Ep. 217 The Shocking Truth about Mold Exposure and Mycotoxin Illness with Dr. Aaron Hartman

Today, I am excited to have my friend and colleague, Dr. Aaron Hartman, joining me! Dr. Hartman is a triple board-certified physician in functional and integrative medicine. 

Our immune systems can go into overdrive in response to many different environmental factors, including some of the things we get exposed to in our food and personal care products. Today, for the first time on the podcast, we will be talking about mold and micro-toxins and their resultant systemic inflammatory side effects.

I like to think of Dr. Hartman as a medical detective because he takes the time to closely examine how and why various factors are present in his patients. In this episode, he and I dive deep into Chronic Inflammatory Response Syndrome (CIRS) and discuss how exposure to biotoxins can lead to a chronic inflammatory response. We talk about mold, contributors to mold exposure, and micro-toxins. We discuss the role of specific types of testing, provide clues for where to look for mold exposure, and explain how it can manifest. We touch on how CIRS can get triggered by seemingly benign things like too much exercise, post-traumatic brain injury, and breast implant illness. We discuss ways to treat those issues, focusing mainly on lifestyle, dietary recommendations, and adding things like specific types of filters to our environment. We also talk about how we can work with our local healthcare professionals to find people in our area to help us get to the root cause of many different chronic inflammatory symptoms. 

I found this conversation very interesting because I believe that many people may be diving down rabbit holes when, in fact, their symptoms might be there as a result of an overwhelming chronic inflammatory response. Stay tuned to learn how to deal with the systemic inflammatory side effects that could result from chronic mold exposure. 

“Twenty-three percent of Americans have the gene that is associated with an increased risk for Chronic Inflammatory Response Syndrome (CIRS).”

– Dr. Aaron Hartman

IN THIS EPISODE YOU WILL LEARN:

• Why is the medical community not talking enough about mold exposure and micro-toxins?
• We look at the symptoms associated with Chronic Inflammatory Response Syndrome (CIRS).
• It can take many exposures over many years for those genetically more susceptible to micro-toxin exposure to become symptomatic.
• There is a case study at the University of Texas on curing POTS Syndrome by treating SIBO with low-dose naltrexone and IVIg.
• Healthcare providers get trained to think about each symptom separately. Dr. Hartman’s curiosity led him to see how many different things are interconnected.
• There are many different ways that people get exposed to mold- even from seemingly benign foods like coffee and peanut butter.
• We need to ask whether or not our innate immune system is activated to respond to the mold we get exposed to or if there might be something else within the CIRS world that could be causing the problem.
• Dr. Hartman created a blog series on his website to walk people through their symptoms to learn if they might have CIRS.
• Dr. Hartman talks about the often-overlooked melanocyte-stimulating hormone (MSH).
• Where should you start, and what should you look for with home-testing?
• Some ways that CIRS can get triggered.
• Everyone has different thresholds for a concussion.
• Overexertion can hurt the body, so you need to listen to what your body tells you.
• Dr. Hartman shares his thoughts on breast implant illness and its inter-relationship with CIRS.
• Some of the ways that Dr. Hartman addresses CIRS symptoms

Connect with Dr. Aaron Hartman

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Transcript

Cynthia: Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent are to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

Today, I was joined by my dear friend and triple board-certified physician in functional and integrative medicine, Dr. Aaron Hartman, who I like to think of as the great medical detective. We dove deep into a syndrome called chronic inflammatory response syndrome or CIRS. We spoke at length about how our exposure to biotoxins can lead to this chronic inflammatory response. We spoke on mold and contributors to mold exposure, mycotoxins, the role of specific types of testing and providing clues to where we need to look at our exposure and how it can manifest. Largely, a great deal of this immune system response that is gone into overdrive is attributable to many factors environmental, things we’re exposed to in our food and personal care products. We also touched on how CIRS can be triggered by things as seemingly benign as over exercise, posttraumatic brain injury, and also breast implant illness, and how to treat this, predominantly focused on lifestyle and dietary recommendations, as well as things we can put into our environment including specific types of filters and how we can work with our local healthcare professionals to find people in our areas that can help us determine the root cause of a lot of symptoms. I found this conversation particularly of interest because I feel there are so many people out there that are diving down rabbit holes, what might be exacerbating their symptoms, maybe this chronic inflammatory response overwhelmed.

Well, today I’m delighted and excited to have a colleague with me Dr. Aaron Hartman. We haven’t talked about mold on the podcast, or mycotoxins, or some of the systemic inflammatory side effects that can come from chronic mold exposure. So, welcome, Aaron.

Aaron: It’s great to be here, Cynthia. I’m super excited our conversations. We’ve already had tons of conversations outside of-

Cynthia: [laughs] 

Aaron: -this world in person and stuff. So, I’m excited to share some stuff with your community.

Cynthia: Yeah, absolutely. One statistic that I found incredibly disheartening that I think is a great way to start the conversation is that 50% of buildings in the United States have water damage. I found that stupefying and surprising. And so, why do you think that we aren’t talking, we as a community in the medical community aren’t talking enough about mold exposure and mycotoxins with our patients?

Aaron: Well, I think there’re a couple things. The first thing is that in medicine, people forget it takes 10, 20, 30 years for something to go from research, to a few practitioners see it, to a few more to publish articles, to mainstream. It took about 30 years for handwashing to catch on when Ignaz Semmelweis invented that right in the 1830s. It took 50 years in the United States and over 7,000 research articles before the Surgeon General of the United States said, “Smoking causes cancer.” It’s just a slow process is the first thing. I actually think if you look at how things typically work, you’re thinking 1996 to 1998 when this was first discovered by Dr. Shoemaker. Now, that’s actually a pretty quick turnaround within 20 years, we’re actually talking about it. 

In the medical world, it’s actually quick to be honest with you. On the traditional medicine side, we tend to talk about things we have singular treatments for our medical system basis things on randomized trials, which you’ve been involved with. I have become a clinical researcher as well. You tend to research things, you can isolate and do single interventions for, and this is something that’s too complex involves people’s health, their environment, workplaces, homes, other infections, a whole host of things. I think it’s outside the realm of that simple model we currently have and it’s taken a while. I think one of the reasons actually taken up so quickly is because so many people are sick from it. You mentioned the 50% number, but 23% of Americans have the gene that’s associated with an increased risk for chronic inflammatory response syndrome, CIRS. So, it’s a lot of people. When you look at the symptoms, your brain fog, ache, nonrestorative sleep, weird skin sensations, rashes, gut issues, all of a sudden it sounds a lot of people I see every day.

Cynthia: Well, and I think there’s also the component of just understanding, it’s very hard for people to necessarily wrap their heads around something they necessarily can’t see. I think for those of us that have looked at mold, we know what it looks like when it’s problematic. But it’s innocuous. It can be hard to discover and discern, people will go to a work environment not realize that there’s a mold issue, they’re feeling sick, they attributed to other things, hormonal fluctuations, they’re diagnosed with fibromyalgia, they’re told they’re leptin resistant, they’re told that they’re insulin resistant, and yet, what’s really at the basis of all of this is that they’ve had this exposure. It’s my understanding and certainly correct me if I’m wrong, for those people that are genetically more susceptible to mycotoxin exposure, it can be multiple exposures over many years. It may not be one major insult. It may be multiple exposures that then fill that bucket that all of a sudden and then they become symptomatic or it becomes problematic.

Aaron: Absolutely. With mold, I’m just referred to as mold issue. It is actually chronic inflammatory response syndrome. It is a technical term and mold is one piece of many pieces within that category. But I’ve had patients, one of them was on a soccer player at UVA. He had overtraining, which overtraining is a small part of CIRS. He actually grew up in a moldy house at UVA, he lived in a moldy dorm. He got a tick bite. From a tick bite, he got Lyme, and he developed Hashimoto’s. We couldn’t get his antibodies squared away until we realized mold was the thing that was sitting there and that inciting event that trigger is what started his whole cascade. You are 100% right. Well, you can have these long-term exposures for years not realize it, because you’re healthy and functioning. And then something, a car accident, you hit your head, a concussion, a traumatic life event, and infection, COVID. I’m seeing people in my clinic with long COVID, who their initiating event like the tick bite is an infection and I’m finding out that they have crazy mold issues in their home. That’s where you almost need a medical detective, someone who’s going to get with these people, take a deep dive and connect all these dots that aren’t necessarily connected on 12 to 15-minute time slot.

Cynthia: And it’s hard. I know one of the things that is associated with CIRS, or mycotoxin illnesses, or things like POTS, so postural orthostatic hypotension, which I saw a lot of in clinical cardiology, and there weren’t a lot of things we could do for these patients as dysautonomia, where they had this dysregulation in their autonomic nervous system. Oftentimes, we would just give them very powerful drugs to increase their blood pressure and then send them to a POTS specialist of which there were not a lot of them. But I know that my colleagues and I all felt really frustrated, because we didn’t have a better way of treating these patients. At that time, I certainly wasn’t even thinking that all of these pieces could come together creating the perfect storm to be like, “What’s the one thing that tips people off?” For you being the medical detective, and I think that’s such a great way of how I think about you is that you take the time to really closely examine all these different factors, and how they can impact someone’s health, and how they can present. 

Like you mentioned, tick bites. Lyme is endemic in the state that we live in and I saw so much of it in the county that I just moved from to the point where anytime we saw something unusual, we started drawing Lyme titers and tick-borne illnesses titers. I think the research was actually done out of University of Virginia was the lone star tick. Because we had people who couldn’t get cleared for bypass surgery, cardiovascular surgeries because they had this mammalian allergy that was secondary to, but seemingly benign tick bites. So, really understanding that tick-borne illnesses are not as benign as we like to think they are that in a small amount of people, they can really go on to develop some pretty significant sequelae.

Aaron: Yeah, it’s really funny, Cynthia, you’re referring to alpha-gal there like, I see that all the time. I see it all the time. I pick it up all the time when I see people with weird things. I’ll do an allergy panel, and their beef and the pig, IG pops up and I throw off an alpha-gal, and just bam it’s right there. It’s really interesting. I personally, and this is where I’ve actually reached out to Dr. Haman and a bunch of my colleagues that are in this world. Sometimes, we’re the people noticing these trends before they come to the surface so to speak. I’ve seen a lot of my patients with chronic inflammatory response syndrome, also have POTS and dysautonomia, also have alpha-gal, also have SIBO. There’s a whole school of fault actually and the mast cell activation syndrome has this thing called the pentad. It’s dysautonomia, GI dysfunction, autoimmunity, leaky gut, and these things actually coalesce together and so, you’ll see someone who has POTS and no one will realize that there’s actually literature from the University of Texas, a case study, a case series of curing POTS with treating SIBO, low-dose naltrexone, and IV IgG. 

Well, if you know what actually dysautonomia is you realize is a neurologic one. Actually, only 30% of dysautonomia is actually autoimmune. There’s a Mayo antibody panel on it. All of a sudden, wait a second, I’m seeing this vascular and neurologic cardiac thing that has a gut component, has an autoimmune component. I’ve actually gotten similar my patients– I have actually had couple in remission just by doing oral IgG, low-dose naltrexone, and dealing with their SIBO. It’s just interesting how connecting these dots. Every one of these things, the old model of medicine, every disease, every entity is a separate silo and nothing connects, right? POTS has nothing to do with your hypermobility, one in 30 Americans is hypermobile. If you’re double jointed, you have an increased risk for sleep apnea, you have an increased risk for leaky gut, you have a higher need for vitamin C, trace minerals, you have lower pancreatic function. All of a sudden, just looking someone touching their skin, looking at their elbows, I’m already thinking, “Does this person have mast cell activation, do they have some mold issues, do they have positive thyroid antibodies? 

In our current system, where we look at these silos and the model is nothing interconnects. In our world, it’s everything. The old model has proved to me that they’re connected and my model proved to me that they’re not connected. That’s one of those things that inquisitiveness that I’ve been doing for years has helped me see a lot of these things interconnect. I’m not sure if you’re familiar with Dr. Shoenfeld’s work. He’s an immunologist at the University of Tel Aviv. He has a really interesting book that’s about vaccines and autoimmunity and he has a syndrome called ASIA syndrome, which is autoimmune/inflammatory syndrome induced by adjuvants. When you read it, it sounds so much like chronic inflammatory response syndrome. But as immunologist, he’s looking at adjuvants, which are things that tickle our immune system, things like chronic infections, things like vaccine dose that he talks in his book about the old vaccines having petroleum distillates in them, I have seen the military people exposed to burning gas and burning fuels developing this Gulf War Syndrome. Is that an Asia syndrome, is it a weird variant of chronic inflammatory response syndrome? There’s one variant of that is silicone.

We have someone in our group that actually all day specializes in the x plants. How many women have weird things related to that? Dental infections, we have experts in our group that deal with dental infections related with these things. And so, that’s where my challenge is not to connect too many dots and make something applicable to the person I’m seeing, so we can get them better. 

Cynthia: Well, I think it’s a really important point, because I trained at a large research institution. I used to think about every body’s system in a bucket. I was the cardiology person and unless someone was dealing with life-threatening issues, we didn’t deal with thyroid, we didn’t deal with immunologic issues. We were very laser focused and yet, over the years, I kept saying that “I’m seeing these interrelationships and yet, I’m strangled in my practice,” because at that time, nurse practitioners couldn’t practice autonomously. Ultimately, I had a physician that came behind me that would agree or disagree with my plans. I’m so grateful that we’re seeing this evolution in medicine that we have people that are connecting the dots in a way that’s done so thoughtfully, because there are so many people that are suffering and I say this with great love and reverence, because I know our peers, whether they’re traditional allopathic trained, or they are integrative, or functionally trained, we’re all trying to do what’s best for our patients. That’s ultimately what it comes down to. 

But we’re so constrained by a traditional model that I think we have to be thinking very broadly in order to meet the needs of our patients at a time and place. When we’re talking about mold, I want to make sure that we further define this just a little bit so that for people have context. We can be exposed to mold in multiple ways. One of the things I see with my patients is that there’s a lot of mold exposure from foods. Foods that are seemingly benign like peanuts, and corn, and coffee tend to be very mycotoxin-exposed foods. This is sometimes surprising. I think peanut butter is something that’s so beloved here in the United States. I go to great extremes to find my husband and my younger son like super high-quality peanut butter, but it has to be small batches and you have to have conversations with people. When I buy coffee, I’m not a coffee drinker, but when I buy it for either gifts for clients or for my family members, there’s a guy in Northern Virginia who is completely OCD about mycotoxin testing for his coffee beans. And so, really understanding that we can be exposed to mold in our environment, in our homes with food. What are some of the other ways that you’re seeing people are getting exposure in their personal and professional lives?

Aaron: If I was to pick one thing, the single biggest thing is probably people where they work and where they live. Food, it’s really interesting. There’re two different camps in the mold world if you are familiar with Dr. Neil Nathan and his work. On those sites, Dr. Haman and Shoemaker. By definition, chronic inflammatory response syndrome is a chronic inflammatory syndrome. The reality is our bodies were designed or made to look at most things, most molds, most bacterias, most things in the world, ignore them. We eat mold all the time, kefir, fermented foods have certain types. I love moldy cheese. But our immune system is supposed to ignore most of that. When you consume mold, typically it gets excreted through urination. When you look at a lot of other people’s CIRS we’re looking at liver excretion. That’s where that gene you mentioned, it actually affects how you excrete it in the bile. We’re exposed to these things all the time. The question is, is your immune system responding? If you eat a bunch of corn chips, for example, you’re going to get exposed to mycotoxins, corn or known to be. Peanuts, horrible with it, wheat and grains. Grains in general have mold issues.

If you check someone’s urine, you see them pee out these mycotoxins. The question is not did you eat a moldy food? The question is, is your immune system responding? Is your immune system going bonkers? Not just your antibody immune system, is your innate, the very primitive part of immune system that’s preprogrammed to recognize these 10 domains, part of our immune system recognizes 10 major domains, and viruses, and bacteria, and mainly viruses and cancer, and our innate immune system knows to attack those. That’s the issue, the labeling part with CIRS. Is that part of your immune system being activated? Do you have the symptoms that go along with that, and then you have the testing that shows that?” That’s where I think to stepping back from the mold and realizing, we look at chronic inflammatory response syndrome, 20% of it is not water-damaged building associated. It’s listeria, ciguatera, red tide, recluse spider bites, concussions, all those kinds of things. Within the 80% that’s water-damaged building, 80% of that is endotoxins and actinomyces, which are not mold.

Once a bacteria coding and once a soil organism, there’s over 40 different particles or things in a water damage building that activate your immune system. Endotoxins, one of those you actually get exposed to in pollution-ridden cities in the air. I think you’re realizing mold is one of the things, but it’s the company that mold keeps in stepping back and saying, “Is there something else in my system, in my body, in my environment that could be a toxin that would activate this innate part of my immune system?” That’s where mold is a big player. I don’t want to minimize that. Like you said, half of the buildings in our country have water damage. But if you only focus on that, you’re going to miss 64% of chronic inflammatory response syndrome. I think maybe that might be a take home message to think about that. Is there something else in this serious world that actually might be messing with you? That’s where I see people get stuck as they’re focusing just on the black mold, just on [unintelligible [00:17:30], just on Wallemia and their [unintelligible [00:17:29] work, just on Penicillium and their HERTSMI testing. It’s like, “Well, that’s great. But you have to realize that’s not the majority of causes for chronic inflammatory response syndrome.”

Cynthia: I think that’s an important differentiator. If someone is listening to our conversation, what are the first steps? Obviously, they need to work with someone who is intricately aware of the nuances related to CIRS? Do you start with personal testing? You start with home testing, where do you generally recommend, if we’re giving a broad suggestion/recommendation?

Aaron: I actually did a blog series. It’s on my website that actually walks people through that. I put it together specifically for this reason for people to help self-discover and if they have a practitioner, it’s open to it to take it to them. With a diagnosis, the first thing is the symptoms. There’re 13 clusters, do you have eight of the 13 positive? One of those is brain fog, one is attention, one is weird skin symptoms, one is hot flashes and gut issues. Do you meet the symptom criteria? Now, I want to put a little caveat there. Also, do all the Brednesen protocol work with dementia patients? Now, patients come to me with dementia, who I automatically jump and do the mold testing but have mycotoxin issues and their only symptom is, they don’t know anything. They have dementia.

Cynthia: [laughs] 

Aaron: Yeah, I’ve realized they’re outliers even in the way this, but I’m acknowledging that. But you have the symptoms first that would fall into this category. The second thing is a second tier of diagnosing, which is the VCS testing, which is a marker of blood flow to the back of your eyeball. When people talk about different lab tests like hypoxia-inducible factor, which is one of the things that’s affected, that’s basically making your vessels let less blood flow go to end organs. The VCS test, which is just a visual computer tests, anybody can do anywhere in the country from the comfort of their own home, it’s literally looking is there enough blood flow going back to the back of your eyeball? MARCoNS testing, that’s the really simple tier one, tier two. If you meet tier 1, 95% of people will actually have chronic inflammatory response syndrome. The VCS test, 95% of it will fail that test, but 5% won’t. You still have to realize there’s still a subset that might pass that. Then there’s a lab testing, which is tier 3 and there’re different clusters in that. It’s interesting that testing itself is looking at, how is your brain interacting with your body? Looking at a cortisol level with your adrenals, but also looking at your ACTH in your brain, is your brain not communicating with your adrenals? 

Looking at their concentration, their osmolality, how much sodium is in your blood and looking at is the brain telling you to do that the gene testing, there are a couple of inflammatory markers like a C4A, which is looking at this innate immune system, TGF-beta and then P9 is actually a marker that Dr. Huston at Vanderbilt looks at for people with inflammation in their heart. In the mold world, we look at for people with inflammation in their tissues. If you meet lab criteria, then you have a 99.97% chance of having chronic inflammatory response syndrome. But the thing I tell people, it’s really funny because when you see someone the clinic, you also have to look at their history, because I’ve seen people who’ve already self-treated, who removed things. There are sometimes clusters positive, but then it’s questionable to do lab testing, because they’ve already done so much work. I think that’s where being a skilled clinician working with someone who seen a lot of his patients to figure out, “Well you’ve actually self-treated.”

Maybe you didn’t know that more fat, lipid therapy, fats help remove mycotoxins from your body. People don’t realize that doing omega-3s, phosphatidylcholine actually helps remove mycotoxins. Getting more fiber, particularly konjac root fiber or beet fiber, okra actually helps get more of these mycotoxins out of your body. Some people have innately just listen to their body, start to figure things out. But to answer the question, I did put a blog series together to actually for this very purpose for people to walk through it because the reality is, there’s a handful of people actually certified in the country to do this stuff. It’s really hard to find someone who has the experience. On top of that, how many of my patients with serious or hypermobile and have undiagnosed sleep apnea. It’s amazing. It’s amazing how many people will have mast cell activation syndrome, which this little small thing or have dysautonomia. All of a sudden, now, if I don’t start treating your dysautonomia and your SIBO, let’s go make it hard to calm your innate immune system down. So, it really kind of [unintelligible [00:21:49].

Cynthia: No. For anyone that’s listening and is saying I’m really curious, we’ll make sure that we link up all these blog posts, which I actually read in anticipation of this conversation, because I wanted to be able to steer the conversation to making it as helpful as possible to listeners. Now, when we’re looking at these labs, one lab in particular, I find really fascinating. The role of melanocyte-stimulating hormone, can we talk a little bit about this? Because when I think about the average middle-aged woman, we’re talking about brain fog, and hot flashes, and weight gain, and weight loss resistance. When I read about this MSH, it really [crosstalk] for me. I was like, “Oh, my goodness.” There really are lots of opportunities where women in particular might be experiencing these symptoms and it might not just be, “Oh, you’re in perimenopause, you’re on menopause.” There could be so much more to it.

Aaron: Well, seriously MSH, there’s this melanocortin molecule that your brain releases at these different stages, your midbrain, goes down to your hypothalamus and pituitary. This molecule is broken up and the ACTH molecule which makes cortisol is a part of this. MSH, actually, there’s a part of that actually helps regulate pain in your midbrain. It’s amazing how many people will have these fibromyalgia symptoms and their MSH is gone and also melatonin. Your melatonin and glutathione are your two major antioxidants in your body. Melatonin is the antagonist so to speak for cortisol. Well, if you’re MSH is down, it’s going to affect that. Then it also plays into things like serotonin. It’s really interesting how a small little thing is related with a whole lot of these other things. I have had a lot of patients with issues actually, there’re certain peptides that actually have MSH analogs that I’ve used with those patients because they’re stuck and we’ll use things. That’s also part of the power of VIP. If you get people down the pathway, sometimes peptides in these patients can be really powerful. But MSH, it’s something that’s you’re absolutely right. It’s overlooked and affects so many aspects of our health, pain, sleep-wake cycles, and even because of its association with that POMC molecule is associated with cortisol, which– Just look at [unintelligible [00:23:56], people have adrenal fatigue, it’s like, “Is it adrenal fatigue or is it mold?”

Cynthia: [laughs] No, there’s so much to it. What I found really interesting is it also impacts the pituitary gland. When people say to me like, “I’m thirsty all the time, I’m having inappropriate amounts of thirst” and they don’t have diabetes, they’re not insulin resistant, which now and now is becoming more and more unusual. 90% of the population is insulin resistant. But when I start hearing those types of conversations, I’m like, “Now I’m going to start thinking like there could be much more to this.” So, for listeners that are listening that are saying, “How in the world do I keep all this straight?” Dr. Hartman has really good blog articles on this. You should definitely check out.

Aaron: What’s interesting is, you’ve mentioned about that too, because one weird symptom is people who could carry static charges, could shock a lot things in the wintertime. People forget that one of the early things with cystic fibrosis was, those people actually carried static shocks because they have high salt on their skin. It’s a similar but lesser degree phenomena that happens with the osmolality and differences where people actually their skin gets a little salty or they get relative dehydration, they want to drink a lot, and it goes right through in their pee. Those are the patients also that sometimes doing focused cell salts and electrolytes can actually help treat some of their symptoms. I think that also probably is a subset that have the dysautonomia and POTS. Part of it is that they can’t keep enough fluid in their arteries. And so, you give them sodium chloride, you probably did in the cardiology clinic, it helps if you give them sodium. This is a little trick I learned as well. You give someone a liter of sodium chloride, a liter bag, lactated ringers work so much better because the lactate actually helps the magnesium get into the cells and that was one of the things I noticed with some of our local POTS experts, they were not using LR with these patients. You talk with the surgeons, they’re like, “Oh, we love LR, it’s great, yada, yada.” I’m like, “That’s because the lactate actually has a metabolic effect on these patients.” I’ve had patients who have flares of POTS related to mold. I’ve basically done IV LR in the office weekly for four to six weeks to actually get them out of their flares. Sometimes, also connecting those dots as well, which makes sense from a cellular level, but just LR is $10 a bag versus $3 a bag, so it’s just not used that much.

Cynthia: Well, it’s interesting. I was a former ER nurse in Inner City, Baltimore. We used a lot of lactated ringers, one of my favorite IV fluids to grab when I was working with my trauma patients. The other thing to really think about when we’re screening, whether we’re doing lab work or this visual contrast sensitivity, when we talk about home testing because this question came up quite a bit when I identified to listeners that we were going to be connecting, where do they start with that? Because I know ERMI testing was a term that I’m more familiarized with, but I don’t know if there are better options that are out there. What should people be looking for?

Aaron: The thing about is, most people do the spore trap testing, which is you go to Lowe’s or Home Depot and get the little test kit with a little petri dish. The problem is for every single spore there are 500 particulates in the air. By the time the spore trap testing is positive, it’s really bad. That’s one extreme. The other extreme is ERMI and HERTSMI-2 testing. You’re using your Hawaii 5-0, Miami kind of thing where you are looking at DNA PCR. You could have had water damage from three, to four, or five, six years ago, you remediate it but you still have micro particulates in your furniture and your carpet, and you still pick that up, which is one of the reasons why if you look at the official protocol, the white paper on it from the Haman-Shoemaker group, they’re like, “You need to wipe the walls down, fog, through your furniture away,” all this kind of crazy stuff, because you can remediate the thing. You could find the cause in your house, but if it’s still your carpet or furniture, every time you sit down, you’re going to rebase the populate the testing on the wall. I like ERMI and HERTSMI-2 testing. If it’s negative, your house is clean. HERTSMI-2– if you look at the ERMI, the HERTSMI-2 is actually the one that they verified for health-related score. So, that’s a little nuance to the ERMI testing. 

But if you do it and your ERMI is low, your HERTSMI-2 score is low, then your house is safe. If it’s elevated, then, well, is it currently an issue or is an issue in the past. The thing with the ERMI and HERTSMI-2 testing as well is that it doesn’t tell you which part of the house is messed up. Is it your air handler, is your crawlspace, is it the master bedroom? Some people will do ERMI’s in each room in the house, but then, well, you could just have a building biologist come out and look at your house and that’s where, I used to do lots of testing on the front of the things even in my house. My house to date, my ERMI is still 16 or 17. My house still, even though– we’ve talked about this. I’ve encapsulated my crawlspace, I’ve got a radon remediation system, I’ve close foamed the walls, I’ve done all this stuff, I’ve got HEPA filter in all the rooms, but I’m not sick and my wife’s not sick. Am I going to throw my furniture away? Am I going to throw all of our rugs away just to get the test to normalize when I’m not personally sick? That’s what gets a little nuanced. I do have some patients that are super sick. These are the people tend to have EMF issues, where literally, the nervous system is on fight or flight and they will react to stop. It’s a part of the brain’s trauma response. These people may need to go to the extreme.

Now, one of my patients actually, when she went through her storage space, had a flare of her CIRS, just by going getting some stuff out and was like, she had her friends throw all their stuff away. There are those patients, but those are not the majority. And so, I love ERMI, HERTSMI-2 testing, but I’ve just reverted these days to basically just having a building biologist come by and look at people’s houses. Because if you look at the testing, it’s probably cheaper long term to have a building biologist come by and spend six hours in your house, use an infrared gun, look at the walls, check the humidity in your base plates, do a crawlspace, pull the panel off your air handler to look at the corals to see if there’s any particulates there. The local guy you see, actually one of my patient’s house, who was– The humidity in the house, the humidity supposed to go down as you go open your house. There’s one up not down. And so, he basically went behind on one of their stairwells on the outside wall and put a hole in it, they had no vapor barrier outside their house. The Tyvek wasn’t there. It wasn’t done. You’re not going to figure that out with the HERTSMI-2 or ERMI test. That’s where I used to do lots of house testing on the front end of things. As I’ve gone on in my career, I’ve just do it less, and less, and less, and less. I’m trying to prove to a husband, or a spouse, or someone else like, “This is legit.” Because I think in the end, it’s probably cheaper and more efficient to have someone come look at your house, if that’s available in your area.

Cynthia: How does someone go about finding a reputable building biologist?

Aaron: That’s a hard ground.

Cynthia: This is probably a terrible question to ask you, but in the back of my head, I’m thinking, “Okay, I know in this area that you and I are both in. I know that you would be my go-to resource.” But if someone’s listening that has done ERMI testing, maybe they’re genuinely concerned after listening to this podcast that they need their environment tested. Is there accrediting agencies, is there a resource people can go to look for finding someone in their area that’s–?

Aaron: Yeah, there’s a David Schrantz, SCHRANTZ, who is one of the biggies, I think he’s out in Colorado relief. He’s one of the big guys and they have a lot of resources with his stuff. There is a nationwide IP indoor environmental professional or Building Biology Organization. But it’s like anything. We’ve talked back and forth about people looking at your crawlspace. It’s being board-certified, I’m board-certified. 

Cynthia: [laughs] 

Aaron: In my book, the certification is the low hanging fruit. Congratulations, you passed the test, you went to school, XYZ, okay.

Cynthia: You sneezed and you passed. Yeah.

Aaron: Exactly. Yeah. It’s hard. There’re those big level ones like I mentioned, but you really want to find is there someone close by. In some places in the country, [unintelligible [00:31:22] travel out of state. One of the guys I used to work with is up in DC, he has an office in DC and in Florida, and he spends half his time in Florida, half his time in DC. He did me a favor to drive down to Richmond till I found my current local guy. He does not allow these guys either, these guys and gals. I wish I had magic. There’s this website, Google is here. The surviving mold website, which is Shoemaker’s website does have some resource on there, but they don’t have something nationwide where you can go and find any state. 

If you’re in Arizona, you’re in luck because there’s a good one down in. If you are in Colorado, I’m DC Air Florida. But most of the country, I don’t know that who’s up in New York State, for example or Washington state. I wish I had a better answer. But yeah, try to find your local mold specialist and see who they refer to. Maybe that’s the best. And again, there’s not a lot of them either. The only thing I explain to patients worthy– The people mess in their tip of the spear, where the air is being compressed in front of the tip of the spear. And so, it’s really a cool place to be, but there’s lot of pressure and it’s everchanging.

Cynthia: Yeah, I bet. That’s certainly helpful for people to thoughtfully make sure that you’re working with a mold certified practitioner first and then find those additional resources. Now, I want to make sure we touch on some ways that CIRS can be triggered because I think this is important. You mentioned overexercising. So, how do you define that? Is that the average 45-year-old acting like a 20-year-old or is this someone who is at an elite level that is really pushing the boundaries of their physical exertion?

Aaron: Well, the person who has exercise-induced chronic inflammatory spot, there’s someone who’s significantly overtraining, there’s someone who’s running two, three, four hours a day, who’s pushing it. Usually, a professional has a full-time job in the daytime, who now is training in the evenings for their marathon or ultra-marathon, who’s just not resting. It’s interesting every time you run more than 40 or 50 minutes, you get a low-grade rhabdomyolysis. Your CPK goes up. All these little muscle breakdown things are actually damage-associated molecular patterns. They actually activate your immune system, and your immune system goes and clears it out, and you feel your muscles. If you’re doing that as severe level routinely, eventually you can activate your immune system. Once people are in that serious state, there’s a whole group of people who develop more like a chronic fatigue thing, where now their exercise and mitochondrial tolerance is all the way down here and they can go to the mailbox and back before they have to take a nap. So, that’s a totally different group that actually– The overexertion is not the primary cause, it’s now that they have serious just daily things are fatiguing. I thought I’ll make that little difference there.

Cynthia: I always think about the people that are still doing Ironman competitions in their 40s and 50s and people who will say like, “I could do this in my 20s and 30s and now my recovery time is so significant. Maybe I’m undermining the health benefits that I used to get from this particular activity.”

Aaron: If you look at professional, elite athletes, I use the analogy of the Bulgarian weightlifting team. They work out six times a day for 40 minutes at a time. They work out for 40 minutes and they rest. They do their massages, they do their cupping, they do their spa cool therapy, and they work out six times a day. A lot of the high-end athletes have Tom Brady’s workout thing. It doesn’t look impressive. It’s like, “Oh, he does this throughout the whole day. He’s literally recouping after everything.” You’re tend not to exercise more than an hour at a time. That’s something else it’s like you’re not working out. If you work out more than an hour straight intense, you’re overtraining, which most people it blows their mind like, “Oh, my gosh, I’m okay.” That’s what the reasons why now and you don’t heal quite as well on your 40. You’re to feel a little achy or hurt here. It’s also really crazy. Think about the athletes who run marathons and how many times you see women with osteoporosis, you see the people stop having their periods, they have these weird hip fractures. Overexertion can have a bad effect on your body and that’s actually a really trending right now for a lot of our patients in their 40s and 50s trying to get back to their youth quarter. We’re in different places in our lives, you know? 

Cynthia: Yeah. No, I think I definitely crossed over that time period probably in my early 40s when I would get up at 4:30 in the morning, and I would go to the gym, and then I would shower at the gym, and go straight to the hospital. After a period of time, I was just so tired. I was never recovering. So, really listening to your body is important. Also, the posttraumatic brain injury, so, people that have a concussion, etc. Is it the amount of concussions that can make them susceptible or can they just have one significant TBI that can tip them off?

Aaron: It’s both. It depends on their tolerance. I had a patient several years ago that actually got a concussion from riding a roller coaster. 

Cynthia: [crosstalk] 

Aaron: Yeah, exactly. The G forces actually gave her a postconcussive syndrome. You’ve got people on that end and then, a mother actually someone I’m working with her right now who got concussion in the OR, is actually a tech in the OR. Then went and played video games all night long. You’ve got all these little nuances, but it can be a degree like a severe car accident TBI. I’m working with someone right now, actually that we may know that had multiple small concussions at the beach as a young lady, then had a big one, that’s flared, her leptins high, she gained a lot of weight. It’s really interesting. We all have our own threshold above which we can have a brain injury. If it’s up here, you can be a professional boxer. If it’s down here– I had another lady who was actually at Home Depot looking cabinets. She leaned over, went up hit the back of her head on a cabinet. That was what gave her a concussion that she took six months to recoup from. You have to realize that we all have different thresholds. Some people have a really high one, some people are really low one, and just being aware of that. Concussions of the degree it’s not you have to be knocked out, what’s symptoms afterwards. Thinking, mood, sleep disturbances. People don’t realize these things are signs of a post-concussion syndrome.

Cynthia: It’s really interesting and I almost don’t want to ask this question, but I did get asked this question, so, I’m going to ask it. So, breast implant illness, there’s a lot of literature concerns, etc. What are your thoughts on this and its interrelationship with CIRS?

Aaron: Okay. I mentioned Asia syndrome. I’m starting to figure out we have not talked [unintelligible [00:37:40]

[laughter] 

Aaron: It’s all [crosstalk] 

Cynthia: For listeners, Dr. Hartman and I are friends. He and his wife and my husband and I are all friends personally. So, yes, it can be [crosstalk] challenging to remember where we talked about when and what. 

Aaron: It was whether 30 minutes ago or 30 days ago.

Cynthia: [laughs] 

Aaron: I need to slow down myself a little bit speaking of that. So, this thing called Asia syndrome and it sounds a lot like chronic inflammatory response syndrome and a couple of components of Asia syndrome are adjuvants like in vaccines, silicone like in breast implants. It’s really interesting how and this is from Dr. Yehuda Shoenfeld’s work at the University of Tel Aviv, he’s recognized that these adjuvants, these things that tickle your immune system. Then with the vaccines, particularly with petroleum products, well, I saw that in a lot of people in the first Gulf War, the Gulf War Syndrome. Was it the vaccines they were getting the 20 plus vaccines was it the anthrax vaccine, was it that and then inhaling burning petroleum for a year that activated these people’s immune systems? If you look at the data, the number of people who got Gulf War Syndrome is almost the same number as the percentage of people in the general population have the HLA-DR, DQ, interesting, right? 

I think breast implants is this little shelf thing over here. Most people do fine with them, just like most people do fine dental implants, just like most people do fine with vaccines. But a small subset of the population who have this gene who can’t clear the toxins, who already have their immune system revved up, and you got to remember that doing a breast implant, they’re mucking around with a lot of tissue and releasing a lot of these damage-associated molecular patterns to activate your immune system. Some of our patients who have actually had explants done, I’ve been doing IV vitamin C, prepping them so they had a minimal impact from removing the implants. But the testing, if you look at a lot on the some of the websites out there aren’t there for breast implant disease, you looked at labs they do, TGF-beta, C4A, [chuckles]. These are almost the exact same labs as we’re looking at for chronic inflammatory response, where the symptoms are fatigue, tiredness, brain fog, body pain, sleep disturbance, fluid imbalances, hormone irregularities, again, this sounds a lot like chronic inflammatory response syndrome. 

In my mind, it’s a different thing. Asia syndrome is a different thing. I personally think it’s one more thing in that 20%. I was talking about the 20% or not water-damaged building. We’re learning more and more what fits in that 20%. I think personally that’s where it fits. It is a real thing and part of the evaluation why I see people for breast implant illness is the lab testing. Essentially, how many of those people be digging in there? Okay. Yes, almost female who has a personal history of trauma, had a head injury, oh, by the way, you’re double jointed and you have some undiagnosed sleep apnea, like guts, bloating gassy, which you have SIBO, which we now know is an autoimmune spectrum disorder. If you dig, these people have other things going on and they had other things going on before they got the implant.

Cynthia: This is why you’re so good at being the detective. Making all these little connections that we were thinking, this is in one bucket and this is in another bucket, but they’re actually all connected. For people that are listening that maybe they’ve had an exposure to mold or maybe they’ve got Ehlers-Danlos, which is that hypermobility that I saw so much of in Hopkins, which is absolutely fascinating. We could probably talk about that for an hour. What are some of the common treatments or ways that you tackle these symptoms, just broadly? Because you can go down a big rabbit hole talking about this, but I thought a lot of these things were very benign. It’s not necessarily spending tons and tons of money having to get your house reconfigurated. But what are some of the supplements or ways that you look at how to address this chronic inflammatory response?

Aaron: Well, the first thing I’d say was induced inflammation. It’s clean your diet up. If you’re eating gluten, you’re eating dairy, you’re eating all day long, it’s amazing. You’ve taught me some stuff and it’s amazing. How powerful interval fasting is or at least, spreading things out to decrease the endotoxins in people’s gut that your gut is making that leak through your liver that then go to your brain. I start with the diet first. Let’s work on the gut. Clean your diet up. The one of the dietary interventions is a low-amylose diet for mold patients. I usually don’t do that because it’s a miserable diet and who’s going to do that?

Cynthia: [laughs] 

Aaron: I might just say, paleo-ish. I mean omni and paleo-ish. We need lots of fats. People don’t realize that these toxins get stuck in people’s cell membranes, which are phospholipids or fats. Eating clean, healthy fats, clean omega-3s, you talk about seed oils a lot. People don’t realize that these things are toxic fats that actually reduce the flexibility of your cell membranes. That reduced flexibility is a partially plasticized cell wall. People forget the plastic on your computer used to be [unintelligible [00:42:26] ground years and years ago. That’s the phenomena. When you take these lipids, you partially plasticize them and stick them in your cell membrane. Just flushing those out with lipids, use a lot [unintelligible [00:42:39] omega-3s, omega-6s that are from non-rancid, non-heated sources. That’s where I start with clean the diet up, healthy fats are a big player and is their ongoing exposure. Maybe you can’t move, so you just get HEPA filters for your bedrooms. 

One thing I tell people and you get down these weird rabbit holes, but if you can remove 99.97% of the particles in the air, is that good enough? For most people, it is. Once you realize that a lot of these mycotoxins and VOCs attached to particles in the air, if we move the micro particulates, the small particles, for a lot of people that’s good enough. This is one concept as well people don’t realize. You have to move the air in each room in your house. Putting a filter on your HVAC is not going to clean that air. You need a HEPA filter in the place you’re sleeping. Start with that. That’s a simple thing people can do and your main living space is getting a decent HEPA filter. So, clean air. Then removing other toxins, part of the issue is a toxin removal. Are you getting other sources of toxins in your clean– What do you clean your house with? What do you put on your body? The average female puts 200 chemicals on her body every day before she leaves the house, what chemicals are you putting? People don’t realize that these chemicals are endocrine disruptors. They act like estrogen and mess women’s hormones up. Start just clean things up, the Environmental Working Group. 

I’ve did a blog series as well on detoxification that dives into clean water, clean food, clean air, clean environment for the purpose of guiding people through how to detoxify. Start there. Because the reality is too big. You can’t address everything. I have patients I’ve been working with for years that have just now at a stage where they are starting to move, because or I’ve patients I’ve worked with and they’re basically doing it all now. So, everybody’s a different place. You have to meet people where they are, but that’s where I’ve started.

Cynthia: Well, I think it’s a really important distinction meeting people where they are because if we come out of the gate with a very overwhelming amount of changes it’s hard for people to do that. I do agree that it all starts with food and for a lot of people just changing how frequently they eat, the food choices they’re making, restructuring their macros, bringing down inflammation can be hugely impactful.

Aaron: Cynthia, I have one story for you for a patient that’s just crazy. You see different practitioners, “You have to remove all the molds and you have to only wear cotton that came from lambs from the southeastern part of the Jordan or whatever.” That’s kind of crazy. I have a patient of mine who was diagnosed at MCV the local university here with Adson’s disease, type 1 diabetes, came to see me and she has a history of trauma and just a lot of things going on her. She was just a wreck. I diagnosed her sleep apnea. I realized that her type 1 diabetes was not really type 1 diabetes, realized she had mold issues in her house. But just changing her diet radically, getting on some better medications for her diabetes, which she’s off of now by the way. She was still in a moldy house and 80% of her symptoms went away. You got to meet people where they’re at. For her, she couldn’t afford to move. She was these old blockhouses that you walk into, and you feel the humidity thing. But for her, realizing she had undiagnosed sleep apnea, her oxygen was going down to less than 70% at night. No one had diagnosed it before. Because she wasn’t an obese male with a big neck. 

Realizing that trauma was a big part of her story and we’re starting to work on that. I’m cleaning her diet up and getting her sugars down as quickly as we could, but some GLP-1s Victoza-type medications and ultimately got her off of that as she stuck with her diet. She really didn’t have the [unintelligible [00:45:58] anymore. I don’t think she ever had it. I think her brain, that whole HPA axis was so messed up that just shut down. 

Cynthia: Incredible. 

Aaron: Yeah, exactly. 

Cynthia: That’s an incredible story. 

Aaron: Yeah. She’s still in the moldy house and she’s doing great. It’s not to say don’t focus on it but meet people where they’re at. Not everybody needs to burn their house to the ground, and bulldoze it, and burn the furniture, and go into debt. I think meeting people where they’re at and realizing it’s everybody’s got their own journey that I go through. There’s hope. I have another patient who actually had breast implants and lived in a moldy house. We were able to get her controlled without taking out her implants. She eventually moved, but she was 80-ish percent better by staying there. It was all these other things in her life that we had to work on. Eventually, she did move. Our bodies have this amazing capacity to selfheal. Everybody’s body’s a little different. Your body is different than your best friend’s body. Just meeting people where they’re at, and realizing the nuances, and giving them the tools, and helping people self-discover.

Cynthia: That’s incredibly empowering and it’s so nice to know that you probably have many, many stories that are just like that that are so incredibly helpful for people to understand that we’re all bio-individuals that each one of us probably needs to take a different approach that there are practitioners out there that will meet you where you are and they don’t practice as I affectionately used to refer to my time at Hopkins in an ivory tower, where everything was perfect because none of us are perfect. We’re all imperfect human beings. I loved our conversation. I could go off on a tangent just talking about trauma. But I’d love for you to share with listeners how to connect with you, how to connect with you on social media, how to find your blogs? If they want to work with you, how they can work with you or your practice?

Aaron: Well, just google Dr. Aaron Hartman, Richmond & Functional medicine, it comes right up. I’m in Richmond. I’ve created this whole ecosystem where if you truly believe the literature that half of all chronic disease in our country can be directly attributed to eating processed foods that 80% of heart disease, and 70% of cancer can be prevented by diet and lifestyle. Educating people becomes the biggest thing we can do for individuals. With that in mind, I’ve actually done blogs on my website. We’ve created actually a whole some courses within a community to help guide people through this and those are all available on my website for people to peruse. I’ve got a reading list, a book list there as well. When I do my next update, I’ll be adding on your book on there as well. I got really little extra book on [unintelligible [00:48:17] interval fasting. Books people can read to get information about how to get yourself better. The hub for all that stuff is my website, which is richmondfunctionalmedicine.com.

Cynthia: Well, thank you as always for your insightful conversation. We’ll have to have you back again.

Aaron: Great, thanks. I’ve enjoyed and hopefully this’ll be helpful to your community.

Cynthia: Absolutely. 

Cynthia: If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.