How to Heal from Complex and Chronic Diseases

How to Heal from Complex and Chronic Diseases

Most of us have had close encounters with the debilitating effects of complex chronic disease, either through our own experiences or those of a loved one. For 47 years Neil Nathan, MD has been a practicing family physician, and he has devoted his life to helping patients with multiple complex problems that have not responded to conventional medical care. 

His current work is focused on reaching as many patients as possible through continual medical practice, mentoring healthcare providers, and creating documented resources. We dive deep into the causes, effects, and healing of complex chronic disease. He sheds light on the enormous effect mold toxicity and lyme disease can have on emotional, physical, and spiritual well being. He empowers listeners with tools for healing, including how to identify many common co-infections and related health problems that can crop up in mold and lyme patients and also how to find healthcare providers.

Dr. Nathan’s message of hope, “if people want to get well, I believe that there is a healing path for them.”

In This Episode We Discussed:

0:00 Intro
3:19 Dr. Nathan’s journey to become a healer of complicated problems
11:35 Why does mold matter in treating complex chronic disease?
14:43 The tragedy of illness not being taken seriously in conventional medical care
18:06 The varied symptoms from mold exposure
20:39 What to do after moving out of a moldy environment
24:05 Importance of labs: We need to know what we’re treating to treat it correctly
25:55 Allowing the body to inform treatment plan
30:30 Dr. Nathan’s opinion on MARCoNS
33:55 Sinus symptoms and MARCoNS
34:45 What differentiates symptoms of mold and lyme?
42:40 High mold foods: coffee, grapes, and wine
45:54 Best diet for mold toxicity patients
47:12 Difficulty of treating complex chronic disease
56:23 There is hope! Suspected damage might just be temporary inflammation
57:50 All about mast cell activation: How the immune and nervous system respond to toxins and infections
1:04:34 Difficulty of testing mast cell activation syndrome and Dr. Nathan’s 2-tier treatment
1:06:23 The limbic system: Areas of the brain that affect emotion, cognition, and pain
1:09:53 Polyvagal Theory: Functions of the 2 branches of the vagus nerve
1:16:34 Exercises to treat the vagus nerve in just 10 minutes a day
1:18:22 Impaired methylation in chronic fatigue and fibromyalgia patients
1:23:36 Timing matters for when to improve methylation in a treatment plan
1:27:00 Psychological diagnosis and addressing zinc, copper, methylation and histamine metabolism
1:28:08 Rebooting your health and spirituality
1:33:04 Just start somewhere: Dr. Nathan’s book as a launching point for hope
1:38:09 Dr. Nathan’s current work

Mentions (People, Products, Technology)

William J. Walsh, PhD, FACN 
Richard Shoemaker, MD 
Michael Gray, MD 
Amy Yasko, PhD, NHD, AMD, HHP, FAAIM  
Ben Lynch, ND 
Paul Anderson, NMD 
Joseph Brewer, MD 
Lawrence Afrin, MD 
Annie Hopper DNRS Program 
Steven Porges, PhD
James Jealous D.O. 
Norman Doidge, MD 
Robert Naviaux, MD, PhD 

Real Time Laboratory 
Great Plains Laboratory 
Frequency Specific Microcurrent 

Books by Neil Nathan, MD 
Richard Shoemaker, MD Mold Warriors  
Stanley Rosenberg Accessing the Healing Power of the Vagus Nerve

Complete Episode Transcript:

Neil Nathan MD:... particularly, if someone begins to describe the sudden onset of an anxiety, depression, feelings like their not even in their body, severe headaches, pains, muscular pains, joint pains, muscle weakness, a marked sudden increase in their sensitivity to chemicals, sound, light, tough, food, muscle  weakness, imbalance, dizziness. And you can see, by my description, that along with fatigue and severe cognitive difficulties, problems with brain form, focus, memory, concentration, word finding, this sounds like a mish-mash of, "Really, one thing can cause all of that?" And the answer is, absolutely it can. And if you have not heard  of it, and if it's never come to your attention, as a physician your first reaction is, "I think you need Prozac and a psychiatrist, not me." And unfortunately, that's how these patients have been treated.

Speaker 1:Welcome to the Collective Insights podcast, where we explore topics and technologies revolutionizing human wellbeing. On this episode, Dr Heather Sanderson has on Dr Neil Nathan. We're gonna go deep  into complex chronic diseases, especially mold toxicity and Lyme disease. Dr Nathan takes us through how to heal from these complex issues, physically, emotionally and spiritually.

Speaker 1:We're excited you're here with us. And now, let's dive in.

Heather Sandison, ND:Welcome to Collective Insights. My name is Dr Heather Sanderson. I'm a naturopathic doctor and I'm on the Medical Advisory Board, here at Neuro Hacker Collective. I'm also the clinical director, medical director at North County Natural Medicine, the clinic where I practice complex  chronic disease. And, thank God, under the mentorship of Dr Neil Nathan, who is one of the absolute experts in navigating the world of complex chronic disease, and I am just honored to have Dr Nathan here today. He's been practicing medicine for 47 years. He has been board certified in family practice, pain management and is a founding diplomat at the American Board of Integrative Wholistic Medicine, and a board member of the International  Society for Environmentally Acquired Illnesses, or ICI.

Heather Sandison, ND:For many years, he has worked primarily with patients who had not received a diagnosis from conventional medical sources, and especially with patients whose illness had made them unusually sensitive and toxic. Hence, extremely difficult to treat. This book has grown out of his experience in this field and it is his hope that it will enable many patients currently suffering and without a diagnosis to begin to find  their way towards health.

Heather Sandison, ND:So, Dr Nathan recently wrote a book and I'm reading his bio from it. And the book is called Toxic: How to Heal your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities and Chronic Environmental Illness.

Heather Sandison, ND:Dr Nathan, thank you so much for joining us.

Neil Nathan MD:Thank you for having me.

Heather Sandison, ND:So, I thought we would dive in by ... and maybe just start by you telling us how you got here. How did you get interested in these chronic diseases in these very difficult  to treat patients?

Neil Nathan MD:How much time do we have? I think I would say that that journey started before I went to medical school. I wanted to be a healer and I thought that when I went to medical school that's what I was going to learn, and it was a bit of a shock to realize that I was going to be taught to be a medical technician  not a healer that encompassed a lot more than anyone wanted to teach. So, I may have been a bit of a thorn in the side of many of my professors who could not decide whether I was the worst medical student to ever arrive at the University of Chicago or brilliant, because I kept asking, "Why do we do this?" Not  to create problems, but because I really wanted to understand what's the underpinning, or the rational for doing it. Why do we do that?

Neil Nathan MD:And I found my profession, surprisingly, unwilling to address that question. It almost always came back, "We've always done it that way." Which, forgive me, was not a very acceptable answer to me. So when I finally  got into practice, my interest was simply helping people and I had this fantasy which, forgive me, I have never let go of, of wanting to help every single person who walks into my room. Now, I know that that is unrealistic, probably to the extreme, but I've never let go of it because, honestly, that is my intention, to help  someone who has come to me to get help.

Neil Nathan MD:And I recognized, fairly early on, that the tools that I was given by conventional medicine were not adequate to help as many people as I wanted to help. And so, I threw myself into learning from anybody who had something to teach. One of my early partners was a chiropractor and I begged him to teach me manipulative  medicine, which he began doing. He in turn hooked me up with osteopaths who taught cranial sacral work and other forms of manipulation. It led me to emotional release work, because the chiropractor I was studying with had been studying Reichan therapy and I found that fascinating, and I plunged into that.

Neil Nathan MD:We had an acupuncturist working at our office. I  plunged into that and I began working with Delores [Kreiger] in laying on of hands and therapeutic touch, and that went on, and on, and on and on. Each journey led me to another door, which I flung open and jumped in, and I spent a great deal of money learning some wonderful things, and I spent a great deal of money wishing I had not thrown another weekend away, like, "Why am I here and what am  I doing here?"

Neil Nathan MD:But over, I guess, the course of my therapeutic lifetime I've acquired a large number of tools that allow me to approach complicated problems from many, many perspectives. Now, we'll add that to two characteristics that I have personally. Number one, I love complicated problems,  so many medical practitioners feel overwhelmed by some of the complicated problems. My attitude is, "Oh, that's so interesting. Bring it." So I'm wired, perhaps, differently than some people are.

Neil Nathan MD:The second is, I have an unusually good balance between my right and left brain  activities, so that I am both intuitive and logical and scientific, and I've learned how to let the two sides of my brain talk to each other and sit back and listen to them, take that in and use that in the service of trying to sort through very complicated things.

Heather Sandison, ND:I have to speak to this a little bit and just second that, that you're describing yourself in a way that  is completely in alignment with my experience of you. So, I first started seeing you speak, I think the first time was at the American Academy of Environmental Medicine. You gave a talk. And you gave two talks, and in them you referenced Will Walsh, who is somebody who I have a ton of respect for, and you talked about methylation. And when you talked about methylation, which is ... We could spend two hours talking about methylation, or a day talking about methylation probably. You talked about Amy [Yasco 00:08:58], and Ben Lynch, and Paul  Anderson, and then Bill Walsh and there was somebody else who I hadn't ever heard of at that point who you referenced all of these different people, and all of these perspectives on methylation and how they effected genetic, or how genetics affected them and how that might start to speak to what was going on in these complex chronic diseases.

Heather Sandison, ND:And then, a couple hours later you gave a talk where you talked about Dr Shoemaker and then, Brewer, Dr Brewer and all of these  other people who have conflicting opinions about the mold topic, another very complex chronic disease, and I just watched you jump from one complex overwhelming topic to another where you had distilled information, filtered it through the egos of the people who had it brought it forward, and then took this really dense information and made it accessible for me and for all the other doctors in the room, and it's a talent that I have not seen elsewhere and something  I'm just ... I'm so grateful to be able to tap into, to some degree, and then to share with other people.

Heather Sandison, ND:So, thank you so much and you do it ... You do. You come to everything with just this intention of service that is incredible, and this commitment to the science. So, I mean, you mentioned reiki, and I think a lot of people start to tune out, sometimes, when we say things like reiki or healing touch. Your commitment is to marry both of those worlds,  that there is this space for the intuitive, and then there's this other space to pull in the hard sciences and the practicalities. So I'm so grateful to you for doing that, and can't wait to dive in more.

Heather Sandison, ND:So today, I think we'll focus our attention on one of my favorite topics, because it's been so profoundly helpful for so many of my patients, but if we can start with mold and where you think mold fits into treating complex chronic disease.

Neil Nathan MD:Okay, sure. Let me just comment that I'm not trying to marry these disciplines. They're already married. Our job is to learn how to take a step back so we can see it for what it is, rather than focus in on it to such a degree that we lose the forest for the trees,  just a side here.

Heather Sandison, ND:I appreciate that.

Neil Nathan MD:So, let me talk about mold. The key important thing about mold toxicity is that so few people are aware of it or understand it, and even the medical field, it is a new subject and it's a controversial subject. It was first brought to our attention  intensely by Richie Shoemaker when he published his first book, Mold Warriors. Now, there had been a number of practitioners, like Micheal Gray, who had already published in that area and were already beginning to help us understand this, but Richie really put it on the map with his understanding of mold toxicity and how it affected so many different systems of the body.

Neil Nathan MD:Prior to ... And I'll tell that story.  I was doing my usual work with a lot of patients with fibromyalgia, chronic fatigue and Lyme disease, and I had a patient come into my office and she schedules an hour visit, and she puts up his book on my desk and says, "I want you to read this." I said, "Okay," and I put it on my stack of books, which is, for anyone who knows me, I have huge stacks of books all over and it wasn't going to the top of the stack. I already had a whole bunch.

Neil Nathan MD:She said, "I  don't think you understand. I'm paying you right now to read this book." I went, "Okay, sure. If you wanna pay me to read." That would be a fabulous job, if I could figure out how to get other people to do that. So I start reading the book. Unfortunately, for those of you who have not read the book, the biotoxin pathways is one of the first chapters of that book. And I read that chapter, and  this was a fabulous comprehensive understanding of how these toxins effect the body in so many myriad ways, really made sense of it. I had never seen anything that clear before. I literally, and this is my nature, I got on the phone and called Richie Shoemaker and said, "I'm coming out there to study with you." And Richie said, "Who are you and why would I want anyone  coming out?" He lives in Pocomoke, Maryland.

Neil Nathan MD:I said, "Because I just read the chapter on biotoxin illness, you've got a lot to teach and I'm ready to learn it." And so, I literally hopped one of the first planes I could find and went out and spent some time with him. And we did become friends, and we did teach together for many years. Although, over time, our views about biotoxin illness began to diverge,  he holds to a specific way of looking at it and I have expanded my thinking to believing that it encompasses a lot more. But that's how I got started.

Neil Nathan MD:So for listeners, one of the take home messages that I would wanna convey is that mold toxicity is really common. All it takes is a water damaged building. If you have ever had  water in your crawl space, a leak in your roof that goes to your attic, a water heater that's broken, rains that have been coming in an open window and pooled, water in a building is a bad recipe and will often lead to the overgrowth of mold, and a lot of people are genetically predisposed to have  that affect them in some powerful ways. And those ways are so many, varied and complicated that when a patient who has been exposed to mold toxin has become toxic starts to describe that, many physicians immediate reaction is, "That's impossible. This is in your head. Nobody could have all of that." We see the same thing with Lyme, by the way.

Neil Nathan MD:So particularly, if someone  begins to describe the sudden onset of anxiety, depression, feelings like they're not even in their body, severe headaches, pains, muscular pains, joint pains, muscle weakness, a marked sudden increase in their sensitivity to chemicals, sound, light, tough, food, muscle weakness,  imbalance, dizziness. And you can see by my description that, along with fatigue and severe cognitive difficulties, problems with brain form, focus, memory, concentration, word finding, this sounds like a mish-mash of, "Really? One thing can cause all of that?" And the answer is, absolutely it can. And if you have no heard of it,  and if it's never come to your attention, as a physician your first reaction is, "I think you need Prozac and a physiatrist, not me." And unfortunately, that's how these patients have been treated. And unfortunately, we are talking about millions of people in this country who have experienced this to some extent, but whose description has  not been taken seriously because of its remarkable different manifestations.

Speaker 1:Let's take a quick break. Next up, we're gonna dive into how being exposed to moldy environments can affect you, and Dr Nathan discusses testing and treatment options for mold toxicity. Thanks for tuning in to Collective Insights, our podcast is brought to you by Neuro Hacker Collective, where we offer a line of cognitive enhancement supplements, including our new caffeine-free version of Qualia Mind.  For $20 off your first order, use coupon code COLLECTIVE INSIGHTS. Now, back to the show.

Heather Sandison, ND:And I would add that another reason it's not taken seriously is because you can have two people with the same exposure who have very different symptoms, or different experiences of that. Can you speak to why that is? And you mentioned the genetics, is that all it is or is there more to it?

Neil Nathan MD:Well, it's genetics and our biochemistry. We are all biochemically extremely different and we manifest things in different  ways. Now, for example, if you had a viral infection, the same virus in one person could localize primarily as nasal congestion or stuffiness, and another person as a cough, and another person that would show up as diarrhea or abdominal discomfort and GI symptoms. So it shouldn't come as a shock that we're all different and the same toxin will show up very  differently in different people.

Heather Sandison, ND:Can you speak a little bit to mold versus the mold toxins and what the difference is there?

Neil Nathan MD:Sure. The effects of mold are in three different categories. The ones that have been the most well understood until recently, are, number one, mold allergy. So we've known forever that people can be allergic to mold, and manifest the typical allergic  symptoms that mold would cause. For example, running eyes, stuffy nose, itchy throat, cough, wheezing, classical allery symptoms. We've also known, although it's been rare, that some people can have a mold infection. Now, this is a serious life threatening infection, fairly rare, but when patients have that type of infection they need to be hospitalized  and put on intervenous antifungal medication.

Neil Nathan MD:What's fairly new, in our consciousness, is what is even more common and that's mold toxicity, in which the toxins that mold make cannot be processed by a significant number of individuals. And when they can't process the toxin, the mold stays in their body and continually triggers a massive outpouring  of what we call inflammatory cytokines. Which very simply put are inflammatory materials that keep us inflamed.

Neil Nathan MD:Now, some of the big issues with that that, again, are only recently understand. Again, Dr Joe Brewer's work in this is primary. We've just recently understood that merely moving out of a moldy environment may not be sufficient to get the toxin out of your body  because, for many people, mold toxin weakens their immune system and they then become susceptible to that mold colonizing, or growing in their sinuses and gut areas. So they may move out of their moldy environment, but the mold is growing in the body, making toxin, which they can't get rid of because of their genetics and we are off to the races.

Heather Sandison, ND:So, what would they need to do to get rid of this?

Neil Nathan MD:There are three major components. The most obvious is, you still have to get out of your moldy environment. You cannot get well if you are staying in a moldy environment. You can get better, but you can't get well. Second, you need to take what we call binders, which are a collection of materials that vary from natural substances to prescription medications that specifically bind specific toxins. And  third, we then need to treat, not for everybody but for most people, we need to treat their sinus and gut areas with antifungal medication and biofilm dissolving agents so we can irradiate it. And then, they can be well again.

Heather Sandison, ND:Do you think there's a role for, you mentioned binders, but what about things like liver support, like glutathione, or sweating, or drinking additional water, or more clean water to make sure that the kidneys are excreting? Do you have  ideas around other things that people can do that aren't just the binders?

Neil Nathan MD:Of course. There's many, many ways of approaching it. So, what I gave you was what I call the basics. Within that, you wanna support the body's systems that help the body to detoxify, so we're talking about the liver and gallbladder, primarily, because the liver takes toxins from all parts of the body and begins processing. The gallbladder  uses bio to bind of most of these toxins. And so, you need to be sure that the liver is working properly. You wanna be sure that the gallbladder is working optimally. You wanna use sweating through the skin. You wanna be sure your kidneys are working properly. You wanna be sure you're taking adequate amounts of fluid to wash all this stuff out. You wanna be sure that your intestine are moving properly, so you're moving these materials  out of the intestine. All of the above are all part of a treatment conceptualization.

Heather Sandison, ND:And then, with the binders, do you think that there's specificity in terms of those binders for different types of toxins? So when we talk about mold, there's a whole list of potential molds that are toxic. And then, they create specific mycotoxin. Now, do we need to test that so that  we can be really good about treatment, or is it the same for all of them?

Neil Nathan MD:It's not the same for all. And both for diagnosis and treatment, I think the testing is really important. It's somewhat expensive, although medicare does cover one of the laboratories that run these tests. But this is such a debilitating issue that I think it behooves us to begin the  journey by knowing what we're treating, so we can treat it correctly.

Neil Nathan MD:Just to give you some examples, one of the ways in which Dr Shoemaker and I disagree is that his primary binder is a medication called cholestyramine. And cholestyramine is a wonderful binder for ochratoxin. It's not a particularly good binder for many of the other toxins, such as strychnines, [inaudible] toxins, [zerglio] toxins. So, if you only  come at this with one binder, what I've seen is you will help a significant number of people, but you will not help other people to whom that's not really the right way to approach it.

Neil Nathan MD:So the basis, to me, of all diagnosis and treatment is, number one, you want the best, clearest diagnosis possible, otherwise you're shooting in the dark. Number two, if you can orchestrate a specific treatment,  why wouldn't you do that?

Heather Sandison, ND:Right, get there faster, hopefully, if you can do that.

Neil Nathan MD:And more specifically, meaning ... Cholestyramine is a fairly expensive medication. So, from an expense point of view, it also tends to be constipating. So if you don't need to go down that road, why go down that road?

Heather Sandison, ND:Avoid it, right, yeah.

Heather Sandison, ND:And then, one of the things that I so appreciate about your approach is  this reverence for how the body responds, and this ability to adapt the treatment plan to the information that the body is giving us back. So when patients say, "I'm sicker after taking cholestyramine," what's your response?

Neil Nathan MD:Then, we need to stop it immediately, let that reaction subside, and then we can either try minuscule doses or we'll switch to something that you can handle. And  I appreciate your pointing this out, because you have to work within that being's ability to process what you're given it. One of the most important principles of treatment is, both the binders and the antifungals have the ability to make you worse. If you overdue binders, they're actually gonna be pulling toxin in through the body faster than that body  can get rid of it. You're gonna get worse. It's literally make you more toxic.

Neil Nathan MD:So one of the common consciousness that people use is, especially if they come to this from the Lyme world where they're used to, if you take an antibiotic and you get a herx reaction or you get worse, the reaction has long been fabulous for killing bugs. This is great. I can  go down a slightly divergent road here and say, we're increasingly aware that that might not be so great, that having someone having an excessive amount of toxin to process is rarely a good strategy. Can't always avoid it, but it is not something to be sought. Now, that's much, much more relevant in the mold word where if you are taking a substance and it is making you even a little bit worse,  not gonna work. You're simply gonna become increasingly toxic. That will begin to shut down all of your organs of detoxification and you will get progressively worse and worse.

Neil Nathan MD:I can honestly say I have not had a single patient fight their way through it, so you often have to really tell patients, from the get-go, any worsening is not acceptable. Please don't get into your head, "  Oh, I'm just a little bit worse. I'll just put up with this. If that's what I have to put up with to get my way through, I will," very erroneous thinking, really important that they immediately begin to really trust and listen to their body, so that it can guide them with the correct dosing.

Heather Sandison, ND:Great. You recently brought to my attention, also, that when you treat with  antifungals, these bugs, so whether they're fungus or bacteria, whatever we're treating, they have the ability to make ... when they're fungus they have the ability to make mycotoxins. They have the ability to make biotoxin, and that is we treat with a medication that puts them alert and more likely to release more toxin, so this is part of the mechanism of how we might be increasing the toxic burden when our intention is to get rid of what's producing  the toxin.

Heather Sandison, ND:So, do you have strategies for that?

Neil Nathan MD:Of course. The number one strategy is, job one in treatment is to get patients on the maximum binders that are specific for what they have that they can take comfortably and without side effects. Once the binders are up, if you kill fungus or candida at a pace that can keep up with  they will be fine. If you kill it too fast, or too suddenly, then you're gonna overload that system with toxin and that is not a good strategy.

Neil Nathan MD:So, from my perspective, the first thing that needs to be done is the use of the correct binders to a point of comfort, then if you proceed slowly with killing strategies for the fungus, you usually will do okay.

Heather Sandison, ND:Can you speak to the MARCoNs testing? So, the nasal swabs for both bacteria, or drug resistant bacterias, and then for fungus, and then, also, other mucosal systems? So, in women is it important to know if there's vaginal floral that might be off, or the guy floral that might be off? How does that play into toxicity, especially mold toxicity?

Neil Nathan MD:In very complicated ways. I  wanna start with that. Let's talk about MARCoNs, which is very controversial and I would not wanna start this subject without laying out what I'm about to describe is my opinion and I wanna be sure that I also bring forth the dissenting opinion.

Neil Nathan MD:So, Dr Shoemaker brought the subject of MARCoNs to our attention early on in his work with  mold and he believed, primarily for theoretical reasons, that if you didn't treat MARCoNs people would not get well. And working with him, as I was at the time, I was treating MARCoNs very aggressively. That means, three antibiotics and BEG nasal spray. I discovered that  prolonged treatment with these, which made me very uncomfortable, didn't seem to irradiate the MARCoNs and patients did not respond particularly well to it. Meaning, I really couldn't see that I was helping anybody. I was using antibiotics in a way that I was very uncomfortable with and I wasn't getting anywhere, and I began to look at, is this really an important consideration  or is this just a little hiccup that doesn't need to be addressed?

Neil Nathan MD:My patients were getting ... So I stopped doing it. I saw no change in the speed at which my patients got better. I couldn't actually see any patient who had ever told me that that approach really helped their treatment. And in conversations with Dr Shoemaker, he admitted to me readily that it was virtually impossible to completely irradiate  MARCoNs.

Neil Nathan MD:So, here I am. I have a treatment that I'm not happy with. It doesn't seem to work. I'm seeing virtually no benefits of it and it may not even be eradicable, so I have completely stopped looking at it, testing it, using it or doing it. In fairness, I have a number of colleagues who find it useful and valuable, and they do believe it is important in treatment.  And we are all engaged in important debate as to, is this true, is this not true? And because this whole science is in its infancy, we're still figuring it out. So I can give you by bias. I cannot tell you that my bias is true or correct and time will tell.

Heather Sandison, ND:Thank you. I will say that, clinically, I have seen it be beneficial for people, especially,  who have sinus symptoms.

Neil Nathan MD:Ah, ah, ah, ah. Okay. Yes, I will say that some people with sinus congestion tell me that that treatment helps them. But then it begs the question, it's a nonspecific treatment, am I really treating MARCoNS to help them get better or am I treating other bacterial species or some of the treatment for MARCoNS involves using a spray of EDTA, which is a biofilm dissolving  agent. Can we say with certainty that it is the MARCoNS that we're treating that is helping them feel symptomatically better? I don't ...

Heather Sandison, ND:Okay. We can't say that for sure.

Neil Nathan MD:We don't know.

Heather Sandison, ND:Yeah.

Neil Nathan MD:Right.

Heather Sandison, ND:These are good questions. So then mold versus Lyme. You mentioned that mold and Lyme have really similar presentations. So how do we know the difference?

Neil Nathan MD:Ah. That's a whole subject and a half. So first of all, your comment is absolutely true. Mold and Lyme, particularly one of the co-infections of Lyme, which is Bartonella, look very, very similar. Which is a bit surprising. One is a toxin, and one is a bacterial infection. The bottom line or the connection is that, they both  stimulate the body to make inflammatory cytokines in a very similar pattern. Which is the underlying process is an immune dysregulation in which the body is making inflammatory cytokines out of control, and those inflammatory cytokines are causing virtually all the symptoms that we're looking at. So if you're looking at someone with that huge array of symptoms which we talked about  earlier, those could be mold. They could be Bartonella. And, it is very difficult to tease them apart, but I'll give you my recipe for doing so.

Neil Nathan MD:First of all, eliciting the most detailed list of symptoms that our patient can give us, is absolutely job one.  Because, some of those symptoms are much more specific for certain of these entities and some not. Example, all of them, Lyme, co-infections and mold, will cause fatigue, will cause cognitive difficulty. So having that, in no way points us at what we're looking at. But, for example, Lyme is more closely associated with joint pain as a primary symptom. Sometimes  it's associated with a specific neurological offense. Bell's palsy, other nerve palsy's or Neuropathy's.

Neil Nathan MD:Ibecia, another co-infection, is more closely associated with sweating and pressure in the frontal area of the head. And, Bartonella, like mold, Bartonella and mold are the closest, have uniquely feelings of numbness  and tingling in parts of the body that should not experience numbness and tingling. Tip of the nose, belly, mid-portion of the back.

Neil Nathan MD:That sensitivity that I talked about, is triggered far more often by Bartonella and mold. Sensitivity to light, sound, touch, chemicals. There's an unusual perception of vibration, internally, that you'll get with Bartonella and mold that you  don't really see with the others. With Bartonella for example, a pain on the bottom of the feet is particularly noticeable, weakness of muscles, imbalance, is much more common with mold. A lightning, electrical type of pain, or icepick type pain, is much more common with mold.

Neil Nathan MD:So as we  kind of delve into the symptoms for any specific individuals, there are certain key descriptions that begin to point us in one direction or the other in terms of what we want to look at.

Heather Sandison, ND:So, then, testing. I'm wondering about testing and also the order of treatments. So say someone has both of these going on, a little bit of mold or maybe a lot of mold, and then positive for Bartonella or Ibecia or Borrelia, where  do you start and how do you get that information? Is it just from the questionnaire or do you do more testing?

Neil Nathan MD:Well, I do testing, because the science that we have is totally inadequate to nail these diagnoses. Sorry about that. But we have some which really help us. Our testing for mold is way better than our testing for Lyme. There are two laboratories, the Real Time Laboratory  and the Great Plains Laboratory that have very different, but very useful urine micro-toxin tests. Meaning, you can get a specimen of urine, send it to the laboratory and they can tell you which micro-toxins you have and even quantitate that to a certain extent. So if you're thinking, mold, and you get a positive test from these laboratories, this confirms your diagnosis and you not only know that they have it, you also know  where start on binders cause you know which toxins you're working on.

Neil Nathan MD:When it comes to Lyme, not so much. One of our better tests, is the IgeniX western blot. Particularly the IGM component. And experts disagree on how accurate it is, but I would roughly say it's about 70% accurate. Part of the problem is  mold and Lyme weaken the immune system so profoundly that that immune system often cannot make antibodies to Lyme, so that on an initial test, you may get a negative Lyme test, even though the history and exposure and tick bite is screaming, Lyme. So if you treat it empirically, after six months, that negative test becomes positive once you've strengthened  that immune system by giving them antibiotics and eradicating the significant bacterial load. So there are reasons ...

Neil Nathan MD:Another reason is that we are now discovering more and more species of the Lyme bacteria which is Borrelia, and our testing is typically for only one species. So the Borrelia burgdorferi is the most common but we're increasingly aware that another species,  Miamotoi, is really coming into play. So our testing is not comprehensive enough to tell us all of the species we might be looking at, that we need to be testing for. But testing is only of the immune system and not of ... it's how the immune system is wrestling with the bacteria, not, is it active, is it present. So it is a clue that it might be present, but it's not slam dunk, you've got Lyme.

Neil Nathan MD:So, those difficulties are magnified when it comes to the co-infections. For example, there are 27 known species of Bartonella, and we only know how to test for two of them. There are a 108 known species of Ibecia, and we only know how to test for two of them. So you can see how testing is useful if you have a positive test that really helps us move in the right direction,  but a negative test for any of these things, does not rule it out.

Heather Sandison, ND:Got it. And when it ... can I go back for a second because one ...

Neil Nathan MD:Sure

Heather Sandison, ND:Of the questions I get a lot about mold is, what about the foods? Really with Lyme as well, do you have to be concerned about your diet? Do you need to change your diet if you get one of these diagnoses of mold or Lyme? And particularly with mold, the question about coffee, grapes, wine, you know, all  of these things that could be potentially high-moldy food, is that of concern to you or do you tell your patients not to worry about it?

Neil Nathan MD:A very good question, around which much is said, and virtually nothing is known. To my knowledge, there are no studies whatsoever, that show that what you eat relates to having either mold in your urine for diagnosis or that it affects you. We know with some  certainty, that inhaled mold is infinitely more causative in terms of creating mold toxicity, we do know that. Because no one's ever studied it, you can say or write anything you want. Most of us, do not think that ingested or eaten mold plays a very big role. I am in that camp.

Heather Sandison, ND:We're taking a quick break here. Next up, we'll discuss Lyme  disease and some other infections that commonly occur alongside mold and Lyme issues. Dr. Nathan offers us hope and takes us through building well-rounded treatment plans for healing of the body and mind. Thanks so much for your support of the Collective Insights podcast. If you like this episode, then please share it with your friends and leave us a review on iTunes. Remember, for the full show notes, visit All right, lets jump back in.

Neil Nathan MD:I have not had patients remove the eating  of moldy foods from their diet and my patients still get well.

Heather Sandison, ND:And I'm in your camp. That is consistent with my clinical experience as well.

Neil Nathan MD:Yep, we're about to do a study with the Great Plains Laboratory in which we're going to take patients, or volunteers actually, and we're gonna do this as a multi-center trial using a number of physicians who are on the executive board of ICI and we're  going to take patients, have them stop consuming all known moldy foods for 10 days, measure it in their urine, and have them pig-out on all those known moldy foods for 10 days and then see what we get. Now to my knowledge, that's never been done. That study should launch and the end of this year, beginning of the year and I hope by early 2019, I'll actually be able to have a preliminary  answer for physicians and consumers of, "to what extent does that matter?" Answer, "don't know." "Does it matter?" "I don't think so." I have had a handful of patients respond to not eating those foods, don't know what that means, but I'm gonna shift gears for a second on food.

Neil Nathan MD:What we do know, is if you're treating mold in which candida almost always plays a role.  You want to be on a high-protein, low-carb diet, because carbohydrates, particularly sugar and fruit, feed candida and feed fungal species and that does make a difference. And we use the same diet for Lyme, because that seems to make a difference as well.

Heather Sandison, ND:Great. Okay, so consistent with both Lyme and mold to have that low-sugar, low-carb diet.

Neil Nathan MD:Yes.

Heather Sandison, ND:High-protein, high-nutrient dense and stay away from the fluff.  So testing for Lyme, kind of complicated, I would say is the short answer to that. Aside from what you mentioned with the IgeniX western blot, is there any other way that you can get to what co-infections or what's going on there? And then, is that important when it comes to treatment?

Neil Nathan MD:Again,  many answers to that question. There are other tests on the market.

Heather Sandison, ND:And then, mold verses Lyme. So if both are going on, where do you start?

Neil Nathan MD:Virtually always with mold. And I'll give you a bunch of reasons for that. Number one, because mold and Lyme look so similar, I can make the mold diagnosis with much more certainty because the testing is better.  Number two, I don't need to jump into antibiotics which are almost always necessary in the Lyme world, I would like to avoid that. So literally, you can't be certain that one is not in play. So if you treat the mold successfully, and all the symptoms go away, you didn't have to provide antibiotics for that patients unnecessarily, from both a toxic effect, effect on their  gut biome, effect on cost, you didn't need to do that. So I would always treat the mold first. It is also less toxic, easier to treat, and much less hard on the body. So, I typically start with mold.

Neil Nathan MD:I can tell you that I've had very, very few exceptions-had a couple, where they had both and for whatever reason, they couldn't start with mold. Their body wouldn't let them then when we started with Bartonella,  their body tolerated and handled it better and then we were able to move on to mold. But they're really exceptions.

Heather Sandison, ND:And then is there an argument that perhaps the body will take care of the Lyme or the co-infections if the toxicity is gone and the immune system starts to work a little better? Or do you not typically see that?

Neil Nathan MD:Yeah, do you see the look on my face? Like, yeah, I wish. These are both nasty processes. For  most of my mold patients, the mold has colonized in their gut and sinuses. They're happy there. This is perfect temperature, lots of nutrients, it's dark, it's comfy, they love their host or hostess. Why would they leave? They're not gonna go away because you wish them away. The same is true with Lyme and co-infections. Perfect temperature, lovely nutrients, lovely cellular  debris to feed upon. Why would they leave? They just don't go away.

Neil Nathan MD:Now, you are alluding to something that's important which is, Lyme weakens the immune system and predisposes to not being able to handle mold. Mold weakens the immune system and predisposes to letting Lyme or co-infections flourish. So, there is a surprisingly high percentage  of patients with both and one of my crusades is to help Lyme-literate doctors understand that when they're not succeeding with their Lyme patients, meaning they've hit a wall, the symptoms remain the same, think: mold. Treat mold. Because, it's a huge issue that is way under-diagnosed.

Heather Sandison, ND:I would say that there's a lot of  Lyme patients ... we see each others patients in this community. There's a lot of Lyme patients that bounce from doctor to doctor to doctor not getting it right and I think there is so much of this. I so appreciate your humility around this, that we don't really know what we're doing, because nobody's getting it right 100% of the time. And that mold piece missing from the equation, is probably part of what is contributing to why a lot of Lyme patients aren't  getting better.

Neil Nathan MD:Yeah, it's huge. And if we can take a step back from that, my practice is evolved over the years to working with what many would consider to be the most sensitive, toxic people around. Meaning, a lot of physicians have referred patients to me when their patients can't take the things they want to give them. And so, I have been forced to really look  into that. And to be honest, it's not really forcing me because being the problem solver that I am, I find this fascinating and it's still in the category of somebody's gotta help these folks, so might as well be me, if I can.

Neil Nathan MD:And so, let me share with your listeners, a number of issues that must be looked at, particularly in the most sensitive patients, but often in patients who aren't that sensitive  that are also preventing patients from getting well. And there are three biggies here. The first one is mast cell activation, which you alluded to earlier. We can talk about that. The second two are ways in which both mold and Lyme inflame the nervous system so that it becomes part of the problem and not the solution. And those two things are limbic  inflammation and disfunction, and polyvagal theory.

Neil Nathan MD:And maybe we should spend a little time talking about all of those three separately, because for many of my patients, I can't even start treatment until I address one or all three of those issues because they are so reactive and so sensitive that until you quiet down that super-reactive system, you're not getting anywhere. These are people  who can't take homeopathics and many physicians haven't had much experience with the very sensitive patients and they are prone to thinking, "Everyone can take a homeopathic, how hard is that?" And unfortunately, they'd be wrong here. But ...

Heather Sandison, ND:Is there also an element of perhaps the toxin is gone, the perturbation is gone, the toxin or the infection is gone, but there are still symptoms remaining that are  some of the damage that has been done by the toxins or the infections? Is that part of the mast-cell activation or part of the limbic disfunction or the polyvagal disfunction or is that separate?

Neil Nathan MD:Several questions in there and the answer to most of those is, yes. First of all, and I hope this is a message of hope, and I know that everyone is not gonna agree with me who practices, I think  that the primary issue is not damage, but inflammation. And the reason I think that, is you'll take someone who's been neurologically impaired, cognitively impaired, have unusual neurological symptoms. When you treat the mold, when you treat the Lyme, co-infections, it goes away. Meaning, it wasn't damaged, it was inflamed. And I have seen that so often, that although I know that damage  can occur ...

Neil Nathan MD:I really want to emphasize for our listeners, my bias that whatever you are wrestling with, even if you have been told by a neurologist, that you have atypical ALS, atypical MS, atypical Parkinson's, atypical Alzheimer's, note the word 'atypical.' Often, these are  mold toxicity or Lyme that's undiagnosed that needs to be treated, and many of the patients that I've worked with have gotten cured. Dr. Dale Bredesen has really recent about this in the Alzheimer's sphere brilliantly, emphasizing the roll of infectious agents and mold as a curative component to what is called: Alzheimer's disease. Which is not when you treat ... but you have to  look for it. Or these patients will simply get worse over time with the assumption of, "oh, you have Alzheimer's and we can barely treat it, so I'm sorry." Looking for a cause, super important.

Heather Sandison, ND:So, mast cell activation. Should we start there?

Neil Nathan MD:Sure. Okay, first of all. Let's talk about what mast cells are. They're an immune cell,  made in the bone marrow. And they're present in virtually every tissue of the body. They're present primarily in the tissues that are in closest association with the outside world. Because their job is to coordinate how the immune system and the nervous system respond or react to toxins and infections.

Neil Nathan MD:So since we're talking about toxins and infections here, it's no shock that mast cells have a major role in  trying to deal with these. And the concept of overload, once the overload of bacteria, bacterial toxins or mold toxins reaches a certain level, they will irritate or annoy or inflame mast cells to the point that they become activated-is the word we use. Another word would be overstimulated, trigger-happy, hyperreactive, so that  no longer are they merely doing their job, now any stimulus which is even slightly irritating to them will get these mast cells to release little granules which are packets of we call modulators into the outside world. The main one of these is histamine. So the tiniest stimulus to an activated mast cell will get it to  release histamine, and here's the fun part, histamine will add to the excitation of already inflamed tissues. So, every symptom that I talked about that is unique to mold and Lyme, we can get that from histamine and the other 200 mediators that are made by mast cells.

Neil Nathan MD:So if we'd like to complicate this a little, lets add mast cell activation. So both, my  experience is that the single two most important stimulators of mast cell activation are mold toxicity and Bartonella. And yes, there are others, but those are far and away, in my experience, the ones that do it. So if a patient has developed mast cell activation, and I will tell you that at least 50% of my patients or more have, it's not rare, now we have another piece that needs to be  addressed to quiet down this activated system. And again, I think it needs to be addressed sooner rather than later. Because ...

Heather Sandison, ND:What type of patient would present ... who should ask their doctor if mast cell activation disorder is affecting them? What symptoms would be unique to them?

Neil Nathan MD:Well none of them would be unique. They would be the exact same gestalt of symptoms I mentioned earlier covering every single symptom of their body. The biggest tip off, would be someone  who reacts immediately after eating or drinking anything. Even in an inconsistent way. It's not food allergy. It's hitting the mast cell in an activated state which will vary enormously. I have seen patients react to drinking water when they were in an activated state. So you have a patient who says, "I know this sounds crazy, but I have these symptoms when I drink water." And to be specific, to answer your  question, If you eat or drink anything and suddenly find yourself flushing, sweating, palpitations, anxiety, itching, hives, abdominal pain, diarrhea, and by quickly, I mean within 10-15 minutes even sooner of eating something, then your looking at someone who very likely has mast cell activation.

Heather Sandison, ND:And then what do we do about it?

Neil Nathan MD:We treat it. We have ...

Heather Sandison, ND:What about testing? Before we go there, cause testing on this one is complicated too. So would you just speak to that for a minute?

Neil Nathan MD:Yeah, I can. There are a number of tests you can do. They are very, very difficult to obtain. They are mostly done by research laboratories, they're highly inaccurate, if you don't put them into a refrigerated  centrifuge immediately and get them on ice. They're also dependent on when you get them. These mediators, including histamine, are in the body fleetingly. Their effects can last, but their presence is very, very brief. So that you literally have to catch them when the patient's at their worst, like a snapshot. So the yield on these tests is very low.

Neil Nathan MD:Dr. Lawrence Afrin, who's considered by many to be the dean of mast cell activation, has to test his patients over and over and over again to get any positive on any of these tests to confirm that's what they have. And because he has been an academic researcher for years, testing is incumbent on the research paper that he produces. And my world, I  think these tests are expensive, inaccurate, hard to get, and not necessary.

Heather Sandison, ND:[crosstalk] So can you do a therapeutic trial?

Neil Nathan MD:Absolutely. And that's what I recommend.

Heather Sandison, ND:And what does that look like?

Neil Nathan MD:Well, I have a two-tiered treatment process. Many patients with mast cell activation will respond primarily to natural materials and supplements, but not to pharmaceutical agents and vice versa.  A few will do both. So I typically will start with a little of both and see what works. So my typical starting point is Quercetin, which is my favorite mast cell stabilizer, for patients who have a strong constitution. I'll start with 500mg, 30 minutes before each meal and at bedtime. Now I wanna emphasize that. Unless a mast cell stabilizers  are already in the body before that patient eats or drinks, it's not going to work. So although it is annoying to remember it regularly, it is very important that those patients take the mast cell stabilizing materials 30 minutes before a meal. It just won't work well, otherwise.

Neil Nathan MD:So using Quercetin in that fashion is one of my first things to do. About 15-20% of patients  are so sensitive they can't take it. Some of those patients will do well on a very, very low dose Quercetin which is a product called Neuroprotek LP, which contains only 40mg verses the 500mg in a standard preparation. I will then try someone on either Claritin or Allegra which are histamine blockers. They're H1 blockers.  And typically I'll start them with one at bedtime, and then add another one in the day. Very often, twice a day treatment is far more effective than once a day, even though that's not recommended on the package. Depending on what my patient responds to or reacts to, I will typically continue that.

Neil Nathan MD:So if they can't handle Claritin or Allegra, some people it'll make them worse, I will work more with the  other natural mast cell stabilizing ingredients. I will use DAO, Diamine Oxidase which is an enzyme that breaks down histamine. I will use a product called, Paramine which is an extract of Parala seed. I will use a product called AlQlear, which is a natural tryptase inhibitor. And again, very carefully and slowly I will wean those into the patients program,  again all of them 30 minutes before a meal.

Neil Nathan MD:If someone has mast cell activation, they will usually find that very, very quickly there is a significant obvious, "I'm better." Like in the, "Wow, I'm better," category, which means we're going to continue that. I will also ask my patients to go on a low histamine diet, for a two week period of time to see if that makes a difference. Typically though,  the histamine diets are quite restrictive, somewhat difficult to do, but I think it's worth a trial. About 50% of my patients who have mast cell activation respond well, and 50% go, "whatever, it's not doing anything." So, if a patient hasn't responded in a couple a weeks, there's no point being that restrictive.

Neil Nathan MD:If a patient likes the medications, I will typically add Ketotifin,  and Cromolyn Sodium, and then an H2 blocker like Pepcid or Zantac, as we try to orchestrate it. The more materials a patient can take, the better they're gonna do. We're coming at this activated mast cell from as many different directions as we can.

Heather Sandison, ND:And does it last forever? If someone ends up with a mast cell activation disorder, are they gonna have it for the rest of their life or is this something that can kind of be reset and not disordered after  a while?

Neil Nathan MD:Well, keep in mind, it is my bias that these things are caused by mold toxicity and Bartonella. My experience is, if you cure them, it goes away. So it isn't that you have it for life. From my perspective, for most of these patients, they can be cured.

Heather Sandison, ND:That's great, good. Yeah, that is very hopeful. The nervous system activation pieces, the limbic  and the polyvagal theory, can you dive into those ones and how that ...

Neil Nathan MD:I can. Let's start with the limbic system. The limbic system is a group of structures in the brain that is grouped together by function. One of the main areas of the limbic system in the brain is called the amygdala. It is primarily responsible for how we process  emotion. So, one of the tip offs that the limbic system is involved is patients with unexplained and potentially severe anxiety, depression, despair, hopelessness, and what we call depersonalization, where they feel like they're not themselves. But the limbic system is more. It also includes areas that affect energy, cognition, and pain. So,  that the majority of our patients are a set up for inflammation of the limbic system which is adding to their issues. One of the methods that I use the most, is the Annie Hopper DNRS program, Dynamic Neural Retraining. I started ... because my patients tend to be extremely sensitive, multiple chemical sensitivities, is something I've been working on for a very long time.  And I discovered maybe around 2009. I stumbled onto the Annie Hopper limbic retraining program. I found it really helpful for chemical sensitivities. I think Annie herself who had been wrestling with chemical sensitivities that had been triggered by the forest fires in northern Canada where she's from and mold exposure, I think she herself thought of it initially  as this is really good for chemical sensitivity.

Neil Nathan MD:As we've been looking at these patients with brain inflammation as a major component of what's going on, it's become more and more advanced obvious in the last few years that her treatment program applies to a whole lot more than chemical sensitivity. In my experience, at least half of my patients have a limbic component. More and more earlier on,  I am going to on some form of treatment.

Neil Nathan MD:Now, I love Annie Hopper's program. There are some other programs. [inaudible] has a very good program. The programs are slightly different. Any of my patients that are sensitive, job one for them is to do something to quiet down that limbic system because it's really critical to make progress.  For most of them within four to six weeks of beginning their training program, they will notice obvious immediate effects. At that point it's not a theory. It's wow, I already feel better. We're beginning to incorporate looking at the whole being more, even from beginning treatment.

Heather Sandison, ND:Then how does that differ from the polyvagal theory?

Neil Nathan MD:Okay. Let's talk  about little bit about what it is. The vagus nerve is the 10th cranial nerve. It comes from the brain. It comes out at the base of the skull. This applies to the heart, the lungs, the intestines, and many of the other organs. And it is a primary component of what we call the parasympathetic nervous system. Now, for years we have thought in medicine about the autonomic nervous system as being too  many things. Sympathetic, fight or flight, parasympathetic, relaxation.

Neil Nathan MD:A newer understanding of this was given to us by a PhD named Stephen Porges in 1994. He began to put together a bunch of research suggesting that there was actually two branches of the vagus nerve. In fact anatomically that has been confirmed. The vagus nerve which comes out of the brainstem as  one nerve actually is made up of a ventral branch which comes from one part of the brain and a dorsal branch which comes from another part of the brain.

Neil Nathan MD:The key here is that we are now understanding that the ventral branch is the one that has the power to override the others. The ventral branch of the vagus nerve is concerned with safety. If a body doesn't feel safe, the nervous  system begins to activate, and bit by bit goes into hypervigilant mode so that it can have its antenna out there trying to look at what the stimuli that that individual is been exposed to, and shut it down.

Neil Nathan MD:What happens is it's a protective mechanism that eventually becomes overprotective so that it begins to question all stimuli. Stimuli that would not even  be perceived by one person is reacted to by patients who have this profound reactivity to them. These are people who wear sunglasses indoors because light is phenomenally overstimulating. They hear a noise and their whole body starts to shake. Food, touch, chemicals, everything becomes hyperreactive to,  because that nervous system is no longer convinced that anything is safe. It begins to say, I don't know if that's safe or not but I'm going to react to this anyway just to protect you.

Neil Nathan MD:What happens to our patients is that they live in a world that they're in hypervigilant mode constantly. And they begin to feel like their body is betraying them.  Now I can't rely on you for anything. You're overreacting to everything. I don't even know what's safe or who's safe where is safe. I don't know how to deal with that. Quieting down the ventral branch of the vagus nerve is what we refer to when we talk about polyvagal theory.

Neil Nathan MD:Now, there are three main approaches that I've seen. There are many more probably that I've seen be effective in that form of treatment.  Now, the vagus nerve and the cranial nerves it's connected to are not the same as the limbic system. They are related and they communicate with each other. If the vagus nerve is in hyper responsive node, it tells the limbic system, you need to be in hyper responsive mode too. Emotionally we will start to overreact to things that the patient's telling us. I never cried at that before and now I'm crying all the time.  I don't understand it. That never bothered me and I'm freaking out. By things that should never, so these are interrelated but they need to be treated separately. They both need to be treated because they both have the same impact.

Neil Nathan MD:There's some exercises that have been developed by a body worker named Stanley Rosenberg. This can be found in a book called Accessing the Healing Power of the Vagus Nerve.  At the back of the book there's a series of 10 exercises. My patients find it very helpful. It takes them 10 minutes a day to do these to quiet the vagus nerve and the connecting cranial nerve. Since Rosenberg is a body worker, his primary treatment mortality that he developed to work with these exercises is craniosacral work. I'm a huge fan  of incorporating osteopathic craniosacral work into the treatment, because that can help with this enormous link.

Heather Sandison, ND:You have some good advice about how to find a good craniosacral therapist?

Neil Nathan MD:I do. There are many schools of craniosacral therapy. The one that is from my perspective the most profound, the one that is perhaps the gentlest and works with patients by not attempting to fix anything but by listening to what is  going on and getting in sync with the body is one that is called biodynamic osteopathy. It was developed by an osteopath named James Jealous. If you Google biodynamic osteopathy, you'll go right to his website. He will list practitioners that he's trained in biodynamic osteopathy. If you're lucky enough to live in an area near one of these lovely people, that's a good place to start.

Neil Nathan MD:The third modality that we found helpful is to use frequency specific microcurrent, which is developed by Carolyn McMacon. If you go to a website called, she'll list practitioners that she has trained. You can ask them for that, and there's multiple other uses of the frequency specific microcurrent tool, including the fact that it can help  the that body with a variety of detoxification strategies.

Heather Sandison, ND:That sounds very helpful. We've been talking about that for a while, how to detoxify. With the limbic dysfunction, what are the strategies there? You mentioned Annie Hopper has a program. Are there exercises? Is it a weekend? Is it months long? Is it an hour a day? What does it look like?

Neil Nathan MD:Okay. You can get it in two main forms. You can go to an Annie Hopper workshop which are excellent, and I  would highly recommend it. However, they tend to be held in hotels, and many of my very sensitive patients can't go to a hotel. The scents and the chemicals would throw them under the bus. They couldn't possibly do that. She does have available DVDs in which she teaches exactly how to do these, I would call them a combination of  exercises and visualizations.

Neil Nathan MD:She based her work on Norman Doidge's research into brain or neuroplasticity. They're very well thought out, and from my experience very effective. She urges people perhaps a little too strongly to do them an hour a day. Some of my patients that are intimidated by that, worried  that their cognitive ability wouldn't allow them to do an hour a day. I urge my patients who are doing her program as do what they can. Modify it for what you can. If that's 15 minutes a day, great. If you can do it an hour a day, that is quite effective, and I do recommend that.

Heather Sandison, ND:Methylation is the other thing that I would love for you to dive into because I really do think that you have this unique experience. I mentioned this  earlier, that you've taken the experts in methylation and come to some of your own way of telling the story about how important methylation is. And where to fit it into a treatment process. It is clinically what I've seen is this is kind of the sexy topic, right? Everybody wants to know their MTHFR status and these huge doses of methyl folate that get prescribed or suggested. I have seen that be just disastrous. You  validated that when I heard you speak. Then there's all these conflicting opinions. Can you help us make sense of where do we start with methylation?

Neil Nathan MD:I can take a shot at it. So first of all, with Rich van [Konenberg] back in 2007, we did one of the first studies on methylation that I know of where we took 30 patients with chronic fatigue and fibromyalgia and  Rich van Konenberg have presented a theory that wasn't getting much airtime, that one of the essential biochemical components of fibromyalgia and chronic fatigue was impaired methylation. Rich, studying Amy [Esco's] goes to work, put together a hypochondriacal list of supplements that he thought would treat them.

Neil Nathan MD:I third Rich lecture in 2007. I was very intrigued. I had a ton  of patients with fibromyalgia and chronic fatigue. I put them on his hypothetical protocol. In fact, I put 50 patients on that hypothetical protocol because I, okay, how well does this work? Most of them got better. Some of them got spectacularly better. Our initial response was, and by the way, I include that in my new book  so people can look at some of that. If you look at some of my old books, I even have some of the graphs and data that we put together to prove what we were doing.

Neil Nathan MD:We got private funding to do 30 patients. We measure their methylation chemistry before we started, at three months, six months, and nine months. We followed their symptoms along with that. What  we found was that everybody's methylation improved to the point of normalcy on tiny doses of 5-methyltetrahydrofolate. We're talking 200 micrograms. I hear that people are using 5 milligrams.

Heather Sandison, ND:Or 12.5?

Neil Nathan MD:Or 50. I've seen that.

Heather Sandison, ND:Oh no.

Neil Nathan MD:I cringe. That wasn't needed in any of  those patients. We used hydroxy B12 as our primary B12 ingredient, not methyl which everyone else is in love with. There's a reason for that. There's a feedback loop in the body with methyl B12. If you are taking it in excess, the body stops making it. Hydroxy doesn't do that. You will get an infinitely better result with hydroxy B12 than you will with methyl B12.

Neil Nathan MD:Moving along, our study seems to have launched the concept of methylation as being important. We proved conclusively that we improved the methylation chemistry. It was also a longer study that is almost never done on nutritional supplements. It went nine months. Virtually no one dropped out of the study, which is almost unheard of. We had wonderful data.  It got people's attention. Everyone went, oh, methylation is a big deal. We got to start methylating.

Neil Nathan MD:That's when the story gets interesting. Somehow the measurement of snips entered into the equation. Now, we did measure snips during our study. We were working with Amy Esco, and our her lab measured snips as part of what we were doing.  The problem at that time, and to be honest it's still a problem, is that there are 39 snips that address methylation. Some improvement, some don't. It has not been shown that treating the snips is the same as treating methylation. Even Ben Lynch who pioneered treating snips publicly announced three years ago at his national meeting that that wasn't a good way to do it. You really needed to look at the chemistry, which I  second, I third the motion, I fourth the motion. That's where it is.

Neil Nathan MD:I'm going to backtrack for a second. It sounds like methylation is important, it is. Here comes the but. Dr. Robert Naviaux's groundbreaking work on the cell danger response has helped us to understand this in perspective. For listeners, if you have a chance,  if you google cell danger response Robert Naviaux, you'll get his paper. Absolutely brilliant. Dr. Naviaux has put together biochemically how a cell reacts when it is being threatened by infection or a toxin, which is the subject of our discussion. It is the mitochondria that recognize the presence of a toxin  or infection by a change in the electrical charge of the cell internally.

Neil Nathan MD:The mitochondria sets off an orchestrated series of events to protect that self. It stops methylating to protect the cell. I'll give you a good reason why. Viruses for example cannot replicate without hijacking our methylation chemistry. We shut  it down so they can't do it. We intentionally shut down methylation when we get sick to protect ourselves. It begs the question, if we jump into methylation before the body wants us to, is that a good strategy or not?

Neil Nathan MD:Merely identifying the one is not methylating well doesn't mean that you need to load them up on methylating material. You need to be in sync  with that organism as to when it is ready to do that. Often it isn't ready to do that until you've already begun treating mold and Lyme and toxins. What I'm seeing is a misunderstanding of methylation and its importance.

Heather Sandison, ND:Is it possible that somebody could be methylating to much? Because usually when we think about this, we're adding methyl donors like 5-MTHF or methyl B12 or [inaudible] TMG or these  methyl donors are things that come up a lot in treatment plans. Is it possible that you've gone too far or that genetically maybe you don't need those things?

Neil Nathan MD:Yes. This rarely happens with our compromised patients who are struggling with infection or with toxicity. It is much more common in patients who have psychological diagnoses, anxiety  and depression that is unrelated to these toxins, bipolar disorders, schizophrenia. Patients with mental disorders have been studied extensively by Dr. William Walsh who you referred to earlier. He's written a lovely book called Nutrient Power where he outlines the important and under tested aspects of those patients. Meaning to them they can often be cured or  improved by addressing zinc, copper, methylation, and histamine metabolism.

Neil Nathan MD:He's discovered that a significant portion of those patients over-methylate. Over-methylating mean that their body can't handle those materials at all, and you will get much worse with those materials. In fact, those patients are often the same ones who will get much  worse if you give them an SSRI to treat their depression. Absolutely there is that rarely in our patients.

Heather Sandison, ND:Got it. Good, good. A lot of your book is about rebooting. It's this idea that all of these things can be cured. That there is hope, and there's a reset process. What else would you want to add? What else would somebody want to be doing or thinking about  as they think about rebooting, restarting their lives as healthier, more functional people?

Neil Nathan MD:Then you would start reading a chapter 9 and go all the way to chapter 18. That will cover that nicely. Rebooting isn't just a physical process. I describe it in different chapters. Rebooting the nervous system, rebooting the immune system, rebooting the gut,  rebooting the endocrine system are pieces of that. The body is not just the physical structure. We are a unity of emotional, energetic, spiritual, and physical components. It's okay to talk about it by breaking it down, but we're one.

Neil Nathan MD:At a certain point in treatment, each individual needs to think about how  they have been impacted emotionally and spiritually. The patients who tended to be the sickest are often patients who have had serious emotional events with various forms of PTSD in their life, be it sexual abuse or war trauma or just very severe psychological stressors that they've had to go to through. There's no question that that does predispose  to people getting more ill. People who are spiritually floundering. People who don't know what they're doing with their life, because life doesn't have meaning or purpose. Where they're on autopilot, they're working long hours, living the American dream, making money but not enjoying it and not knowing what to do with it.

Neil Nathan MD:Part of these illnesses as it is with every illness is a wake-up call to the individual who has it to  go, how is my life out of balance? Just physically out of balance. Not just do I have a toxin, do I have an infection or something of that nature, do I not methylate well? How is my life completely out of balance? At some point during treatment it becomes imperative that we begin to explore this. Because I do find that patients may improve physically. If they don't begin  to look at these and address them, they're going to have difficulty with complete healing.

Neil Nathan MD:The patients who have healed completely, they have almost a spiritual reawakening. I've seen that a lot. Not that I recommend any of these illnesses to anyone as a path to enlightenment. It can be if perceived in the right way. If you look inside and go, that  does give my life purpose. How am I off base? How am I not pursuing connections to my family and friends and community and being of service? Those are the questions that really become imperative at some point that are a critical component of rebooting.

Heather Sandison, ND:Maybe is there some opportunity in the suffering in the process of healing, is some opportunity for that to to create meaning  and maybe for them to get back to other people who are going through the process potentially? Or in all kinds of ways. Do you think there's a cure for everyone?

Neil Nathan MD:Yes, if the patient wants to cure. I know that may sound a little odd. After I've been practicing medicine for a while, it came as a shock  to me to discover that there were people who for whatever reason didn't really want to get well. That they had embraced either victim consciousness or embraced the invalid role and were terrified that if they got well, they actually have to manifest a life. It became so comfortable within that context that they weren't really motivated to get well anymore.  If people want to get well, I believe that there is a healing path for them. I may not have that healing path but I believe that somebody out there does.

Heather Sandison, ND:Where can people find more information? You've got a number of books that you talked about. I also know that you have hours and hours and hours of video and radio conversations with Bob Naviaux, with Joe Brewer, with some of the characters that you have referred to in the past hour and a half here.  Can you help point us in the direction of where to get more?

Neil Nathan MD:Sure. My first comment is read my book. I don't mean it to be self-serving about the book really was written to be a launching point for hope and for information to help people who are struggling to understand what they need to be looking for. I've got tons of reference in those books for specific areas of study.  If you like, you can go to my website, which is just In it there are radio shows that I've done. They're archived. You can listen to radio shows that I did with Joe Brewer, Richard Schumacher, Lawrence Afrin, and on and on. There's a fair amount of good information in there.

Neil Nathan MD:I view the ISEAI group, I-S-E-A-I as a pioneering leading group in this arena. We have as sister organizations ILADS, the American Academy of Environmental Medicine, the Forum for Integrated Medicine, TFIM, are all groups that we are working with to promote the pieces that we understand  the best. The new group ISEAI which is the International Society for Environmentally Acquired Illness is going to have its first national meeting in May of this year. I certainly encourage all physicians and healthcare practitioners to consider going there.

Neil Nathan MD:We're going to be certifying physicians in the process of how to look at all this complicated information and sort through it and provide  effective treatment. They have a great website with a great library of things you can look at and read. For consumers I will encourage you to become affiliate members and to look into that group as a wonderful resource. Am I answering your question?

Heather Sandison, ND:Absolutely, thank you. You are full of resources. What if somebody wanted to have a consultation with you? Is that an option? Do you see patients?

Neil Nathan MD:I do.

Heather Sandison, ND:By design you're about four hours from anything.

Neil Nathan MD:Correct. This is to stop people from getting to me. I've kind of evolved into a work schedule that I love in which I work two days a week, two full days. I don't want to stop seeing patients because that's where the rubber meets the road. Those are the questions that have come up that I need to answer.  What I've seen in my colleagues is that when they stop seeing patients, they lose their cutting edge. That's not something that I want. I love what I do. I love learning. I don't see stopping.

Heather Sandison, ND:You're saying there's a chance people could get on your schedule?

Neil Nathan MD:I'm pretty full up. By pretty full, there's very little room on the schedule. However  I am devoting several days a week to consulting with physicians and their patients. I do welcome consultations. You can look at my website for that. I am increasingly insisting that patients work with their treating physician so I can really serve as a consultant. That way I can teach more, reach more people, and that's  really what I want to be doing.

Neil Nathan MD:As you know, I just recently started a mentorship program for physicians in which I want to reach more physician yet. If physicians are interested, they can go to that section of the website and sign on. I've got is going currently and I wouldn't be doing any of that till the beginning of next year. Yes, you can get a consultation but I really insist  now that you have on board a physician who's open to my helping them sort their way through the diagnosis and treatment.

Heather Sandison, ND:Ideally it sounds like maybe if there was somebody who wanted to get some advice from you, they could sign up as a patient of one of your mentees ideally and then discuss the case with you either with the patient in the conversation or not, but download your wisdom and experience  and fuse it into their plan, but without needing to fit into your wait list and the two days a week that you have for patients.

Neil Nathan MD:Yeah. I can't say I never take a new patient because that's not true. I just have almost no room in the end at this point.

Heather Sandison, ND:How wonderful, what a gift for that patient to be able to give the provider, the mentee that they maybe  link up with that all of us get to learn and grow together.

Neil Nathan MD:Yeah, that was the whole point of doing this, which is I really want to share with people what I know.

Heather Sandison, ND:Thank you.

Neil Nathan MD:I have no intent of retiring, but the universe works in mysterious ways. I really wish to share that information now.

Heather Sandison, ND:Thank you so much for sharing as much as you have today. It's been very enlightening. Although I've had  the honor and privilege of hearing a lot of what you had to share through your books and through hearing you talk in the past, every single time I get a chance to spend time with you, I learn more and more. Thank you help me dive a little bit deeper and for sharing with our listeners all of these pieces and also the resources so that they can dive even deeper and get the healing that they're looking for.

Neil Nathan MD:My pleasure.

Heather Sandison, ND:Thank you, Dr. Nathan.

Neil Nathan MD:Thank you.

Heather Sandison, ND:See you at the next mentoring meeting.

Neil Nathan MD:See you at the next  mentoring meeting.

Heather Sandison, ND:Bye now.

Neil Nathan MD:Okay.

Heather Sandison, ND:Thanks for tuning into this episode with Dr. Neil Nathan. If you like this episode, then please share it with a friend and leave us a review on iTunes. If you're hungry for more information to take control of your overall health and well-being, check out our free e-book that offers a well-rounded approach to brain health. It's called the foundational guided to neurohacking. You can find it at  You're in for a real treat with our next episode on the podcast. Navine Jane, an entrepreneur driven to solve the world's biggest challenges through innovation joins us to talk about his work on disrupting healthcare with the goal of making illness elective. We can't wait to share it with you. See you next time.

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