Season 5, Episode 3: Debunking The Myths Surrounding Molds and Mycotoxins with Dr. Kristine Burke

Evelyne: I am doing well today. I’m very excited for this conversation because I loved our last interview so much. I’ll talk a little bit more about that. Dr. Kristine Burke is the founder and medical director of True Health Center for Functional Medicine in Northern California. And our last episode, which aired in February 2024, was all about endothelial health and cardiovascular health and women. And if you want to hear more of Dr. Burke’s backstory, check out that episode. And I loved your analogies and how well you explained concepts around endothelial health and the endothelial glycocalyx and nitric oxide. And I did want to mention that since that show aired, those cases that you talked about did get published. Congratulations.

Dr. Kristine Burke: Thank you.

Evelyne: Yeah. If you search for the effect of a dietary supplement containing remnant sulfate from monostroma nitidum, I hope I’m saying that correctly-

Dr. Kristine Burke: You did.

Evelyne: … on carotid atherosclerotic plaque, a case series. You’ll find it and we’ll also link it in the show notes. So congratulations on that. And Kristine, one of your other passions is around treating mold-related illness. And before we dive into that, what is lighting you up this week?

Dr. Kristine Burke: Oh, well, I’m actually preparing to give a talk at the Women’s Health Symposium for A4M next week on endothelial health in women.

Evelyne: Nice.

Dr. Kristine Burke: And so I’m really excited about that. And then we’re also progressing really, really nicely in the randomized controlled trial for reversal of cognitive decline in dementia. So a lot of fun things happening around here.

Evelyne: I love that. So I’m definitely excited to dive into that. I’ve noticed that, so friends and colleagues have been affected by mold. They’ve had to move out of their homes, go through extensive treatments, and I’ve noticed it’s really a burden on people’s lives. It affects their health, their finances because it’s so expensive to remediate, to replace belongings. What is going on with what appears to be some sort of mold epidemic? And how did you get into this?

Dr. Kristine Burke: So those are two great questions, both with rather lengthy answers. So I’ll condense them in. I think as to the question, why we’re seeing so much more mold illness, I think there’s probably a number of factors that come into that. One, 40, 50 years ago, we didn’t build our houses out of paper. We used plaster and not drywall, wallboard, which is paper lined plaster, or gypsum, but the case is the same. So I think we’re seeing more effects from that. I think also some of the mass construction and building suburban homes in mass that we maybe see a few more construction defects, particularly around the really important penetration points like windows and roof penetrations and fireplaces. Those are common places that we see water intrusion that leads to mold.

And then the third interesting piece of it is the potential impact of EMF and Wi-Fi on the toxicity of the mold itself. And if you have listened it all to Dr. Dietrich Klinghardt, he often will talk about a Petri dish study that they did that’s unfortunately not published, but he talks about it frequently at conferences where they exposed growing mold to EMF and then they had mold that was protected from EMF in a Faraday cage. And there was somewhere between 400 and 600 times more mycotoxins, the poisons, produced by the EMF-exposed mold. So maybe it is that now we all live, in the last 20 years, in the near constant presence of EMF and so does the mold, and that may be contributing to why we’re seeing more mold related illness. So maybe the mold, or some of it, was there all along. I mean, we know mold is a natural part of the environment, but now it’s made more toxic by the EMF.

Evelyne: Very interesting. I have heard that before, but I didn’t write it in any of my questions, so thank you for bringing that up. It does seem a bit hopeless because mold is literally everywhere like our homes, and of course it is a natural part of the environment. But it’s also in workplaces and classrooms. But then interestingly, it does affect people differently. Why is that? And can you talk about the genetic component?

Dr. Kristine Burke: Yeah, so actually that’s a piece of how I even ended up in the mold world. So I was doing work in functional and precision medicine and doing chronic disease reversal. And I started learning especially with fibromyalgia and chronic fatigue patients about the contribution of mold and mycotoxins, the toxins that they produce. And so that was how I initially got interested in it. But shortly into my journey, my sister’s family actually was very, very significantly affected. And my brother-in-Law who gave me permission to share his story last night, my brother-in-Law actually, who was a very high functioning person at a tech company, ended up having acute anxiety, panic attacks, was literally non-functional to the point of he would see something and burst into tears. He was completely emotionally unregulated, just this 180 degree shift in his personality and his ability to function at home and at work.

And I had just started learning about the potential impact of mycotoxins on the brain and how we can see brain inflammation and we can even see autoimmune brain inflammation as a result of that. And so he was my first Hail Mary. And I started working with him on that. And we worked through all of the components of treating, trying to find the mold. It was extremely difficult to find in their house. It actually took four years before we found the worst part of it because the worst part was the most hidden and not apparent. And then my sister had the same exposure and she was actually also working in a moldy school environment, because she’s a teacher, and her manifestation of mold illness was she just kept gaining weight. No matter what she did, how hard she worked out, how strict she was with her diet, she just kept ballooning up.

And then my nieces each experienced their own form of mold related illness. One had more mood related symptoms. And then the other, unfortunately the time period that this occurred in was right during COVID. And so my older niece actually spent all of her time during COVID lockdowns in the living room, which is a separate room from their family room, and that was the place that had the heaviest mold exposure. So their master bedroom had a 4000, the kids’ rooms were a 1000, and that form a living room was 60,000 on their counts. So she spent all day every day in that room. And her manifestation of the brain inflammation was unfortunately damaged to the way her visual cortex processes information. And now she has visual snow syndrome, which means her vision looks like an old snowy TV when the antenna wasn’t adjusted correctly. And I unfortunately remember those days I remember having to stand by the TV to make it get better reception, but that’s what happened to her.

So each member of the family with the same exposures was affected in completely different ways in their health. And some of that may be the genetic component. And so the genetics have actually become less a part of how we manage mold illness than it was originally. So originally Dr. Ritchie Shoemaker, who was really the pioneer in mold-related illness, he discovered that there were these certain genetics, these certain HLA haplotypes, if you will, that impacted the way the immune system processed these biologic toxins. And that made some people more susceptible to the effects of them because the immune system didn’t identify them as foreign, didn’t tag them to be removed from the body. And so with ongoing exposure, they would just accumulate more and more of them.

But as that work has now progressed out into more practitioners, the organization that I’m involved with, ISEAI, the International Society for Environmentally Acquired Illness, I’m a founding member, the collective experience of the practitioners in that organization is, while it can be helpful to know that someone has susceptibility genetics, you already know that because they’re presenting with issues from mold exposure. But there can be people who don’t have those specific genetics who can be very, very ill and people who have the dreaded combo that can get ill but then get well very well. So it doesn’t really impact what we need to do or how we manage people. And so I think a lot of us are moving away from that testing because it adds an additional expense and it’s no longer really informing our decision-making.

But where I will tell you that it can be really useful is we see mold-related toxicity as one of the most common toxin exposures in our cognitive decline patients. And for most of those people, it’s their only manifestation of the mold-related illness. They don’t have the classic mold illness symptoms. And I say classic, even though it has a huge variety of symptoms. And so it’s often difficult to get them to believe or the family members who are seemingly unaffected to believe that mold is a part of this illness journey. And doing the genetic susceptibility testing can help you to identify, because inevitably they have that, that can help you to identify this is why this person is affected and maybe other people in the family aren’t affected because they don’t carry this same genetic susceptibility.

Evelyne: That is so interesting. So many interesting parts you just shared like the relationship to cognitive decline, especially because you’re involved in those trials. But also I’m curious with your sister’s family, where was it in the living room?

Dr. Kristine Burke: So it was so complicated that they spent thousands and thousands of dollars on testing because it was so hard to find. But he was still sick. He was the most apparently ill. And so ultimately they did a fungal enzyme test and they did differential testing looking specifically only for the DNA of the one type of mold that seemed to be the highest in their house. And then by doing that, they narrowed it down to this formal living room, but they still didn’t know where it was. And then we happened to have a heavy rain season and for whatever reason, my brother-in-law moved their armoire in that room and found a little tiny moisture spot. So they thought that was the location.

But then as they got into it, they saw that it had tracked around near the fireplace. So they took off the whole mantle and all of the paneling around the fireplace and it didn’t look too bad. There was a little bit of difficulty. But then the rain came again, and during that, literally water poured in through the chimney, so when they took the fireplace insert out, they could see water that had been coming in inside the chimney, but outside the fireplace insert. So completely hidden from view. And that had created massive amounts of mold in that area. And it had happened because the flashing around the chimney had been improperly placed, and so it leaked around their chimney. Crazy.

Evelyne: That is crazy. Especially because I’m sitting next to the fireplace right now and I know it’s humid in here because I just got five mosquito bites while you were chatting. Oh my gosh. And then you brought up something interesting about your niece too with her change in vision. And we might switch back and forth because you brought up so many interesting things I want to ask about. But I want to talk about testing. I think this is one of the biggest questions that comes up, and it’s also a source of confusion, and from what I’ve realized, also a source of controversy. So testing the patient versus or and testing the home. But then differentiating between tests and with the vision part, I remember reading about the visual contrast test. Can you tell us more about those?

Dr. Kristine Burke: Yeah. So the testing is definitely a challenging area, and I think this is a place where the practitioner in particular needs to be comfortable with the shades of gray and layering the different testing on top of each other to help give you the best picture of what’s happening for the patient and their home or their work environment or whatever the case may be. So one of the interesting things that happens…

Well first let’s go back and talk about, so a mold colony, let’s just say in a wall. So a water intrusion event happens, mold grows usually or often on the back side of drywall so we can’t see it. We don’t know that it’s there. And in the process of that colony expanding, there’s competition because it’s not just one type of mold. It’s usually several types of mold and then also different types of bacteria. So within that community, there’s competition. And the way that the mold tries to defend its territory is by producing these toxins called mycotoxins. And there’s hundreds of different types of mycotoxins, probably at least 300 that have been identified at this point. And we only test for about 11 or so of them. So we’re only getting a little picture, a window of what may be happening. And that can be tested both in the person and in the home, and we can circle back around to that.

So when we’re looking at what’s happening to the individual. It’s not just the presence of the mold itself, which conventional medicine has really viewed more as an allergic reaction or a direct irritant or something that invades you, like aspergillosis of the lung where the aspergillus mold or fungus invades the lung and creates an infection. Those are the ways that conventional medicine has looked at mold illness. But what we see is really more the impact of the mycotoxins, the poisons themselves in the person’s system. And one of the things that those mycotoxins do is they create a tremendous inflammatory response within the body. And there’s a specific collection of symptoms and of different cytokines, which are the cell signal messengers that indicate different types of inflammation, that are collected together and collectively called CIRS or chronic inflammatory response syndrome.

One of the things that happens in that process is that the brain becomes inflamed, and specifically the visual cortex has difficulties differentiating the contrast between different colors. So the visual contrast sensitivity test is done using lines of gray. So if you think about the old awnings with the blue and white stripes, so it’s pictures like that with the stripes, different widths of stripes, different intensities of color, always shades of gray in this testing. And then they show those in different orientations and fascinatingly, when the brain is affected by these biologic toxins, whether they be toxins from mold or some types of bacteria can make these toxins, like Borrelia, the bacteria that causes Lyme can make toxins that cause the same effect. Then that diminishes the ability to differentiate the difference between those lines, the contrast.

And so we can see that mapped out on this VCS test or visual contrast sensitivity test. It’s readily available online, it’s free to take the test. I think it costs about $15 now to get a printout of your test results. And it is important to pay for it and get the full printout. People sometimes try to screenshot it for me and I don’t get enough information, but $15 is cheap, people. Do the test. But that’s a great way of looking at whether or not your brain is showing evidence of being impacted by these toxins. So that’s one of the easy low barrier to entry, low expense ways of testing.

Evelyne: I want to ask a follow-up question. So in your dementia reversal program, are you doing that test with everybody? Even if you’re not suspecting mold, if somebody is having any kind of cognitive decline, do you do that test, and when you do it, are you going to think of mold? Or could there be other reasons why somebody doesn’t do well on that test?

Dr. Kristine Burke: Doesn’t have a normal test?

Evelyne: Yeah.

Dr. Kristine Burke: So we’re not actually using it in the dementia reversal study, and part of the reason why is one of the things that can impact it is cataracts. And so it’s less valuable in the older population and more valuable in a younger population.

Evelyne: Gotcha.

Dr. Kristine Burke: In terms of what are the things that can affect the test, the different widths and orientations give us different markers on the test outcome and the specific areas of those markers can give us information on whether it’s nutritional deficiencies that are contributing to the impairment, whether it looks more to be biotoxins, a combination of those. And then the final column is more consistent with the bacterial-related biotoxins like we see with Lyme disease. So we can get some information about that from the way the person performs on the testing, not just whether the test is normal or abnormal.

Evelyne: Gotcha. And then go ahead and continue to talk about the mycotoxin testing.

Dr. Kristine Burke: So when we’re looking at mycotoxins in the person, the testing that we have available is urinary mycotoxins, and that means that we’re looking for those specific mycotoxins or chemicals in the person’s urine. By default, that means that it’s an exhaust test, it’s what we’re eliminating. So we’re only getting a snapshot of what that person is eliminating at the time of the test. It’s very valuable snapshot, but it doesn’t really tell us what’s stored in their body. There could be very little additional that’s stored. There could be a lot that’s stored. There can be completely different toxins that are stored.

So one of the things people often try to bring together is what are the urinary mycotoxins that were present on my test and do they match with the molds I’m finding in my house? And that is an exercise in futility because the urine mycotoxin testing is not necessarily telling us about your active exposure. It’s telling us the accumulation, what your body’s detoxing. It’s not giving us that direct information. And so it’s not appropriate to try to use that to determine whether or not the molds that are being found in your house are “a problem or not a problem”. That’s just not an appropriate conclusion to draw. It can be helpful if they match. It’s lovely. But if they don’t match, it doesn’t mean that what was found in your house isn’t potentially a problem. So then that brings us to testing the house.

So the most common way that we use to test a house from a medical perspective is a test called the ERMI test, the Environmental Relative Moldiness Index. And this is where some of the controversy comes in. So the test was developed by the EPA. They did it using a sampling of several thousand homes in Ohio. So that’s the basis population. And the intent of it was to try to give us a reference for how relatively moldy one place was compared to others to generate some normative data so we could see, okay, well what’s common, what’s normal, well above normal? And that’s really how the test is scored. So an ERMI score of two is what we’re generally aiming for, or less than two, because two is about the 50th percentile. So that doesn’t mean that there’s no mold. That just means that you have relatively an average amount of mold. Now, depending on the sensitivity of a person, that could still be a problem or that could be great. It’s not a problem for the people who are in that home.

There’s also problems with only using that final score because the way the test is done is you’re gathering the dust in the home and then that dust is being analyzed for the DNA, so by PCR, for the DNA of these specific mold species that tend to be elevated when there’s been water damage in a home. And then that group, the water damaged building molds, the volume of molds in that group is being compared to the common indoor molds. So you’re trying to get a sense of, of the community of molds within this home, do we have a relatively high representation of these species of mold that typically we only see from water damaged building materials? And then by doing that, you can start to get a sense of what’s happening within that home.

Huge number of pros and cons in each of those areas, but it is a very, very useful test if you don’t try to make it something that it’s not. It’s not absolute. It’s not perfect. There can be introduction of outdoor molds or molds from the outside can be brought into the home, that could be part of the home environment. And while that may not reflect a problem with the home per se, it still reflects a problem for the inhabitants of the home. So you just have to develop a sense of understanding of what the limitations of the tests are and what the information is that you’re really getting from that.

Evelyne: Interesting. So how do you guide your patients in interpreting that? Because I’ve also seen that it’s so hard to find a clean test for people, like people who, it feels so defeating, they get out of a moldy situation, there’s remediation, they need to move. They have spent so much money on the remediation, on the testing, on their health and then trying to find a new place to live, and it comes back with more mold and mycotoxins. So are there acceptable levels, in your opinion, and are there molds that are less dangerous than others? How does that work?

Dr. Kristine Burke: So yes to both of those questions. Part of it has to start with the susceptibility and the vulnerability of the person who’s ill. And part of it has to do with how you’re analyzing the data. Before I answer that, let me just take us back to another form of testing that’s commonly done by companies that are not familiar with managing mold from a health perspective. And that’s air testing. Air cassette testing, air sampling testing are all different ways of that.

What they’re doing in that testing is they’re setting up a little air sampler in the room and they’re just sampling the air that’s in the room. And the theory behind that is what’s being sampled from the air is what the inhabitants are breathing. But it’s really not that simple. And an abnormal test is useful. If that test is positive, you’ve definitely got a problem in your home. But what’s been found is that 80% of the time when there’s a problem in the wall inside the wall, the air testing misses it. So it’s only catching about 20% of that.

Now, once remediation has been done, and the mold remediation means removing the mold in the mold affected building materials and then cleaning that to eliminate the mold in that space, once that’s been done, air testing is a useful way of sampling the room to see whether or not the remediation has been successful because everything is open. It’s not hidden now. But it’s not at all and should never be used as the only way or the way to sample a home to try to determine where and if you have a problem. So that’s a really important piece of the puzzle. And then that made me forget where we were going on the other side.

Evelyne: We were talking about the ERMI test and whether there are any more acceptable molds or mycotoxins, yeah.

Dr. Kristine Burke: So one of the ways that that’s been looked at is a calculation that can be done from the ERMI test called the HERTSMI-2, and that’s an acronym, H-E-R-T-S-M-I-2, and that collects the, oh, I’m not sure I’m going to remember, six or seven of the more damaging molds, and then it scores them based on how abnormal the levels of those are.

Now again, this test has some limitations. It’s very useful if it’s abnormal, it does tell you that there’s a significant problem and that people who are mold sensitive are likely to be affected. But one of the species that is in that test, because Dr. Shoemaker who did all of this original work, is on the East Coast, one of the molds on that test is Wallemia. And we have very little to no Wallemia in California, which is where I practice. So Wallemia is almost always negative. That gives us a falsely low score on the HERTSMI-2 test. And then one of the mold species that we have very, very commonly here, penicillium brevicompactum, that’s not part of the test. It’s the most common mold that we see here.

So for us, the HERTSMI-2 isn’t super valuable. It comes on the test report. I like to use a company called Lis Biotech, and they give a beautiful report, it’s color-coded. The more concerning molds are highlighted so that you can easily see if you have very high numbers in those categories. So it’s a really easy report to go over with patients to help them understand what may be going on in their home. And then we use that information to prompt how we proceed next. So if the person knows that there’s been a water intrusion, they’ve had a roof leak or the washing machine overflowed or the ice maker in the refrigerator, the tubing broke. That’s, by the way, a very, very common scenario. I do not have an ice maker hooked up to my refrigerator anymore.

Evelyne: Interesting.

Dr. Kristine Burke: But if we know where we’ve had an intrusion, then that’s always a good place to start with the inspector. But you want to have an inspector that knows what they’re looking for in terms of for the health of the occupants, because we want to try to make sure that we take care of every area that’s potentially affected.

Evelyne: Thank you for sharing all those nuances around testing. This is all super interesting. And honestly, it’s also very scary because it is so common and so many things can go wrong in a living environment, in a work environment, in schools. It’s very scary. So I also want to take it back to testing the patient. So in addition to the urinary mycotoxin testing, from my understanding with mold, it’s not just the mycotoxins, but there are other volatile organic compounds or VOCs. So I’d love for you to touch on that. And do you also do any serum allergy or sensitivity testing? How do you tie all that together?

Dr. Kristine Burke: So the VOCs are an important part of the illness complex. They’re not easy to test for, but they are the things that are responsible for that musty odor that we can sometimes smell. A lot of molds don’t make that odor. And so people will commonly say to me, “Well, we don’t smell anything in our home. It doesn’t smell musty.” I understand, but that does not mean that you don’t have a problem. So that’s an important piece of it. Mostly we work on that component by eliminating the colony that is producing the VOCs so that we can reduce the exposure to that.

When we’re looking at the serum testing, we’re generally looking at the blood markers that are a part of that CIRS panel, the chronic inflammatory response syndrome. We typically narrow that down to the three that we find to be the most commonly affected and impactful in our management of the patient. So that’s something called TGF-beta, MMP-9, and then MSH. MSH is melanocyte-stimulating hormone. So that’s a measure of the hypothalamus and the impact that the mycotoxins have had on the brain. So we’re getting these pieces, the two cytokines that are the inflammation signal markers, and then this one marker of the brain. And then using those, we can monitor those over time. The TGF-beta will be very sensitive. It’ll go up a lot when there’s exposure. It’ll often go up when people are remediating their home, especially if containment hasn’t been done properly, which often happens if people try to DIY it. And so those are the blood markers that we’re typically looking at.

Evelyne: And do you do any allergy testing also, like IgE or IgG testing?

Dr. Kristine Burke: Yeah, that’s a good question. So some of my colleagues are using IgG or IgE testing to look at how the mycotoxins or the mold spores themselves are impacting the immune response. I really haven’t incorporated that into what we’re doing because we have such a successful system and I haven’t found the need to identify that component. And there isn’t a lot of data yet on whether or not we can rely on that IgG or IgE testing to tell us what’s going on.

So the IgE testing is our classic allergy. So that takes us back into the conventional medicine world. Do you have a mold allergy? Most of what we’re doing has nothing to do with mold allergy and everything to do with mold toxicity, and those are just really different things. So I don’t typically use that testing. It’s also partly because it’s additional expense for the patient, and this whole process, as you’ve mentioned, can be very, very expensive. It can be made less expensive by making good decisions and choosing the right people to work with. But some of the testing, that’s why we try to trim it down in terms of the CIRS panel, which typically has eight or nine markers to these three. So we can try to mitigate the cost for the patient, but get the information that we need to be able to take care of them effectively.

Evelyne: Great. This is very helpful, very clinically useful. So thank you for sharing all that. So armed with all of this information that you have, where do you start? Let’s talk about the solutions.

Dr. Kristine Burke: All right, so usually first we’ll start with testing the patient. So the VCS test and the urine mycotoxins. And then when that comes back abnormal, as inevitably it does, then we’ll do the urine mycotoxin testing, or we might do that upfront if we already have a high index of suspicion and we already know that they’ve had a mold problem in their home, then that information tells us, okay, you’ve been exposed to a significant amount of mold, so now we need to find out is that in the home where you’re living or does it appear that that’s been something that you’ve been exposed to elsewhere? And then is that elsewhere somewhere that you lived in your past or is it your office or your school or where is it that you’re getting this exposure?

Because the very first and most important thing that we want to focus on is eliminating the exposure. Everything else is just bailing a sinking boat if they’re still living in the environment that got them sick. That seems to make a lot of sense, but I will tell you that that is often the most difficult thing to get people to do. It’s expensive, I understand that, but we cannot get well in the environment that we got sick in.

Evelyne: And then in terms of treatment, what does that usually look like? I’m sure it varies from person to person, but what is your program? How do you go through sequentially? Say somebody has done proper remediation, where do you go from there?

Dr. Kristine Burke: So what we want to do is we want to start creating a way for those toxins to get out of the person. Most of the time when somebody is mold ill, it’s either because they’ve been in a tremendous exposure and sometimes just getting them out of the exposure can really go a long way to helping them to get better. But more often it’s this accumulation of these toxins in the body. And one of the interesting things that we see is that in thin people… Okay, so first of all, these toxins have to be stored in fat. They aren’t water-soluble. They have to be stored in fatty tissue. And so if someone is overweight, then the toxins typically get stored into their body fat. Or as in my sister’s case, like we talked about, the body adds fat to create a storage depot for all of these toxins. She was getting a double whammy from home and from work.

And so in thin people that don’t have a significant amount of body fat or have a lower body fat, the greatest collection of lipid soluble tissue is the brain. And so the mycotoxins, I believe, become more concentrated in the brain. And I think that that’s often why we see this impact on cognitive function when maybe we don’t see a lot of the other symptoms that we would typically see. So getting someone away from the exposure environment, you mentioned moving, we’ve talked about remediation, these are all options for reducing that.

Then we have to start helping the body to get rid of the toxins. So we’re going to use things that are going to promote the way that we get rid of toxins. So glutathione or NAC, for example, N-acetyl cysteine that promotes the production of glutathione. Now there’s an interesting caveat with NAC in mold-related illness because it requires nine NAC molecules to make a TGF-beta. So if you have a very elevated TGF-beta, we really don’t want to be giving you more NAC because you’re probably going to be squirreling that away to make TGF-beta because your body is sounding a super loud alarm and it wants all of its resources to go into letting you know that there’s a problem.

That’s the same reason or one of the same reasons that people with mold-related illness often wake up a lot during the night. It’s a really interesting phenomenon, but because nighttime, while we sleep, is the time that the brain detoxifies, that the brain offloads its metabolic waste products and toxins that it wants to try to get rid of, when those toxins start getting dumped into what’s called the glymphatic flow, which is the lymph system of the brain, and then into the circulation, those circulating toxins send a signal that the body is under attack or that there’s a threat, and that will often wake the person up. So one of the things that we will commonly see improve as we both remove exposure and remove the toxins from the body is that sleep improves. So that’s just an interesting aside.

But the way that we try to get the toxins out of the body after we’ve facilitated all of our liver detoxification support is by using binders. So binders are components like activated charcoal or bentonite clay, chlorella, even Saccharomyces boulardii, which is actually a beneficial yeast that will bind to some toxins and help the body to get rid of them. So these binders bind to the toxins as they are released into the gut. So the liver processes them, they get squirted into the gut with the bile, and then normally they would be excreted. Now in our vulnerable population, those toxins get reabsorbed in the gut and then they just enter the circulation, get stored again. And that’s why these people tend to develop accumulation of large amounts of mycotoxins. So the binders will bind to the toxins that have been excreted into the gut and then help them to leave with the poop. And that’s what we want. And we just want to create this little conveyor belt of getting rid of the toxins from the body. And it’s a long process. For most people, it’s two or three years.

Evelyne: Oh, wow.

Dr. Kristine Burke: And it’s also a little bit tricky. So it’s not something that I would encourage people to do on their own with themselves because if you do it if incorrectly, if you are doing it too fast and you’re overwhelming your own detox capacities, you can actually create more tissue damage and create more problems than you have without doing that. So I would absolutely recommend that this is something that’s done with the guidance of a skilled practitioner.

Evelyne: So for our practitioners listening, and even as I’m listening to you, I’m thinking, oh my gosh. Because when you’re talking to a patient, do you tell them, “We are going to be doing this for two to three years?” I mean, I guess-

Dr. Kristine Burke: Yes, I do.

Evelyne: You do? Tell me how that conversation goes? And how do you handle the resistance? Because a lot of protocols, you’re on something for, I don’t know, three to four months, and then I’m sure you do see improvement as soon as you start some of these things and you’re also addressing other issues. But how do you talk to your patients about that?

Dr. Kristine Burke: Well, you don’t actually see improvement as soon as you start. Sometimes people will get a little bit worse, and that’s really where that balancing act comes in. And the other interesting thing that happens in the analogy that, since you said you love my analogies, I’ll share my analogy with you. So the analogy that I often use for patients… Well first, let me say the thing that happens.

So we do our initial mycotoxin testing. We identify, yep, there’s a heavy burden of mycotoxins in this body, and we initiate our interventions, including our binders. Then four to six months later, we test the urine again so we can check on our progress. I would say probably 75%, 80% of the time the test looks worse, there’s more toxins. But remember what we’re testing is exhaust. So that means that we’re mobilizing toxins from where they’ve been stored and we’re now putting them through our elimination pathways. One is urine, one is stool. Stool is much more efficient than urine.

So the analogy then becomes, when we first started our work, we had our task was to clean out the attic. And we popped our head up through the attic access and we saw all this stuff in the attic. That was our first mycotoxin test. But then as we start unloading things and unpacking them and digging through boxes, all of a sudden, oh my gosh, I didn’t know that we had grandma’s old armoire in here. You start finding things that you didn’t realize were present when you first took a look-up in there. And so the process of getting rid of the mycotoxins is cleaning out a 50-year-old full attic. There’s a lot of stuff in there, it’s going to take time, and the time-limiting step is your detox capacity. And there’s only so much that we can do to modify that because a lot of that is genetically determined as well.

So that’s the other side of the genetic puzzle is how well you come equipped to get rid of these toxins. And it’s another reason why two people in the same home with the same exposure, one may be ill and the other is seemingly unaffected.

Evelyne: Very, very interesting. And so I’m sure that because you’re wanting people to eliminate properly, you’re also using fiber and making sure they eat plenty of fiber and maybe magnesium and things like that. And with the binders, I assume you have people take them away from food. Do you take them more because you’re treating mold? Or would it just be a regular dose that somebody would recommend?

Dr. Kristine Burke: Yeah, so some of that’s dictated by their sensitivity and also by how challenging it can be to try to take binders, which do, as you said, have to be taken on an empty stomach. So that means an hour before anything else that they eat or drink. So food, supplements, medication, water of course is fine. Or two hours after anything that they’ve eaten. So there’s a pretty limited window of opportunity. And combine with that, the fact that most of the people that we’re working with are ill, so they have lots of physiologic imbalance that’s occurred as a result of the oxidative stress and the immune dysfunction and the leaky gut and all of the problems that can come from having these poisons in your system. And so there’s a lot of other things that we need to support to try to help that person to feel better.

So we’re trying to fit all of these different things into a day. And so most of the time we end up just using binders once a day, although if we have someone who is adept at all of that fine-tuning, we can try to get it in twice a day. But then again, that just depends on making sure that they’re not overwhelming their detox capacities. And we usually assess that by how the person feels. If they start taking a binder or they increase their dose of binder or they increase the number of times per day and they start to feel icky, headachy, achy, nauseous, fatigue, any of their typical mold symptoms, sometimes that could be mast cell activation, then that’s too much and we need to back up to the dose that they tolerated without having those symptoms.

Evelyne: So you just made me think of another question. For binders, I have been under the impression that maybe we shouldn’t take them all the time long-term because they can deplete some minerals, and some, depending on maybe brands you’re using, they can contain heavy metals. Of course you’d want to use something where those have been purified. But so what are your thoughts on that? Is it just that as long as you are eating sufficient minerals or supplementing with minerals at the same time, that you can take the binder?

Dr. Kristine Burke: Yeah. So in our experience, so all of that is correct and accurate. That’s one of the reasons why the binders, I always tell people they do not play nice in the sandbox with anything else. And then the next question people will say is, “Well, what about…” I’m like, “No, nothing. You don’t even need to say it because whatever’s going to come out of your mouth, the answer is no.” But that’s one of the reasons why we’re really, really strict about having those be taken in isolation. But in our experience, when we’re appropriately supplementing and augmenting what people are taking, we’re also helping them to manage their food plan so that they’re getting a high quality, high nutrient density food intake, that with all of those things, when we measure and we monitor the nutrients that we follow, we’re able to maintain them at optimal levels. So I think that we can mitigate that. And then more important thing is getting the poison out. Because we can give as many vitamins as we want or really great supplements, but if the person is poisoned, they’re sick, in some way.

Evelyne: As you’re talking, I’m thinking, I can completely understand why some practitioners love treating mold and others just stay so far away from it. It’s very interesting. But I think it’s so important for practitioners listening to even just be aware of these little things that you’re sharing, maybe a patient or client who you hadn’t thought of mold as being the issue. And I think that’s the most common because people just go around in circles sometimes to different practitioners until something like this gets uncovered. So I want to talk about diet, and I also want to talk about a case study. I actually would love to ask about your brother-in-law because you mentioned he was having some of those psychological issues. And I’m curious, did he ever go to a conventional doctor? Because I feel like based on what you said, he might be just prescribed a medication, right? Can you share a little bit more about the story?

Dr. Kristine Burke: Yeah. Well, I mean luckily I’m his primary care physician.

Evelyne: Oh, good.

Dr. Kristine Burke: And so he saw me for all of the above.

Evelyne: Great.

Dr. Kristine Burke: And we did end up having to use some pharmaceutical medication because it was bad. It was really, really bad. There was a point in time when he literally required a sitter. Someone in our family had to be with him 24/7.

Evelyne: Wow.

Dr. Kristine Burke: Yeah.

Evelyne: That’s scary.

Dr. Kristine Burke: And ironically, it was 24/7 in the house that had the massive mold contamination in the fireplace, and none of us knew it because you couldn’t smell it. It had no smell. So that was a huge part of the problem and part of why it was a long, long journey to try to get him back.

But yeah, I mean, I can just tell you, I mean am a practicing family physician as well, and I did conventional medicine for 17 years before I started doing integrative and functional medicine. And he absolutely would’ve been admitted to a psych hospital. There’s no doubt in my mind he would’ve lost his job. He probably would’ve lost his marriage because he wouldn’t have gotten better with psychiatric medication because that wasn’t his problem. And yeah, it’s really impactful for our family that it just happened to be that two years before, I had started learning about how to treat people for mold because we might’ve lost him. We really might’ve lost him. Mary Ackerley, I don’t know if you know her, she’s an integrative psychiatrist in Arizona, and she does a lot of this work, and so she often says, “”Black mold, black thoughts.”

Evelyne: Wow.

Dr. Kristine Burke: I think a lot of our mental health crisis, probably at least in part, is accelerated or augmented or triggered by how some people react to mold. So yeah, he would’ve absolutely been multiply medicated, and in a psychiatric hospital,

Evelyne: You just gave me chills. That is so crazy. And how’s he doing now?

Dr. Kristine Burke: Fantastic.

Evelyne: Oh good.

Dr. Kristine Burke: Fantastic.

Evelyne: Good.

Dr. Kristine Burke: Yeah, he’s excelling in his career and we got everything managed and he’s back to his old self.

Evelyne: Wow. It is scary to think how many people are walking around with these issues, and it’s a mold problem. It’s very, very scary. I have a few other questions that I really want to get to. So I want to take it back to the binders for a moment. Do you use cholestyramine as well? I don’t know if I’m saying that correctly.

Dr. Kristine Burke: Yeah, so we use some cholestyramine. It’s a pain in the patootie to take, so it’s very hard for a lot of patients. The commercially available form has dyes in it, artificial dyes, and it also has some fillers in it that I’m not excited about. And then it either has sugar in it or it has artificial sweetener in it. And so I don’t love that in any form. We will use colesevelam, which is WelChol, the generic for WelChol. It’s similar in its mechanisms. So they both are bile acid binding resins. So they bind to the bile much in the way that we’re using the other types of binders. It’s not quite as potent as cholestyramine is, but it’s in a capsule form. So it’s much, much easier to take.

We’ve also moved away a bit from using, CSM is the abbreviation that we like to use. You don’t have to say cholestyramine a million times. So the other reason that we’ve moved away a bit from using CSM is that in the last probably five years, many companies, Designs for Health included, have come out with really nice blends of binders that make them more effective. And so we’ve just had less of a need to use cholestyramine, but there are sometimes some places where you need the potency of having all of those additional binding sites that it seems to have.

Evelyne: Interesting. And then you’ve mentioned diet changes. We talked a little bit about fiber, but while you are actively working with someone, do you have them also minimize potential sources of mold exposure in their diet, like say from peanuts and other things? Talk a little bit more about the diet component.

Dr. Kristine Burke: So the diet component’s a controversial piece, and that actually would take us all the way back to the beginning of our conversation about mycotoxins and food role in mycotoxins. So we can come back to that. But I’ll answer this question first. I think for most people, we don’t have to rigorously eliminate those types of foods. I mean, we will definitely educate them about the foods that tend to be the most highly contaminated. So peanuts, peanut butter is one. Coffee unfortunately is another one. And so those really come down to the sensitivity of the person again. If I have someone who’s really sick, then I don’t really want any… to the extent that we can help control it, we really don’t want to be introducing any additional molds or mycotoxins into their system.

But for the majority of people that we’re working with, we’re uncovering this because they have some form of chronic inflammation that we can’t resolve, or they have an autoimmune disease, and it’s part of my root cause investigations, or interestingly, they have very high LDL particle counts. LDL-P goes way up in a subset of people in relation to mold and mycotoxin exposure. And so that’s something to keep in mind when you see someone that has a significantly elevated LDL particle count, like 1800 to 2000 plus. And Dr. Wolfson did a really great lecture on mold and mycotoxins in their relationship to cardiovascular disease at the Forum for Integrative Medicine Conference a couple of years ago.

But so I think in general, the food piece is a lesser contributor and really comes into play when the person is really ill and farther along in that illness journey.

Now, taking us back to the impact on mycotoxins, this is something that a lot of people who know a bit but aren’t super educated in this treatment arena can sometimes, I think, get a little off track. While there is mold in foods. And we can certainly capture some of those mycotoxins in the urine when we’re doing a urine mycotoxin test, all of us are exposed to these things, and the mycotoxin test reference range is based on the normative population. So when we’re saying that we have an abnormal amount of urinary mycotoxins, that means that we are above or sometimes 1000 fold above the 95th percentile. So our entire population, the reference population of presumably not ill people that were tested to get the reference ranges, they were all having all of these food exposures at the normal frequency in the population. And so that’s what our reference range is based on. That’s the other reason that I don’t believe that the food piece is a significant contributor to the average mold ill person.

Evelyne: Interesting.

Dr. Kristine Burke: A super sensitive one for sure, it can be.

Evelyne: I’m glad I asked about this. So I did a urinary mycotoxin test back about two years ago after having a water leak and going through remediation in the apartment I was living in. And I came back with moderate levels of ochratoxin A and aflatoxin B1, which I was told were likely related to food, not environmental exposure. And now you’re making me think, okay, if that’s comparing to the average person, I know that every time, for anybody listening, every time I’m like, I need to add this supplement and this supplement and this supplement, it’s a little hard. But I have not been taking a binder regularly, just probably because I take so many other things. And sometimes because I stay up late, I tend to go for some late night snacks because I get hungry again. But now I’m thinking, okay, maybe that’ll keep me from eating too late is to take my binder. So very interesting.

Dr. Kristine Burke: Well, I don’t necessarily think, and I wouldn’t recommend that a binder be part of someone’s normal regimen. I think it’s part of a treatment regimen. I don’t necessarily see it as part of a regular regimen. I think if you have a known exposure, like you go on vacation, you’re staying at the VRBO or an Airbnb and it’s like, oh man, it’s musty in here, but you’re there for a week or two weeks or whatever the case may be, then maybe come home and take binders for a few weeks to help your body to offload those toxins and reduce the chance that it’s going to get deposited into your tissues. But I would not consider a binder to be something that I would want in a regular regimen. I would want to be monitoring the mycotoxins, monitoring the visual contrast sensitivity, and stopping the binders when it looks like we’ve finished the job.

Evelyne: Great. Thank you for that. All these little tips. I especially love what you shared about cardiovascular health and LDL. That’s very, very interesting. So I have one more question regarding just, so when you finish treatment with somebody, even if it’s taken a long time, do you feel like it’s possible to get someone to a stage of health where they are less susceptible? Because it seems like mold co-occurs with a lot of other conditions, and it’s like the chicken or the egg. And so a lot of people probably have a lot of chronic inflammation, whether it’s due to something else or due to the mold. And so is there ever a point where they can be well and maybe can withstand an exposure?

Dr. Kristine Burke: So one of the things that mycotoxins cause is many of them have immune-suppressing capabilities. So one of the ones that we see commonly because it’s made by penicillium, and I told you at the beginning, penicillium brevicompactum is one of our most common high mold species around here. So that produces mycophenolic acid. And mycophenolic acid has actually been purified into a drug, and it’s a drug that’s used, CellCept or Myfortic, to suppress organ transplant rejection. So it’s an anti-rejection, immune suppressing drug. That’s how powerfully it suppresses the immune system. Now what’s interesting is it doesn’t suppress the immune system in a way typically that those people get sick all the time or they’re susceptible to things. But it changes the way the immune system responds and reacts and protects the body in different ways, which is really fascinating. So I think that that’s one of the ways that people can become extra sensitive, because the mycotoxins are creating that damage. There’s mycotoxins that, especially aflatoxin, for example, ochratoxin, sorry that these are the two that you came back on your test with, but those can be cancer causing. Those are carcinogenic.

Evelyne: Oh, gosh.

Dr. Kristine Burke: There are several of them that are damaging to the kidneys. And then roridin E, which is in the class of trichothecenes, is a neurotoxin. And it’s such a potent neurotoxin that it’s used in chemical warfare. So there are chemical warfare agents that use this mycotoxin as the way that they damage the nervous system, which by the way was by far the highest mycotoxin level that my brother-in-law had, which is no doubt why his brain was so significantly affected at the time.

So the different mycotoxins have different effects, which is another reason why people get sick differently, because it’s not going to create one thing. It’s not like, oh, you get strep in your throat and you get strep throat, and it has this classic pattern that it follows. This is a class of chemicals, it’s a poisoning. It’s not a disease that follows a predictable course necessarily.

Evelyne: Very interesting. So for our rapid fire questions, Kristine, since you answered the other two before, I’ll just ask you the last one. What is something that you’ve changed your mind about when it comes to working with mold?

Dr. Kristine Burke: Probably the biggest one was when I first started working in mold, of course I started through Dr. Shoemaker’s work, and he is super adamant, he won’t even work with people until they’re out of the moldy environment. And the soft part of my heart was like, I can’t do that to people. They’re suffering and they need help and I can’t just… They’re also interestingly crippled by the mold. The mold creates a complacency, like an apathy in the person where they feel pretty helpless to do something, which is super fascinating. That could be a whole nother conversation. And I still do this to some extent. So I would start working with people in helping them with the binders and trying to calm their immune systems down and doing all the things that we do. But then what we found is that that complacency, that apathy would make them paralyzed to get out of their environment because they were getting help.

And so that is something that I have changed my mind about, and I’ve gone from being a little soft on that to being really, really hard-nosed on exactly what I said at the beginning, you can’t get well in the environment that poisoned you. And so sometimes those are really hard conversations. And a lot of times there is discord in a couple, in a marital couple or in people that are living together because the person who’s sick is somewhat incapable of advocating for themselves. And the person who isn’t sick doesn’t understand how it could be something in their home if they’re not both sick. And so there’s always a lot of family dynamic around that too. But yeah, that’s definitely the thing that has changed the most is how no nonsense I am about, you have to fix this.

Evelyne: Interesting. Thank you for sharing. And as I was preparing for this show, I was looking at the 12 step Shoemaker protocol online and I thought, oh my gosh, this is really, really intense.

Dr. Kristine Burke: Yeah, we’ve diverged from the Shoemaker protocol, I think a lot of us in this space have. I mean, his work was amazing and none of us would be able to do what we’re doing without that. But I think as the field has grown, we’ve discovered other ways that we can also help people through this journey. But nonetheless, I do sometimes find myself when someone’s stuck or I can only get them 80% of the way going back to that and okay, what piece of this have I not addressed or have I not covered? Or what else do I need to be thinking about for this person?

Evelyne: That’s very helpful. Thank you. Well, thank you so much, Kristine. This was another super helpful, insightful show, and I loved the stories you shared as well as all the little clinical pearls related to both diagnosis and treatment. So thank you. Where can practitioners learn more about you?

Dr. Kristine Burke: So my website, the Center, we actually moved into a new building and we rebranded as True Health Center for Precision Medicine now.

Evelyne: Great.

Dr. Kristine Burke: And so our website is TrueHealthCPM.com.

Evelyne: Wonderful. Well, thank you again, Kristine. I really appreciate it.

Dr. Kristine Burke: Thank you for giving me the opportunity to share this info.

Evelyne: And thank you for tuning into Conversations for Health. Check out the show notes for any resources we share today. Please share this podcast with your colleagues. Follow rate or leave review wherever you listen or watch. Also remember, the transcript for every show is available on our website Podcast.DesignsForHealth.com. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting edge research and practical tips.