at the military housing office, on post, on base, wherever you are located or your family is located, there is someone who should be identified as an advocate who's familiar with the options in the process of what do I do with this? They can help you communicate and coordinate some of the moving parts and the stakeholders, the people that need to be helping or that need to be at the table. And they can help you come up with and execute a plan. All right, now, chain of command, I mentioned to you, they are motivated to make sure that the family unit is as ready as possible to train, deploy, fight, and win the nation's war. And part of this attention is on mold exposure, especially in the housing. So all you need to do. Well, I'm not going to simplify it like that, but making sure the command chain and the command team is aware of the issue as early as possible is going to be important and helpful. Soldier Family Readiness Group, or the sfrg, is the family network that can always work behind the scenes to help spouse, to help primary soldier, anyone in the family unit. And it's a network of people who have been there, done that. And you are going to find someone who has been there, done that, who has gotten insurance coverage for some of the water damage or issues to mitigate, who has dealt with emergency relief funding that needed to be unlocked because I had expenses because I had to move my family and we had to temporarily live here instead of there. There's going to be a lot of challenges that you will find someone has been there, done that. And sometimes it's Facebook support groups too, but sfrg, military spouse networks, you're going to find a lot of good information. Medical team, I talked to you about the importance of making sure those records end up in the medical documentation in the EMR system, the electronic medical record system for the military health system that's determining whether something is included or excluded from a longitudinal exposure record. So making sure whatever you type up, even if it's a memorandum for record that a copy of it lands in the medical record system. Mold inspectors, insurance companies. From an insurance company standpoint, they will often have some coverage if the mold is related to pipe burst, storm events or house flooding issues. If not directly related to those, or if you say no on the conversation, then they default to the to the response of I apologize, it's not got covered. Now I'm not saying to tell them or be dishonest by any means, but if it does connect back to an incident, an issue, a storm event, by all means mention it. And that may unlock some funding support. So emergency relief funds is funding when you need it as well. And there can be zero interest options for loan options just to cover the immediate need. Change the AIR foundation so you guys and what you do, your mission set and your ability to educate the population about what do I do, how do I think about this, how can I approach this? I just included one of the links mini classes about testing and testing options. I found that fantastic. So I really appreciated that. Now when we talk about leveraging lifestyle and nutrition, there's a couple of concepts that I just really want to define real quick and say that this was born out of the COVID Covid call to action. So when Covid broke the world Back in 2020, there was a time period where there was a bunch of human performance and healthcare professionals that were like minded and we said hey, lifestyle and nutrition has a role here. We can optimize the immune system resilience and its function and human systems biology. We can optimize this to make it resilient, to make it to where we have evidence around these comorbidity factors that are leading to more severe presentation of COVID illness and disease. So let's focus on what works. Let's focus on what we have evidence for. And we said, well from the lifestyle and nutrition standpoint there's personal protective lifestyle and personal protective nutrition, PPL and ppn. It is as important as ppe and that's defined as for ppn it's the food and nutrients and for ppl it's the activities of daily living that enhance immune and metabolic resiliency to reverse disease and optimize performance. So the concept's way bigger than the content because this can be designed, developed as a checkbox way of thinking to tailored to any mission set to any threat. So when we talk about it for mold, I'm going to cover a couple of things that you can do from a lifestyle nutrition standpoint. But don't forget the general foundations of, you know, whole food diet, high quality fiber and protein, anti inflammatory strategies and you know, nutrients, micronutrients and foods, antioxidants, microbiome, microbiome building. And then over here on the lifestyle sleep. Just the simple thing about chronic sleep deprivation can knock your immune system down by 50% in a three day period. It just getting insufficient sleep, that's not even like being awake for multiple days straight. That's probably even further down. So stress, exercise, staying connected and feeling connected and then time in nature we know just breaks from technology in general. Resilient mindset as well. But once again I'm going to focus a little more specifically on how do you support your immune system to better tolerate and to be more resilient in the face of mold exposure. So in general, we always talk about starting with food first. We know that there's certain micronutrients that are defined as being higher in specific foods. But there's a whole area of science that looks into the dark matter of food right now because there's so many compounds and chemicals that we don't know exactly what they do but but we're finding patterns of them being important to either the immune system metabolism, hormone regulation or microbiome function. So there's so much more that we're learning about the compounds that are contained in food that you always want to start with food first. And the combination of the context as well as the micronutrients that come from food first strategies unreplaceable. So you always start there. And in terms of foods and then supplemental nutrients, they're all accomplishing some of these goals. Off to the far right, you want to decrease and uptake the storage of mycotoxins. So any opportunity to bind it with dietary fiber and adsorb, some of those toxins and pass them through the GI tract or even the urinary system that's part of it. So a simple act of staying hydrated is extremely important and then mitigate inflammation and oxidative stress. Upregulate Those detoxification phase 1 and phase 2 biotransformation pathways. Pathways increase the elimination through the intestinal and urinary tracts and then support microbiome and intestinal integrity and function. So the foods on the left are accomplishing that and some of the supplements and micronutrients that are being identified here with some dosing ranges. Single disclaimer here. I'm not offering this as a treatment. This is just Generally some strategies that can optimize some micronutrient levels or achieve certain effects in the body that accomplish what we're saying on the right. So as a starting point, there's some pretty foundational nutritional support that I'll have my patients initiate. And that's things like a high quality multi vitamin D and 2000 to 4000iu per day magnesium at nighttime, typically, because it's not only a keystone nutrient, it's a calming nutrient. Fish oil, 2 to 3 grams per day and then fiber. And I'll try and give them a very specific goal and say, Hey, 30 to 40 grams per day. There was one caveat that hey, flaxseed. There's a couple brands that had some cadmium in it, so just try not to do too much of that or find out which brands they were. But in general foundational ones for me when I know that their immune system's being taxed and there's an inflammatory or oxidative stress burden already. And then as needed, patient specific, discuss with your practitioners. You know, do you need some N acetylcysteine support or some liposomal glutathione support? Would taking chlorella or modified citrus pectin help bind some of these toxins and eliminate them through the GI or the GU tract? Would taking EGCG or Matcha or some of those compounds help with those phase one and phase two biotransformation pathways? So that's some nutritional support specific for mold and achieving those effects. On the right. The. Once again, the interactive map, interactive diagram here was just a really great resource that I found pretty helpful. And Change the Air Foundation. I know you guys have tons of resources and there's plenty of groups and resources that you can look to for. Okay, what can I do myself at home? From an inspection standpoint, from a mitigation standpoint or a moisture control standpoint, there's a lot of strategies you can incorporate and I would say those are the ppl concepts. So I'm just going to wrap things up and then ask if you've got any additional questions and make myself available. But you want to understand the operational environment and we understand that there's garrison training and deployed environments and that you can find mold in military housing both on post, off post, you just got to ask for it. Especially if the pattern is broad and multi system. And then the training environment and deployed environments, military equipment, tents and some of the vehicles, especially canvas covered vehicles, those are potential opportunities for exposure. Identify and communicate risk. You want to figure out if you need to be inspecting certain parts of your house, or if you need to invite professional inspection, you want to make some connections between clinical symptoms and findings and get that documented in a medical record somewhere. And then you want to be able to communicate the impact on the readiness of the family unit. Do not hide this. Let command teams know early. They will motivate and move certain stakeholders to address your problem and to either get you out of the situation that you're in, get you the funding that you need to mitigate the issue, and they will maintain accountability on some of these stakeholders that might be dragging their feet otherwise. So I already mentioned document everything. Building and leverage your team. We talked about who you know, who can be on your team to help and then control the controllables. And we talked about some concepts of ppn, PPL to achieve those effects. Thank you for the time. Hopefully that wasn't too fast and too broad stroke, but I was just aiming to be informative and not inclusive per se.

That was wonderful. Thank you so much. I actually should have started with this. First of all, let me say thank you for your service and for the men and women out there who are currently or former military personnel. Thank you for what you do. You have our utmost respect. Oh, I'm sorry, did I cut you off?

No, no. That was a perfect segue. So when people express genuine gratitude, knowing functional medicine and being in the military context, you can't help but help. And you can't help, you can't unlearn these things. And when I go out of my way and go 10 to 15 minutes over, because someone needs to know something right now, like, we need to fix this, you cannot leave without a clear understanding of what can be done. And if I go out of time or go out of my way, that led to this immense, immensely rewarding experience because they've had conversations they've never had before in their life and the ability to help them after they've sacrificed so much for me, it was a different response that rather than saying, you're welcome, I would say you're worth it. And it was life changing and the bright spot of my week anytime I had the opportunity to do that. So thank you for saying thank you and you're worth it.

Yeah, no, I think this is so important. And thank you for shedding light on this, this, this problem. Because our servicemen and women deserve to feel better. They deserve to be at their best. And if that's not reason enough, I mean, it really is a national security issue, as you've kind of, you know, alluded to that they need to be, you know, feeling their best so that, you know, they can do their jobs and do them well. One of the things, you know, I loved about your presentation is you talked about the home environment, indoor environment, and then you also paired that with the health aspect and you mentioned a number of resources change, their foundation being one. And we have other talks on our summit that people can go to for those actionable things. But one of the things that I think we see so often when those impacted by mold related illness is that they sometimes dismiss their symptoms as being related to something else. I'm getting older, I'm tired, you know, I've got the kids, you know, their spouse is deployed and they're, you know, single parenting. So, so just high level summary again, can you give us three symptoms that people maybe are ignoring that might be related to this? That after today's talk they might go, oh yeah, maybe I want to think about what's going on in my environment. Like just top three or four.

Sure. I would say allergic type symptoms or multiple chemical sensitivity that comes out of nowhere anytime you hear yourself saying ever since.

Yes.

So if there is a notable change in health status, especially related to skin conditions, inflammatory airway conditions, if you get asthma that's developed out of nowhere, if you get skin conditions or eczema flares that have really kicked up ever since, like if you start hearing yourself saying that, then take a look at your environment, take a look at those things that have changed and do not exclude, do not forget to look at your living environment or your work environment. Because once again, the buildings that people are operating day in day out of like on post in a military context can easily be the source or an issue. So inflammatory skin conditions, inflammatory lung conditions and then generalized systemic wide, either histamine related or inflammation related issues. And that can be as simple as like joint aches and pains, achy muscles and headaches. That might be enough. So body wide symptoms especially that have changed significantly since. Yeah. You know, ever since then you want to look at the total environment. What are you doing differently, where are you living, where are you working and just generally take a walk, take a look, take some pictures.

Yeah, Document, document, document. I love that. Yeah. Because I think sometimes people don't realize, you know, sometimes they'll move from a home and symptoms will go away and they won't make the connection that maybe it had something to do with that indoor environment. And the tricky thing, just to kind of add to that about living in a water damaged or moldy environment is that, you know, you may have one set of symptoms, somebody else is going to have a different set of symptoms. And you talked about that at the beginning, which I love that it's going to depend on dose duration and, you know, pre existing conditions and just, you know, your body makeup in general. I do want to offer one tidbit for anyone listening and maybe you can comment on this and then we'll wrap it up, I promise. Because I know we're over time, but one of the things that we see happening this is not just in military housing. In general, dead or dormant, mold is still a health hazard. Stopping the water source is an important step, but you have to remove that mold growth or that colony. You cannot paint over mold and that does not solve your problem. And so we sometimes see that as an. You can't put bleach over mold. We don't recommend that. You can go to our website to learn about why that you want to make sure when these interventions are happening in your home or your building that they're being handled correctly because you don't want to risk exposing yourself further to those mycotoxins and mold fragments and mold spores, because in any state it's a problem. Do you have anything to add to that? I just wanted to make sure our people.

You nailed it. Yeah. The fragments, the spores, the components, and some of the. The mycotoxins that are already present, like there's components that will still wreak havoc.

Yeah.

Yep.

Thank you so much for your time today in this presentation. It was so actionable and I love that you're going to make it available as a PDF. So all those great links, all those reference things, people can check it out. So when you're done, maybe head on over if you're listening and download that PDF. Thank you so much again for being here.

Appreciate you tremendously. Thank you.

And for anyone listening, do me a favor. If you found this helpful, be sure to check out our other interviews on our summit, but head on over to changetheairfoundation.org and check out our newsletter and sign up, because it really is the best way to get helpful interviews and information and tips like this directly to your inbox because you're worth it. Steal your line. All right, thanks so much. Take care.

Bye. Bye. Sam.