Is a Hidden Infection Causing Your Fatigue?

Are you suffering from unrelenting fatigue that doesn't seem to respond to any intervention?  Perhaps you've asked your doctor to check your thyroid function and it came back normal.  Perhaps you've been testing for iron-deficiency anemia this, too, was normal.  Or perhaps you've been told by an integrative medical doctor that your adrenal function is suboptimal.  Maybe what you haven't thought of is the fact that you could be harboring hidden pathogens in your body that are robbing your energy and stealing your steam!

If basic testing fails to reveal a cause of your fatigue, you may want to have your doctor test for occult infection. More sophisticated investigations can reveal the presence of all kinds of pathogens capable of colonizing the body and evading the immune system.  Some of them include: Parvoviruses, HHV6, Epstein-Barr, Cytomegalovirus, Mycoplasma, and Borrelia burgdorferi. Other patients have a history of chronic fungal infections or biotoxin exposure.  A history of chronic mold exposure is a feasible explanation for such symptoms, as is the presence of B. burgdorferi.

Chronic fatigue syndrome is a complicated disorder characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn't improve with rest.

Chronic fatigue syndrome has eight official signs and symptoms, plus the central symptom that gives the condition its name:

• Fatigue
• Loss of memory or concentration
• Sore throat
• Enlarged lymph nodes in your neck or armpits
• Unexplained muscle pain
• Pain that moves from one joint to another without swelling or redness
• Headache of a new type, pattern or severity
• Unrefreshing sleep
• Extreme exhaustion lasting more than 24 hours after physical or mental exercise

If you see a good medical detective, a physician trained in functional medicine, they can work with you to test for any of these underlying causes of the fatigue,

A study of 375 patients with apparently no cause for their disabling fatigue revealed pathological stimulation of white blood cells with abnormally elevated patterns of natural helper and natural killer cells, important infection fighting agents in the immune system in 53% of patients.  It showed depleted levels of IgG subclass three in 59% of the study population.  More than 50% had circulating immune complexes and many tested positive for ANA antibodies, usually seen in autoimmune diseases like lupus.

Why is it that some patients who get an infection recover and have no fatigue and others may be colonized with pathogens and suffer from intractable lack of energy?

It appears that part of the answer lies in the genetic polymorphisms or variances in our bodies response to infection and inflammation.  For those who develop severe fatigue in response to toxic exposure, like mold or infection, their immune systems respond more robustly to the threat with massive production of cytokines, like IL-ß1 or TNF-alpha.

Moreover, polymorphisms in TNF-alpha,IL-1β, interferons (IFNs), IL-6, and IL-10, acting together or separately can make the severity and response of immune system more profound in response to infection.  Why does this happen?  Well these pathogens can trigger TLR's (toll-like receptors) by either PAMPs (pathogen-associated molecular patterns) or DAMPs (damage associated molecular patterns).  Activation of the TLRs causes a massive cytokine surge that becomes like a domino-effect and keeps on going unrelenting in susceptible individuals, contributing to the inflammation, depression and fatigue.  This vicious cycle of pro-inflammatory cytokines that continue to trigger more inflammation and amplify the cycle, leading to more damage and inflammation.

The initial infection followed by chronic inflammation of the immune system could explain the cause of fatigue in these genetically susceptible individuals.  Some patients also suffer from cognitive dysfunction, memory loss, or brain fog as well.

What are some common hidden infections that may be causing your fatigue?

• Epstein Barr Virus (EBV)
• Cytomegalovirus (CMV)
• Human Herpes Virus (HHV-6)
• Parvovirus (Parvo B19)
• Mycoplasma sp.
• Borrelia Burgdorferi
• Chronic mold and mycotoxin exposure

Chronic fatigue syndrome is just a label.  It's useful to identify a group of symptoms that causes significant fatigue and may affect one's life dramatically causing inability to function or hold a job. It does not represent one clincial entity but the cause may be multi-factorial and different in each individual.  It may share a final common pathway of dysfunctional immune activation and inflammation that keeps on going in a self perpetuating manner (like the Energizer Bunny gone bad!)  From a functional medicine perspective it's important to get to the root cause of the chronic fatigue symptoms and cognitive impairment.   Most of these infections, including the inflammatory response (CIRS) to mold and mycotoxins can be measured by ordering conventional lab testing through a knowledgable practitioner.  Ask your doctor to see if he can help you determine the root cause of your fatigue.  Treating the root cause (or infection in this case) just might give you back your life!

References:

1. The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability
2. A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and sickness behavior

Is Mold Exposure The Cause of Your Symptoms?

Are you one of the many people unknowingly living or working in water damaged building? Did you know it may be dramatically affecting your health? It's estimated that indoor air pollutants, including mold and mycotoxins may be contributing to more than 50% of our patient's illnesses. Typically we think of smog, smoke, and outdoor pollution as detrimental to our health but indoor air quality may be an even bigger risk to your health. Many patients are unaware that a toxic home or workplace is contributing to their symptoms.

Exposure to water-damaged indoor environments is associated with exposure to molds. The most common types of mold that are found indoors include Cladosporium, Penicillium, Alternaria, and Aspergillus. Stachybotrys chartarum (sometimes referred to as "toxic black mold") is a greenish-black mold, which grows on household surfaces that have high cellulose content, such as wood, fiberboard, gypsum board, paper, dust, and lint and is usually an indicator that there has been elevated moisture present or previous water damage.

Some molds secrete mycotoxins, that can be measured in the urine, such as ochratoxin, aflatoxin, and trichothecenes. Exposure to mold and mold components is well known to trigger inflammation, allergies and asthma, oxidative stress, and immune dysfunction in both human and animal studies. Mold spores, fungal fragments, and mycotoxins can be measured in the indoor environments of moldy buildings and in humans who are exposed to these environments. Most of the time, we are exposed to molds, like stachybotrys, through the skin contact, through ingestion, and by inhalation. Most common are reports of exposure involve water-damaged homes, schools, office buildings, court houses, hospitals, and hotels. It's estimated that as many as 25% of buildings in the US have had some sort of water damage. Molds have the ability to produce various symptoms, such as skin rashes, respiratory distress, various types of inflammation, cognitive issues, neurological symptoms, and immune suppression. The most common symptoms associated with mold exposure are allergic rhinitis and new onset asthma.

How do you know if you've been exposed to mold or mycotoxins?

Top Symptoms Associated with Mycotoxin-Associated Illness:

• Fatigue and weakness
• Headache, light sensitivity
• Poor memory, difficult word finding
• Difficulty concentration
• Morning stiffness, joint pain
• Unusual skin sensations, tingling and numbness
• Shortness of breath, sinus congestion or chronic cough
• Appetite swings, body temperature regulation,
• Increased urinary frequency or increased thirst
• Red eyes, blurred vision, sweats, mood swings, sharp pains
• Abdominal pain, diarrhea, bloating
• Tearing, disorientation, metallic taste in mouth
• Static shocks
• Vertigo, feeling lightheaded

Checklist that might indicate mold exposure or mold sensitivity (from ECH website)

• Do musty odors bother you?
• Have you worked or lived in a building where the air vents or ceiling tiles were discolored?
• Have you noticed water damage or discoloration elsewhere?
• Has your home been flooded?
• Have you had leaks in the roof?
• Do you experience unusual shortness of breath?
• Do you experience recurring sinus infections?
• Do you experience recurring respiratory infections and coughing?
• Do you have frequent flu-like symptoms?
• Do your symptoms worsen on rainy days?
• Do you have frequent headaches?
• Are you fatigued and have a skin rashes?

How do I Treat Mold/mycotoxin Exposure?

1. Remove yourself from the contaminated environment (don't even think about going on to other treatments until you get out of the contaminated environment)
2. Avoid exposure to porous items (paper, clothing, etc) from the moldy environment.
3. Use clay, charcoal, cholestyramine or other binders to bind internal mycotoxins
4. While you are using binders, you must maintain normal bowel function and avoid constipation. You can add magnesium citrate, buffered C powder, or even gentle laxatives if needed but constipation is the enemy of detoxification!
5. Treat colonizing molds/fungal infections in the body
6. Common locations of colonization include sinuses, gut, bladder, vagina, lungs
7. Test and treat for candida overgrowth - living in an environment with mold leads to immune dysregulation that allows candida to overgrow in the body
8. Enhance detoxification support
1. Some common supplements used to aid detox are liposomal glutathione, milk thistle, n-acetylcysteine, alpha lipoid acid, glycine, glutamine, and taurine. Methylation support is also key and involves optimal levels of methylcobalamin (B12), methyl-folate, B6, riboflavin, and minerals
9. Invest in a high quality air filter and home and at work, like Austin Air or EL Faust
10. Avoid common mycotoxin containing foods:
1. Corn, wheat, barley, rye, peanuts, sorghum, cottonseed, some cheeses, and alcoholic beverages such as wine and beer. Others include oats, rice, tree nuts pistachios, brazil nuts, chiles, oil seeds, spices, black pepper, dried fruits, figs, coffee, cocoa, beans, bread.

Other Treatment Options

• Follow Dr. Jill's Low Mold Diet - many patients to well on a paleo, grain-free diet since grains are often contaminated with mycotoxins and molds
• Sublingual immunotherapy (SLIT)
• Anti-fungal herbs and medications
• Infared sauna
• Detoxification support - oral and IV
• Remediation procedures for environment and belongings
• Create a "safe" place, with little potential for mold/allergens and great filtration system - this could be a bedroom or other room that is mold and chemical free
• Some patients benefit from IV immunoglobulin therapy (IVIg)

Chart from article in Townsend Letter July 2014 that explains sources and binders for common mycotoxins:

More Helpful Resources:

1. Guidance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure and Moisture Indoors
2. A Review of the Mechanism of Injury and Treatment Approaches for Illness Resulting from Exposure to Water-Damaged Buildings, Mold, and Mycotoxins
3. Chronic Inflammatory Response Syndrome - Dr. Berndtson
4. Slide Presentation on Mold Toxicity
5. Paradigm Change - information on role of mold toxins in Chronic Neuroimmune Disease
6. Real Time Labs - Urinary Mycotoxin Testing
7. Fungal spore DNA detectible in tissue and body fluids of patients exposed to moldy buildings
8. Stachybotrys chartarum: Review of Toxicology Literature

Quick Tips to Decrease Allergen Exposure at Home

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1. Houseplants – Keep slightly dry to decrease mold growth.  Avoid placing them in the bedroom due to mold sensitizing
2. Christmas trees - Unfortunately they grow mold quickly.  Use artificial instead of live trees if you have allergies.
3. Nickel Allergy?  Use clear nail polish on the back of blue jean buttons to keep from skin exposure to nickel.  You may also paint the backs of jewelry such as earrings to protect your skin.
4. Perfume – Avoid using commercial perfumes...many contain volatile organic compounds (VOCs) and other harmful ingredients.  Instead try applying essential oils to your neck & wrists.
5. Candles & air fresheners – These may be as allergenic as cigarettes and they pollute the indoor air.  Try using natural essential oils, like peppermint, eucalyptus, or cinnamon or burn soy-based candles instead.
6. Spices – Use caution with key offenders: coriander, poppy seeds, pepper, paprika, cumin, saffron
7. Soaps and detergents – Choose those without phthalates, parabens and sodium laureate sulfate (SLS).  Check out EWG's guide to healthy cleaning products.
8. Carpeting – Install hardwood flooring wherever possible and get rid of the carpet due to build up of dust mites and other allergens.
9. Wall paint – Avoid volatile organic compounds in your air by using low VOC emitting paints
10. Declutter  – Take a good look around the house and eliminate “dust catchers" like silk flowers, stuffed animals & knick-knacks. 
11. Dry-cleaned clothes – Air them out outside with plastic off before bringing inside to let the chemicals off-gas.  Better yet use a green dry-cleaner, like Revolutionary Cleaners.
12. HVAC filters – Change filters every 1-2 months minimum.  Install HEPA filters with higher allergen rating.  Switching frequently allows the filter to catch more allergens and prevent them from re-circulating.

Final word?  Love your pets but don't sleep with them if you have allergies...

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Tips for Dealing with Herxheimer or Die-off Reactions

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Dealing With Yeast Die-Off (Herxheimer) Reactions

  

Yeast overgrowth can happen in response to improper diet, poor immunity, difficulties in digestion and antibiotic use. Poorly digested food can lead to putrefaction (rotting) and encourages the growth of organisms.  Antibiotic use destroys the normal balance of gut flora and leaves an open field for bad bacteria and fungi to move in.  Hormones and steroids can make this condition worse, too.  Most importantly, over-consumption of simple sugars & refined carbohydrates will feed the yeast.  If the immune system is weakened or there are not enough probiotic ("good" bacteria) to combat the yeast, then it begins to grow unchecked and cause symptoms, such as "leaky gut".

In this blog, I am addressing specific patients who are being treated for fungal dysbiosis (yeast overgrowth), who may experience a worsening of their condition after starting a program for yeast control. This may be very unsettling & discouraging if it is not understood.  It must be addressed effectively in order to avoid worsening symptoms. Here are some strategies to minimize the chances of suffering unnecessarily from a Herxheimer (die-off) reaction.

Common Symptoms of yeast die-off include:

Fatigue, brain fog, gastrointestinal distress such as nausea, gas, bloating, diarrhea or constipation, low grade fever, headache, sore throat, body itch, muscle and joint soreness or pain, flu-like symptoms. Other symptoms include: lethargy, intense sweet cravings, rashes, irritability, joint stuffiness, or muscle pain. In susceptible individuals with pre-existing neurological symptoms such as hyperactivity, irritability, tantrums, and difficulty concentrating, their symptoms may temporarily intensify.

Yeast die-off reactions are not necessarily a sign that yeast treatment is succeeding. It may be an indication that yeast cells are dying in large numbers, and an indicator of the body's toxic overload. At that point, more poisons are being released than the body can adequately cope with at one time and may be a sign the system's elimination pathways (liver, kidneys, & bowels) are overburdened or blocked (as in constipation or liver congestion)

If properly undertaken, treatment for yeast related health problems should not lead to severe yeast die-off reactions.  Patients with elevated heavy metal levels may more problems with “die-off” symptoms

Strategies to minimize discomfort & shorten duration of die-off reactions

·       Reduce the dose of anti-fungals: Some patients may have to stop altogether for a few days. Dr Jill will generally start doses slowly and increasing them over time to help you deal with the possible die-off symptoms

·       Enzymes: Adding enzymes with meals may improve the digestion of foods and limit putrefactive short chain fatty acids with enzymes.  Use pancreatic enzymes, NOT fungal or plant based enzymes.

·       Stay hydrated:  Dr Jill recommend 4-6 fluid ounces of warm water every forty-five minutes, throughout the day.  Mineral water may help, too!

·       Get your sleep:  It is imperative to rest when experiencing yeast die-off reactions – 8-10 hours per night is essential.

·       Neutralize toxins:  There are ways to neutralize fungal toxins. Dr. Jill may recommend molybdenum, biotin, pantethine or liver support to accomplish this.  Activated charcoal may also help.

·       Alkalinize:  You may buffer the toxins by taking alkalizing agents immediately upon experiencing die-off symptoms. Such products as AlkaSeltzer Gold. Drinking mineral water may also help.

·       Antioxidants:  Provide extra antioxidants to quench the oxidative reactions created by the toxins.  Dr Jilll may prescribe vitamin C, Vitamin E or A, alpha lipoic acid or N-acetylcysteine.

·       Sauna & baths:  If you have access to a sauna, begin slowly (15 minutes per session) scrub all skin surfaces with a stiff brush and shower immediately afterwards. Another helpful detox regimen is Epsom salt baths – use 3-4 cups in hot bath and soak for 20min every night.

·       Keep your bowels moving:  You must address any issues with bowel elimination if you have constipation – if you are not eliminating, you will reabsorb any die-off toxins being released! 

More remedies for constipation:

·       Use magnesium citrate 500-1000mg daily or until normal, soft bowel movements 1 or more X daily.  You may also add Ascorbic Acid 5-10grams daily to bowel tolerance.

·       Start every morning with a tall glass of warm water.  8 oz of coffee may also be helpful.

·       Try a few tablespoons of extra virgin olive oil, several times daily on an empty stomach.

·       Mix 2 TBSP of ground flax or chia seed into water & stir , let sit for 10minutes, stir & drink on an empty stomach.

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