Environmentally Acquired Illness, Parts I and II

Environmentally Acquired
Illness
Sonia Rapaport MD
Haven Medical
Chapel Hill, NC USA

…is a holistic approach to deciphering the
complexity of biological systems that starts
from the understanding that the networks that
form the whole of living organisms are more
than the sum of their parts.
–Institute for Systems Biology
Systemsbiology.org

Institute for Systems Biology.
Systemsbiology.org
Network of Networks
“It is collaborative, integrating many scientific
disciplines … to develop solutions to the
world’s most pressing health and
environmental issues.”

Danger
Response:
Symptoms
Genetics
External
Triggers
Somatobiome

 Genetics
 DNA: nuclear and mitochondrial
 Transcriptomics
 RNA
 Proteomics
 Proteins
 Metabolomics
 Metabolites

 “Home-biome”: a built environment
 Epigenetics: Nature’s contribution to the
development of an individual (Nature-vs-Nuture)
 Tissue specific gene expression
 Transcriptomics

 Skin
 GastrointestinalTract
 RespiratoryTract
 Genital UrinaryTract

 Infective organisms
 Bacterial
 Fungal
 Topical
 Personal care products
 Airborne
 Trauma
 Physical
 Skin breakdown
 EMF

 Foods
 Allergens
 Infections (viral, bacterial, parasitic)
 Biotoxins (ciguatoxin, etc)
 Non-food
 Toxic Chemicals (glyphosate, phthalates,
styrenes, etc)
 Reabsorption of toxins
 Intestinal permeability: tight junctions

http://trulyglutenfree.co.uk/what-causes-gluten-illness/

http://trulyglutenfree.co.uk/what-causes-gluten-illness/
Alessio Fasano Physiol Rev 2011;91:151-175

 Routes of absorption:
 Oropharynx
 Alveoli
 Olfactory nerve
 Water-Damaged Buildings (WDB)
 inflammagens
 aka mold
 Pollutants
 VOCs

 Trauma
 Personal vs witnessed
 Post-Traumatic Stress Syndrome (PTSD)
 Abuse
 Emotional
 Physical
 Adverse Childhood Events (ACE)

 The study of the microbial communities that
live in and on our bodies and the roles they
play in human health and disease.
https://commonfund.nih.gov/hmp
 nasal passages,
 oral cavity,
 skin,
 gastrointestinal tract,
 urogenital tract. (https://hmpdacc.org/)

Scientific research = Microbiota + genes
Common usage = gut microbiome

The collection of living organisms present across
all the ecological niches of the body.
GI Microbiome
Dermo-biome
Doederline Flora
Urinary biome
Oro-biome
Rhino-biome
Sinu-biome
Bronchio-biome
Vasculo-biome

 Categories of organisms
 Beneficial
 Commensal
 Infectious
 Types of organisms
 Viral
 Bacterial
 Parasitic
 Fungal

“The cell danger response (CDR) is the
evolutionarily conserved metabolic response
that protects cells and hosts from harm.”
–Naviaux, 2013.
…whole body metabolism and the gut
microbiome are disturbed, the collective
performance of multiple organ systems is
impaired, behavior is changed,
and chronic disease results.

“When the CDR persists abnormally, whole body
metabolism and the gut microbiome are
disturbed, the collective performance of
multiple organ systems is impaired, behavior is
changed, and chronic disease results.”
–Naviaux, 2013.

 Pattern Recognition
Receptors (PRR)
 Toll-like receptors
(TLR)
 RIG like receptors
 NOD like receptors
 C type lectin receptors
 Induced by
 PAMPs
 DAMPs –Naviaux, 2013.
–Mitochondria in innate immune responses. West PA
et al. Nat Rev Immunol. 2011 Jun: 11(6): 389-402.

Immune
Autonomic Nervous System
Hypothalamic-Pituitary-Adrenal (HPA)Axis
Mitochondria

 T Helper Response
 TH1/TH2 balance
 TH17: autoimmunity
 Innate Immune Response
 Cytokine production
 Acquired Immune Response
 Antibody response (depends on antigen presentation)
 Mast cells
 Connective tissue, mediator release
 Microglial cells
 Neurological tissue

 Autonomic (Vegetative) Nervous System
 Sympathetic: Fight or Flight
 Parasympathetic: Restore and Repair
 Enteric: Gastrointestinal
 Other areas of importance:
▪ Vagal tone: PolyvagalTheory
▪ Limbic system: Cyclical Amplification

 CNS hormonal regulation
 Hypothalamus: CRF
 Pituitary: ACTH
 Adrenals:
 Adrenaline
 Noradrenaline
 Cortisol

 ATP Demand
 Free radical production and damage
 Defective mitochondrial biogenesis
 ATP as DAMP
 Affected organs:
 Brain: memory, brain fog
 Muscle: weakness, trigger points
 Autonomic nervous system: dysautonomia. POTS

External
Factor
Internal
Factor

Infection
Impaired
immunity
New
infection
Further
immune
impairment
Stress

Mitochondrial
dysfunction
Dysautonomia
Decreased
cardiac output
and blood flow

Emotional
trauma
Limbic system
dsyfunction
Sympathetic
overactivation

 Anxiety, Depression,
Panic Attacks
 Insomnia, Hypersomnia,
Circadian rhythm
 Reflux, Leaky Gut
Syndrome, SIBO
 Candidiasis, Frequent
Infections
 Fatigue,Weakness,
POTS
 Headaches, Arthralgias,
Pain
 Rash, Histamine
Intolerance, Allergies

 Limbic system
responses
 Circadian rhythm
dysregulation
 Intestinal permeability
and motility dysfunction
 Immune dysregulation
 Mitochondrial
dysfunction
 Inflammatory cytokines
 Mast cell activation

 Buildings:
▪ Water-damaged buildings (home, work)
▪ Environmental toxins
 Foods:
▪ allergens, toxins
 Infection history;
▪ Viral history
▪ Bacterial exposures:Tick bites, fleas
▪ Parasites, other infections
 Traumas:
▪ Traumatic Brain Injury (TBI)
▪ Emotional, childhood
 Dental history

 Direct
 Cultures
 Toxin levels
 Indirect
 Inflammatory markers
 Antibody responses
 External
 Buildings
 Insects

A. Immune supportive
▪ Remove inhaled biotoxins and inflammagens
(water-damaged buildings)
▪ Repair intestinal permeability
▪ Reduce autonomic dysregulation
B. Infections
▪ Lyme, co-infections
▪ Activated viruses
C. Cycle Resetting
▪ Limbic system retraining

(EAI-WDB)
Aka Chronic Inflammatory Response Syndrome (CIRS)

DIARRHEA Shortness of breath
Anxiety insomnia JOINT PAIN
Temperature Dysregulation
BlurredVision THIRST
Night sweatsvertigo
Aches headaches FATIGUE

Testosterone Anti-Diuretic Hormone
DHEA progesterone Leptin
OSMOLALITY VIP
Melanocyte Stimulating Hormone
ACTH thyroid
Cortisol ACLA ESTROGEN

 Lyme disease
resistant to treatment
 Inability to lose
weight
 Low testosterone
 Insufficient response
to BHRT
 Treatment failures
 Chronic inflammation
 High csCRP
 Psychiatric symptoms
 Memory problems
 Sudden changes in
vision
 Thirst, frequent
urination
 Chronic Fatigue
 Shortness of breath
 Asthma

 Suspect
 Evidence of Biotoxin Exposure
 Clinical picture: Symptoms and Signs
 Diagnose
 Abnormal labs and clinical tests
 Physical exam
 Treat
 Improvement with treatment

 Fungi
 Spores
 Fragments
 Mycotoxins
 Bacteria
 Mycobacteria
 Actinomycetes
 VOCs
Factors contributing to toxicity of water-
damaged buildings: a toxic stew

Bioaerosols
Mycotoxins
DNA Fragments
Hyphal Fragments
Bacteria Fragments
Endotoxins/LPS
Beta Glucans
Mold Spores
Spore Casings
Actinomycetes
Nocardia
Streptomyces
Mycobacteria
Protozoa hemolysin
MARCoNS
Chlamydia
Mycoplasma
MicrobialVOCs
BuildingVOCs
MicrobialToxins
Micro-particulates
Ultrafine particulates
Nano-sized particles
Berndtson, et al. Medicallly Sound Investigation and Remediation of WDBs in Cases of CIRS-WDB. 2016.

http://www.newsometeamrealtors.com

http://www.mold-answers.com/pictures-of-mold.html#gallery[pageGallery]/22/

 Mold Spores
 Temperature
 Nutrient source
 Dry wall
 Framing
 Furniture, personal effects
 Moisture
The ONE thing we can control is dampness

 25 - 50% of all American buildings have
water damage (NIOSH, EPA)
 Acceptable humidity levels:
▪ < 55-60% < 30-45%
Summer Winter

1. Aspergillus penicilloides
2. Aspergillus versicolor
3. Chaetomium globosum
4. Stachybotrys chartarum
5. Wallemia sebi
HERTSMI-2 testing
Representative of different moisture
requirements

Stachybotrys
• Sticky spores being
released into the
atmosphere
• High humidity
required
From EPA’s mold brochure
Environ Health Perspect. 1999 Jun; 107(Suppl 3): 495–499. Overview of investigations
into pulmonary hemorrhage among infants in Cleveland, Ohio. Dearborn, DG, et al.

Shoemaker, R. www.survivingmold.com
• Common in
damp homes
• Low humidity
required
• HVACs

 Inhalation of airborne particulates
 Direct toxic effect vs chronic inflammation
 Asthma:
 25% of all asthmatic children
 Correlation with FEV1%
▪ Clin Exp Allergy. 2015 Jan 8. doi: 10.1111/cea.12482.
[Epub ahead of print] Decreased FEV1 % in Asthmatic
Adults in Scottish Homes with High Environmental
Relative Moldiness IndexValues. McSharry, et al

 General:
 Fatigue, Sweats-
especially night sweats,
Static/shocks, Skin
sensitivity
 HEENT:
 Headache, Light
sensitivity, Blurred vision,
Red eyes,Tearing. Sinus
problems, Metallic taste
 Respiratory:
 Cough, Shortness of
breath
 Gastrointestinal:
 Abdominal pain, Diarrhea
 Genitourinary:
 Frequent urination
 Musculoskeletal:
 Morning stiffness,
Weakness, Joint pain,
Aches, Cramps (especially
claw-like cramping of
hands or feet)
 Hormonal:
 Excessive thirst,
Temperature regulation
issues, Appetite swing

 Neurological
 Unusual pain
 Ice pick pain,
 Lightening bolt or electrical
pain,
 Numbness,
 Tingling,
 Vertigo (dizziness),
 Problems with fine motor skills,
 Tremors,
 Tics,
 Atypical seizures
 Cognitive/Psychological
 Memory problems
 Focus/concentration problems
 Confusion and Disorientation
 Decreased learning
 Problems finding words
 Mood swings/depression
 Anxiety/panic symptoms
 Executive function problems:
(judgement; problems with
abstract concepts, planning,
and the ability to multitask)

 Muscle aches
 Joint aches
 Fatigue
 Headaches
 Unstable temperature
 Difficulty concentrating
Flu-like symptoms

 Direct neurological effect of cytokines

 Visual Contrast Sensitivity (VCS)
▪ Spatial frequency (parallel bars of light and
dark)
 PoorVCS
▪ Problems with night driving
▪ Light sensitivity
▪ Blurred vision

  MMP-9 (cytokine)
 TGFB-1 (innate immunity)
  C4a (complement cascade)
 Impaired Somatobiome: MARCoNS
 VEGF (angiogenesis, immune
regulation)

Low MSH
•Insomnia
•Chronic pain
•GI problems
•MARCoNS
VIP
•PACAP system
•Regulatory
hormone
ADH/Osm
•Thirst
•Frequent urination
•Low Osm/low ADH
ACTH/Cortisol
•Stress hormones
(HPA)
•insomnia
Sexual
Hormones
•Aromatase
upregulation
Hypothalamus

Millington G. 2007.The role of proopiomelanocortin (POMC) neurons in feeding behavior. Nutrition &
Metabolism 2007, 4:18

 Testing:
 Low in >95% of CIRS patients
 Normal range: 35-81
 “Sick normal” range: 0-40
 Hypothalamic POMC cell product
 Correlated with endorphin production
 Immune function
 Regulatory Function

 Anti-Diuretic Hormone/Arginine
Vasopressin (ADH, AVP):
 Reduces diuresis, improves water retention
 Responds to Osmolality (Osm)
 High Osmolality inducesADH production
 Dysregulation:
 Low ADH, high Osm

 Adrenocorticotropic hormone (ACTH):
 Stimulates adrenal production of cortisol
 Normal diurnal cortisol patterns
 Stress responses
 Dysregulation:
 Low ACTH, low Cortisol
 Normal/high ACTH, high Cortisol

Aromatase upregulation
Cholesterol  Pregnenolone  Progesterone  Cortisol
Aldosterone
17-OH-progesterone
Androstenedione
Testosterone
Estrone
Estradiol
Aromatase
Symptoms:
• Testosterone deficiency
• Estrogen dominance
• PMS
• Luteal phase defects
• Menopausal symptoms

 NeuroQuant (MRI)
▪ Computer program applied to 3D-MRI
images
▪ Measures volumes of brain regions
▪ EAI-WDB: a unique pattern of hypertrophy
and atrophy of specific areas of the brain
▪ Reversible changes
 Shoemaker RC, House D, Ryan JC. Structural brain abnormalities in patients with inflammatory
illness acquired following exposure to water-damaged buildings: a volumetric MRI study using
NeuroQuant®. Neurotoxicology andTeratology. 2014 sep-Oct;45:18-26.

1. Genetics
2. ExternalTriggers
3. Somatobiome
4. Danger Responses
a) Immunity
b) Autonomic Nervous System
c) HPA
d) Mitochondria

 HLA: Shoemaker HLA susceptibility
 Transcriptomics
 Mitochondria
 Sarcin-Ricin Loop
 Ribosomal RNA
 Risk Factors
 EDS: ConnectiveTissue
 Detoxification: Methylation, Sulfuration, etc

 Major histocompatibility complex II (DRB/Q)
 Chromosome 6p21
 Two genes
 Cell-surface proteins
 Capture extracellular antigens
 Regulate acquired immune response
 Disease associations

 Multisuscpetible: 4.3.53, 11.3.52B, 12.3.52B,
14.5.52B, 13.3.52A
 Mold susceptible: 7.2.53, 7.3.53, 13.6.52A,
13.6.52B, 13.6.52C, 17.2.52A, 18.4.52A
 Borreliosis: 15.6.51, 16.5.51
 Low MSH: 1.5
 Dinoflagellates: 4.7.53, 4.8.53
-Ritchie Shoemaker, MD

 Shoemaker HLA susceptibility (24%)
 HLA allele frequency databases
▪ Belgium: approximately 90% of total alleles identified as
‘susceptible’ type
 http://www.eupedia.com/genetics/HLA-
DR_allele_frequencies_by_country.shtml
 B7 and CD28/CD152 costimulatory/coinhibitory
signals
 Variable cell surface expression:
▪ CMV
▪ HHV-6
▪ Trauma

 Support detoxification pathways
 Improve HLA expression
 Treat viruses
▪ Plasmyc
▪ Anti-viral herbals/medications
 Treat and prevent trauma
▪ Adverse childhood events
▪ Meditative practices
▪ Limbic system restructuring programs
 Vasoactive Intestinal Peptide (VIP)

1. Eradicate exposure
2. Remove absorbed biotoxins

 Find the source:
 Building history: leaks, floods, fire, dust
 Musty smells
 Visible mold (take a photo)
 Patterns of illness: timing
 Don’t forget cars
 At risk buildings: schools, rentals, dorms, hotels
 Testing
 Find a safe place

 Air Purification:
 Good quality air purifier
▪ Air purifiers
▪ Air cleaners/ozone
 Check humidity
 Humidity monitor (humidistat)
 Get dehumidifier and use as needed

 Testing the environment:
 Mold DNA: qPCR
▪ HERTSMI-2: $155
▪ ERMI: $290
▪ Only tests that correlates with human health
 Mold spore trapping (air flow testing)
 Find the sources of moisture
 Remediate and Retest
 Removal of contaminated belongings

 Prescription Medications
 Cholestyramine
 Welchol (Colesevelam)
 Over-the-Counter Options
 Activated Charcoal
 Diatomaceous Earth
 Betonite Clay
 Zeolite

http://www.slideshare.net/Vijaykumar1919/excretionofdrug-vk

Welchol
 2 tablets/dose
 3x/ day
 Can take 1/4-1/2 tablet
 Take with food
 Cost
Cholestyramine
 4x more effective
 1 packet/dose
 4x/day
 Flexible dosing
 Available as pure and
with sugar/dyes
 Taken away from food

 To raise PPAR- γ initiate for 10 days:
▪ No amylose diet (amylopectin)
▪ High dose fish
 Challenges:
▪ Constipation and reflux
▪ Wait 2 hours after certain drugs
▪ Sensitive patients (e.g., Lyme)
 Treatment duration:
▪ Treat untilVCS normal
▪ IfVCS is normal, continue for 2-3 months and retest

 MARCoNS: Multiple Antibiotic Resistant Coagulase
Negative Staphlococcus bacteria
 Borrelia
 Viruses
 Candida
 Funneliformis mosseae?
 Other commensal/infective/toxic organisms
 Reduction in beneficial organisms

 MARCoNS: Multiple Antibiotic Resistant Coagulase
Negative Staphlococcus bacteria
 Thrive in water damaged buildings
 Resistant to multiple antibiotics
 Colonize deep nasal cavities
 Biofilm producers
 Staphylococcus Aureus competitor ?
 Low Melanocyte Stimulating Hormone (MSH) ?

 MARCoNS:
 Bactroban-EDTA-Gentamicin (BEG)
 EDTA/colloidal (nano) silver
 Mucolox additive (mucoadhesive polymer)
 Sinu-rhinobiome repair (L. sakei)
 Regulation through improved immunity:
 Transfer Factors
 Gut Microbiome: Probiotics, prebiotics

 Tickborne diseases:
 treatment protocols
 Viral activation:
 antivirals herbals/medications
 Biofilm producers:
 treatment protocols

 ADH/Osm dysregulation
 Treat withVasopressin (DDAVP)
 Caution: patients with enlarged cerebellum and EDS
 ACTH/Cortisol dysregulation
 HPA support
 Sexual hormone dysregulation
 Women: progesterone support
 Caution: testosterone may feed aromatase upregulation
 MSH andVIP
 VIP intranasal spray: dose QID
 Reverses Neuroquant changes
 Criteria:
▪ No MARCoNS
▪ No ongoing exposure
▪ NormalVCS

 Flu-like symptoms such as headaches, chills,
fatigue, brain fog, muscle and joint aches
 Food sensitivities including wheat
 Clotting and bleeding
 Allergy symptoms, rashes, GI symptoms, brain fog,
interstitial cystitis, asthma

 Cytokine Production:
 Flu-like symptoms
 Innate Immune Response:
 T-regulatory cell dysfunction (TGFB1 elevation)
 Complement cascade (C4a elevation)
 Auto-Immunity
 Anti-gliadin Ab
 Anti-cardiolipin Ab
 Mast cells
 Histamine response
 Degranulation and other mediators

 Cytokine Production:
 Cytoquel
 Transfer Factor,Transfer Factor Enviro
 Innate Immune Response:
 Transfer Factor
 Curcumin
 Auto-Immunity
 Transfer Factor
 Avoidance
 Mast cells
 Quercetin
 Ketotifen

 Vascular:
 Orthostatic hypotension/Tachycardia (POTS)
 Hypertension
 Venous pooling, volume depletion
 Intestinal:
 Slow transit constipation, SIBO
 Diarrhea
 Intestinal permeability/leaky gut syndrome
 Psychiatric:
 Anxiety, Panic
 Obsessive-Compulsive Disorder (OCD)
 Cognitive:
 Brain fog
 Attention and concentration problems (ADD)
 Metabolism:
 Fatigue

 Reduce Sympathetic Nervous System Overactivation
 Meditative practices: HeartMath
 SCENAR
 L-theanine
 Essential oils
 Support Parasympathetic Nervous System
 Meditative practices
 Massage
 Dry Brushing
 ImproveVagal Nerve
 Essential oils
 Neuroplasticity: gargling, gagging
 Enteric Nervous System
 Stimulate Migratory Motor Complex (MMC)
 Iberogast

Adrenaline
Noradrenaline
Cortisol
EAI: Danger Response
HPA Axis
Adrenal Glands

INSOMNIA
• Can’t fall asleep
• Can’t stay asleep
• Can’t fall back to
sleep easily
• Awaken in the
middle of the night
• Awaken in the
morning tired
http://justinhealth.com/lab-tests-and-symptoms/

 Meditative practices
 Diet
 Small, frequent meals
 Lean proteins, lower carbohydrate
 8-10 cups clean water daily
 Healthy fats
 Sleep
 8-10 hours minimum
 Phosphatidylserine for nighttime cortisol modulation
 Combination: Cortisol Manager
 Gentle exercise
 Laugh

 Nutrient and Herbal Support
 Adaptogens:
▪ Ashwaganda
▪ Eleuthero
▪ Ginseng
▪ Rhodiola
▪ Holy Basil
 Vitamins: C, D, B complex
 Minerals: selenium, zinc, magnesium
 Amino Acids:Taurine, Mixed amino acids
 Adrenal Cortex
 Anti-inflammatory herbs: curcumin, resveratrol
 Combination products: Energy Multiplex, Cytoquel
Note: Caution if using hydrocortisone which can cause significant suppression of
ACTH

 Mitochondrial function and genetics
 ATP demand due to sympathetic nervous
system tone
 ReactiveOxygen Species and Mitophagy
 TGF-β1 effects
 Mycotoxin effects: PAMPs, DAMPs
 Mitochondrial role in innate immunity

 Energy centers of the cell
 Produce AdenosineTri-Phosphate (ATP)
http://www.smartcancertherapy.com/the-primary-cause-of-cancer.html

http://prodomweb.univ-lyon1.fr/priam/REL_JUL03/RALSTO_ALL/PRIAM_REPLICON/RES_PRIAM/map00190_org.html

 Unique mitochondrial
genetics
 Maternal inheritance
 Higher mutation rates
 Random segregation
 Heteroplasmy
 Threshold expression:
Mutation
▪ Severity
▪ Relative numbers
▪ Organ reliance on OxPhos
http://hihg.med.miami.edu/code/http/modules/education/Design/Print.asp?CourseNum=2&LessonNum=4

Henchcliffe C, Beal MF. 2008. Mitochondrial biology and oxidative stress in Parkinson disease
pathogenesis. Nature Clinical Practice Neurology (2008) 4, 600-609. doi:10.1038/ncpneuro0924
STRESSORS
1
2
3
4

West PA et al. 2011. Mitochondria in innate immune responses. Nat Rev Immunol. 2011 Jun: 11(6):
389-402.

 GSK3 inactivation is involved in mitochondrial
complex IV defect in transforming growth factor
(TGF) β1-induced senescence. Byun HO et al. Exp Cell
Res. 2012 Sep 10;318(15):1808-19.
 TGF-β1 stimulates mitochondrial oxidative
phosphorylation and generation of reactive oxygen
species in cultured mouse podocytes, mediated in
part by the mTOR pathway. AbeY et al. Am J Physiol
Renal Physiol. 2013 Nov 15; 305(10): F1477–F1490.
 Epithelial Cell Mitochondrial Dysfunction and PINK1
Are Induced byTransforming Growth Factor- Beta1
in Pulmonary Fibrosis. Patel A et al. PLoS One. 2015;
10(3): e0121246.

PAMPs, DAMPs, and Mitochondria
 PAMPs:
 Pathogen Associated Molecular Patterns
 MARCoNS, Fungal DNA, Mycotoxins
 DAMPs:
 Danger Associated Molecular Patterns
 Distressed cells: tissue hypoxia
 “hidden-self”

 Mitochondrial constituents as DAMPs:
 Injection of mtDNA into joints induces inflammation and
arthritis
 Splenocytes exposed to mtDNA (not nDNA) increase cytokine
secretion
 mtDNA is released into circulation during trauma and shock
 Mitochondrial extracts (with mtDNA) cause systemic lung and
liver inflammation in vivo
 ATP as source of Cell Danger Response

Mycotoxin Stimulation of Mitochondrial DAMPS
 NLRP3 Inflammasome
 Member of NLR family
 Activates caspase 1, leading to pro-IL-1B, IL-18
 Increased ROS production may be critical for activation
 Trichothecene mycotoxins activate NLRP3 inflammasome
through a P2X7 receptor and Src tyrosine kinase dependent
pathway. Kankkunen P et al. Hum Immunol. 2014 Feb;75(2):134-40.
 Roridin A (WDB-mycotoxin) acts as microbial danger signal
 Triggers activation of NLRP3 inflammasome in human primary
macrophages

 Centrally positioned for innate immune
responses
 Enhanced crosstalk between metabolic and
immune pathways
 Augment host ability to sense microbial
virulence mechanism

Magnesium
Carnitine
CoEnzyme Q10
ATPD-ribose
https://www.umdf.org/what-is-mitochondrial-disease/

 Lipid ReplacementTherapy
http://www.bbc.com/news/health-32434347
Phosphorylated
Fatty Acids

 Functional Support: (ATP production)
 D-ribose
 Magnesium
 Carnitine
 Coenzyme Q10
 Structural Support: Lipid ReplacementTherapy
 NT Factors
 Combination products:
 Riboscardio
 Energy Multiplex
 ATP Fuel
 Reduction of superoxide free radicals
 H2Absorb

 Boundaries:
 ImproveTight junctions:
▪ Restore
▪ Curcumin, resveratrol, tea polyphenols, glutamine; Cytoquel
▪ Enteragam (IgA)
▪ Diet: avoid glyphosate and alcohol, consume fiber and green tea
 Immune regulation
 Transfer Factors: general, targeted
 Vitamins C & D, Zinc, Astragalus, Mushroom extracts
 Reduce background infections
 Viral activation
 Tick-borne diseases
 Parasites
 Fungal infections
 Stress management

 Mitochondrial dysfunction
 Riboscardio
 ATP Fuel
 Hydrogen (H2 Absorb)
 Symptoms of dysautonomia
 L-theanine
 Limbic System Restructuring
 Hypoxia
 HBOT
 Gentle Exercise
 Improve hydration
 Treat anemia
 Supplemental oxygen
 Treat sleep apnea: CPAP, dental appliances

 Limbic System Restructuring:
 Dynamic Neural Retraining System
 Amygdala Retraining
 Calm SympatheticOveractivity
 Loving kindness meditation
 HeartMath
 SCENAR, Massage
 HealingTrauma
 PoetryTherapy

① History
a. Exposure to WDB
b. Other external triggers
② Home testing:
a. qPCR: HERTSMI, ERMI
③ ClinicalTesting
a. VCS
b. Physical exam
④ Laboratory testing
a. Immune response:TGFB1, C4a
b. Hormonal dysregulation: MSH,ACTH/Cortisol, ADH/Osm, Sexual
hormones,VIP,VEGF
c. MARCoNS
d. Mycotoxin testing
e. Infections, titers
⑤ Additional testing
a. MRI with Neuroquant analysis
b. CPET

① Address negative epigenetic events: viral, trauma, nutrients
② Remove biotoxins
• Binders
• Removal from environment
• Re-exposure avoidance
③ Support healthy somatobiome
• Treat MARCoNS
④ Treat danger response dysregulation
• Hyopthalamic dysregulation: DDAVP,VIP
• Immune support:Transfer factors, repair tight junctions
• Autonomic nervous system support: meditation, plasticity
• Adrenal/HPA support: adaptogens
• Mitochondrial support: mitochondrial cocktails
⑤ Manage infections
• Lyme, co-infections
• Activated viruses
⑥ Cycle reset: DNRS,Amygdala Retraining

Join:
Membership categories:
Diplomate: certified/experienced providers
Member: providers, indoor environmental professionals, researchers
Affiliate: interested public
Founding membership through 2018
Contact us:
iseaidocs@gmail.com
iseai.org (coming soon)

Environmentally Acquired Illness, Parts I and II

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