Author: Gilles Pesant, Mech Eng. written with his expertise while observing the expertise of his wife, "Dr.Kim." The article is written in "the doctor voice" for those used to reading Dr. Crawford's blogs.

The Two “Sick Patients” with Mold Toxicity

Mold toxicity means you’re sick and your home is sick. Plain and simple. Or is it? Unfortunately not. I always spend a considerable amount of time reviewing the list of symptoms of each one of my patients during our visit. Sometimes, it is evident that someone’s illness results from exposure to mold toxins; sometimes, it’s far from it.

When I have any doubt, I always ask patients to take a quick and simple test available online called a VCS test. False positives occur in up to 5% of cases and false negatives in about 8%, but it is nevertheless beneficial for screening purposes. More details on this later.

However, it is only after reviewing their lab work that I can tell for sure whether or not mold is playing a role in their condition. This rules-out any guesswork and provides the scientific basis that allows me to make a definitive diagnosis.

When I have a diagnosis of mold toxicity, I now find myself dealing with two distinct patients: the 1st one is a human, and the 2nd one is a building. In other words, I am now facing a medical issue but also an environmental one.

The importance of this is that no matter how effective my medical treatment is, this patient will never become ultimately better unless their environmental issues are dealt with and remediated properly.

Treating health conditions caused by exposure to mold toxins is undoubtedly not easy. Unfortunately, resolving the environmental issues proves to be even more challenging in many instances. If someone doesn’t know where the problem is, it’s often necessary to obtain a professional inspection to ascertain if there is mold toxicity or not.

Why Perform a Mold Inspection?

A mold inspection is the first step in addressing issues related to a building’s contamination with mold because it provides the assessment of the condition of the building.

Just as physicians need a diagnosis before determining the appropriate medical treatment, the mold inspection will determine the mold remediation plan.

Understandably, there is some psychological trauma resulting from the realization that your home is what is making you sick.

Some patients simply cannot come to grips with the fact that their house, which they built so carefully in some cases, is the culprit.

They, unfortunately, remain in total denial and categorically refuse even to get a proper mold inspection.

When this happens, all I can do is treat their other ailments, but I know that exposure to mold toxins will continue its ravaging effects over the long term.

They usually feel better after a short time due to the treatment of their symptoms, but, ironically, they invariably misinterpret this as evidence that their environment is just fine.

Sadly, feeling better reinforces their conviction, and they become defensive or downright combative when I bring up the mold issue. Luckily, this is not my typical experience with patients. But, let’s circle back a moment regarding mold inspection. Just as many doctors are not “CIRS-literate,” such is the case with many mold inspectors.

Why is it So Important to Find a Good Mold Inspector?

When a patient is diagnosed with CIRS (often called “mold illness”), they need to hire a professional to inspect their dwelling. Still, if they unluckily find someone not adequately qualified, the inspection is usually done improperly and will often fail to identify the full scope of the mold issues.

If an inspector erroneously concludes that nothing is wrong or that a quick clean-up will suffice, CIRS patients get confused since they receive contradictory opinions.

Their physician tells them that their environment is causing their symptoms, but the inspector tells them that this is not possible because their place is just fine.

What we then have is a nightmare scenario for the physician. Why? This patient will be much less likely to take the appropriate steps to get their dwelling more thoroughly decontaminated to the acceptable level.

Why does this happen? Because, in large part, the mold inspection/remediation industry does not yet recognize CIRS as an actual problem.

Until recently, it was impossible to map an individual’s gene sequences quickly and affordably.

But genomic sequencing technology combined with advancements in computer processing power and laboratory equipment has progressed at such an astonishing pace that it is now possible for physicians to order routine tests designed to look for and identify specific genes.

This technology proved to be a potent tool for microbiologists and researchers. It is now well established in the scientific literature that an individual’s specific set of genes often determines the level of mycotoxins that will cause them harm.

In other words, acceptable conditions for some people are not suitable for others.

Several genes have been identified as so-called “mold genes” because they impede the ability of the immune system to detect and eliminate mycotoxins absorbed in an individual’s body during exposure.

Someone can have only one or two “mold genes,” or none. While it is not unheard of for someone without any “mold genes” to develop CIRS, the more “mold genes” one has (meaning two), the higher the likelihood of developing CIRS, and usually, the worse the symptoms are.

Unfortunately, this knowledge has not yet made its way into any state’s mold inspection or remediation training certification programs.

Many mold inspectors and remediators believe that a building is safe for everyone once remediated to current standards. Consequently, these inspectors are skeptical that some individuals require an environment meeting a higher level of decontamination than is taught in their program.

Nothing is perfect, and it is impossible to remove every trace of mold spore dust after remediation of a contaminated building. As a result, the industry has settled on a level of contaminants considered normal (basically “good enough”). The problem is that “normal” is only acceptable for someone who does not have any “mold genes.”

For these reasons, finding a good mold inspector (one who understands that CIRS is a real thing and that everyone is not equal-genetically speaking) is essential.

Without some appropriate extra remediation measures, patients suffering from CIRS will continue having exposure to an unsafe environment. As a physician, treating their conditions is fighting a losing battle. They will get considerably better but will never achieve the results we should expect, which is a full recovery.

Since you can’t necessarily trust mold inspectors or remediators, let me give you a quick course in mycology.

Mold, what is it, and how does it harm us?

Mold is not an animal nor a plant; it is part of the “Fungi Kingdom.” Therefore, it is a living organism that requires food and specific environmental conditions to grow and spread.

While mold is an essential part of the ecosystem and a beneficial one, some species (but not all of them) have developed the nasty ability to produce dangerous toxins called “mycotoxins.”

Mycology is the branch of biology specializing in the systematic study of fungi, including their genetic and biochemical properties. The term “mycotoxins” comes from this branch of biology.

Mold spores are everywhere, outside as well as inside. Therefore, it is customary to find mold spores around your house. However, a “normal fungal ecology,” a term you will find in every mold inspection report, means that the spores captured in your home, despite being alive, have not “set up shop,” representing: established growing colonies.

Spores considered part of a normal fungal ecology should not be producing toxins, the process that certain mold species use to kill other mold species and take over. Instead, it is a fight for food and a matter of survival, one of the pillars of the evolutionary process.

Outside in nature, there is plenty of food for every species. Once inside a building, however, nutrition becomes more limited (we’re talking about organic materials such as drywall, wood, fabric, etc.).

Most toxin-producing species very rarely do so outside in nature. However, they will coincidentally become toxic if they start growing inside a building where they will invariably come in contact with other species.

This phenomenon can be observed under a microscope in a laboratory when growing cultures in a petri dish. Some toxin-producing varieties will not do so if there are no other mold species in the same petri dish. However, the moment you add another species to the mix, you will quickly see mycotoxins appear.

As you might expect, when mold starts growing inside a building, there is always a variety of species. Therefore, it is just a matter of time until some begin producing mycotoxins.

Molds are complex structures, and they come in many different forms. They grow in “colonies,” which we can see on moldy surfaces. On the other hand, spores are too small to see with our eyes, but they are visible under a microscope. Mycotoxins, for their part, are so small that they are invisible under any microscope.

It is essential to understand the distinction between mold, spores, and mycotoxins: mold is a living organism made of cells; a spore is just a component of the mold structure (also made of living cells); a mycotoxin is an organic compound, in other words, a chemical.

As the name implies, mycotoxins are toxic to humans and animals alike. Moreover, they include a particularly dangerous family of toxins called “neurotoxins.”

Neurotoxins are toxins that are destructive to nerve tissue. In other words, they affect and damage the nervous system, including the brain. Other toxins cause symptoms in different tissues such as the liver, the kidneys, and the cells of respiration called mitochondria.

The variety of mycotoxins, in part, explains why symptoms from CIRS can vary wildly from one patient to another. As a result, it is a condition that is not easy to diagnose for the uninitiated physician and is thus so often misdiagnosed.

Speaking of diagnosis, you might be wondering why it seems that more and more buildings are moldy; are they, or are we “spotting it” more? It’s a bit of both, quite frankly.

Mold Contamination: a very old issue, a very modern problem

More and more physicians (particularly in functional medicine) claim that some previously unexplained symptoms could have resulted from toxic mold exposure.

This whole mold toxicity problem might sometimes sound like a new hype. How come we rarely heard about this in the past? Our ancestors were exposed to moldy houses, too (remember those “musty” basements)?

The answer is: yes, indeed, they were. However, a lot of things have changed dramatically since then.

For one, many ailments they were suffering from were not known to be caused by mold toxin exposure. And the field of mycology, along with advancements in mold toxicity, has grown in leaps and bounds.

Maybe this explains, at least in part, why some of the mysterious symptoms our ancestors were experiencing for real were actually “unexplained.”

“Idiopathic” is the medical term used to describe a symptom that has no diagnosis. In other words: unexplained symptoms have no known cause or remedy. How often have you heard someone say: “I was told it’s all in my head”?

As technology (along with new scientific tools) evolve, so does the medical body of knowledge. For example, while it was nearly impossible 30 years ago to map the genetic sequence of some organic tissue, now everyone can quickly get their genetic code identified and analyzed through commercial or medical services.

In this context, it only makes sense that some former “idiopathic” symptoms are just now revealing their long-hidden causes. Therefore, the medical community is just beginning to understand the effects of toxic mold exposure on the human body. This understanding is evolving, and it is slowly making its way into the mainstream medical establishment.

In addition, our homes have changed dramatically.

We use different construction methods and materials when building our modern dwellings. For example, we impregnate them with chemicals and use glue, sealants, paints, coatings, etc.

Depending on your age, you may not realize that air conditioning was very rare until the ’70s and practically nonexistent in residential buildings before the ’60s.

Here are some critical factors that might help explain our “modern mold problem”:

  1. Not all mold species are toxic:

Mold spores are plentiful outdoors: the dirt in your backyard garden is full of them, but they are not toxic. The reason some mold spores become toxic in certain conditions is simply a matter of survival and evolution.

Most mold from the “toxic species” begin producing toxins only if “food” is in short supply. These toxins (called “mycotoxins”) are made within the spores but spread to the dense mass bathing the colony (viewed under a microscope; to the naked eye, colonies often look more like a powdery substance).

As the colony grows, anything that comes into contact with it becomes contaminated. So you can picture colonies as tiny blobs of slime that continuously expand to the point where they eventually cover a large area of the material upon which they grow.

Some mold species also expel their spores in the air, which allows them to travel over long distances and seed new colonies wherever they land.

So, what’s the takeaway?

It is essential to understand that mold colonies need three things: Moisture, Heat, and Food (organic matter) to proliferate.

Unless you live in an Igloo, there is enough heat and “food” in your house. However, the amount is limited (compared to a forest). Hopefully, however, there is not enough moisture.

In your garden outdoors, there is plenty of food and moisture (and heat in summertime) for everyone. So there is not a lot of competition. Bring those spores inside your house, though, and that’s a different story altogether.

In a nutshell, mold spores (only certain species) produce toxins to kill other mold species in an attempt to take over. You know, “survival of the fittest.”

The problem for us humans (and animals alike) is that, unfortunately, many of these toxins are “neurotoxins,” meaning they cause damage to our nervous system. The focus on potential neurological issues is why mold growth inside a building is often considered a severe problem. There is simply not the same abundance of organic matter (“food”) indoors as outdoors, and there’s typically not enough moisture.

As a result, if mold is allowed to grow inside a building (due to a water spill or water leakage, for instance), you can be sure that some species of the toxic category will eventually settle in and produce toxins.

Remember that mold spores are plentiful outdoors, and many are airborne. Each time you open a door or a window or go in and out, some of these spores are invariably being brought in with you. However, as long as the conditions for growth are not present in the building, these spores will simply remain dormant and will cause no harm (just like when you are stirring dirt in your garden).

However, this flow of mold spores is also why water leaks or spills, resulting in moist areas in a building quickly becoming a fertile breeding ground for mold even if the house looks otherwise clean. The leak is often limited to a cramped space or semi-enclosed areas, such as behind a bathroom cabinet. This type of space is called a “micro-climate.”

  1. Modern houses “cannot breathe”:

How often have you heard that newer houses “cannot breathe” while older homes were very “leaky”?

To reduce energy waste, we build our houses as airtight and insulated as possible to prevent hot or cold air infiltration. While this is a good thing from an energy conservation standpoint, it also means that there is practically no air circulation from the outside and, in turn, less air circulation in-between walls or wall cavities.

Walls in modern construction are never “solid” and contain therefore empty spaces or “cavities.” These enclosed spaces communicate throughout your house, allowing air to migrate from one cavity to another. Still, the volume of air circulation is relatively small and certainly cannot be described as air “flow.” Consequently, the materials will not dry very quickly or easily if a water leak occurs.

Being “leaky,” older constructions allowed some outside air to infiltrate these cavities, promoting air circulation between these enclosed spaces. This air leakage is what some builders or construction workers refer to as “breathing.” One consequence is that water spills were allowed to dry faster than in modern-day construction.

In other words, in a modern “airtight” house, wet materials will take longer to dry unless you control the humidity by dehumidifiers or air conditioning. If a water leak occurs in a modern building and is not quickly addressed, the immediate surrounding area will remain humid, creating a perfect breeding ground for mold. Remember what mold spores need to proliferate: food, heat, and moisture.

So, are older houses better? No, not really. As described in this article, other factors have changed, but an older house is more likely to have experienced water damage at one point or another since it has been around longer. On top of that, unless they have been thoughtfully remodeled, they are typically wasting a lot more energy than newer ones.

  1. Mold species are evolving to adapt to their new environment:

As mentioned previously, building materials have also changed significantly. Many modern materials are now impregnated with fungicidals (chemicals that impede fungus growth). Almost every material can be treated this way: paint, drywall, wood, even concrete.

You will be hard-pressed to find any air conditioning duct material in the U.S. not impregnated with one such chemical.

While this seems like a good idea at first glance, scientists now see that many fungi species are becoming more resistant to these fungicidal agents (much like bacteria are becoming more resistant to antibiotics).

This is the paramount principle of evolution.

  1. Air conditioning is exacerbating the problem (sometimes causing it):

The advent of residential air conditioning has made our dwellings more comfortable but also more susceptible to mold growth if not designed and installed correctly.

To understand this, let’s first talk about humidity:

“Humidity” is the % of the maximum amount of water molecules held in the ambient air at a given temperature and pressure.

We can ignore the atmospheric pressure variation here for all practical purposes.

It might help to picture air as being just like a glass. 50% humidity simply means that the ambient air is holding ½ of the water it can support at the current temperature (the glass is ½ full.). 100% corresponds to the “saturation point” or “the glass is full” point.

You might remember from your physics class that the higher the air temperature is, the more considerable the amount of water the air can hold (the glass becomes larger as the temperature increases). So keep this thought- this is important because that explains why condensation occurs on cold surfaces.

Picture that glass of iced tea that you bring outside on a hot summer day. All those droplets of water that form on the surface of the glass seem to appear out of thin air because…wait for it- they do.

The air temperature very close to the surface of the glass is cold, much more so than the ambient air. Because of that sudden temperature drop, the air in contact with the glass can no longer hold the water in it, hence the water droplets appearing out of the blue. That’s condensation.

The humidity of the air in contact with the glass has rapidly gone from, let’s say, 60% to above 100%, meaning the glass has overflowed.

What does this have to do with air conditioning? In a nutshell: condensation over cold surfaces.

When your A/C system is running, the air inside the network of ducts is much colder than the ambient air. Therefore, if any outer surface of this ductwork (or any other system component) gets too cold, condensation will occur just as it does on your glass of ice tea in the summer.

All ductwork is insulated for this precise reason. Unfortunately, it is all too easy to compress or damage this insulation during handling and installation unless the installers use a lot of care.

To make matters worse, in a conventional vented attic, it is not possible to avoid having some portions of ducts and register boxes covered by the insulation installed on top of the ceilings.

Since air can migrate through the insulation (no matter whether it is the loose, blown type, or fiberglass batts), the amount of moisture in the air is the same everywhere. However, the temperature is not. The surfaces of the buried duct or boxes are colder than ambient air, a situation worsened by the insulation. The cooler the surface is, the higher the likelihood of condensation.

Therefore, it is critical to look under the insulation by physically displacing it when inspecting the attic to look for condensation and mold. Also, the ducts connected directly to the HVAC air handler cabinet are always the coldest components since the air they carry has just passed the system’s cooling coils. Therefore, you must meticulously inspect these components if you are looking for moisture.

As you can imagine, condensation over any ducts will lead to wet materials (wood, drywall, etc.), perfect organic food for mold.

Since air conditioning was nonexistent in the days of our grandparents, their houses had no or fewer cold surfaces indoors that could cause condensation. But, of course, that also affected their lifestyle as they left windows open in the summertime, and used ceiling fans liberally, all of which promoted more ventilation. We can therefore conclude the following.

What can we conclude about how we build houses?

Mold in houses was not as much of a problem “back in the days” for several reasons:

  • We built houses differently, and building materials have changed significantly since then.
  • Mold spores that made their way into houses did not necessarily become toxic.
  • Some mold species are becoming more resistant to fungicides and becoming more difficult to avoid or eradicate.
  • The advent of central air conditioning systems can create conditions favorable to mold growth in modern houses if not installed correctly.

What steps should I take if I suspect that my house is toxic?

  1. Don’t ignore it! I have encountered many people who just cannot get past the psychological barrier and are incapable of coming to grips with the idea that their house might be moldy. Somehow, they remain in denial, and their health continues to degrade.
  2. If you are a patient of mine, I will ask you to perform an ERMI test as a preliminary confirmation of whether or not our suspicions are confirmed. This also gives me an overall picture of the condition of your house by looking at two things: what species of spores can be found in your home and what kind of concentration levels are present (a lot or just a little). If the ERMI is suspicious for “active mold growth,” I’ll ask you to do #3; below.
  3. Hire a professional inspector. They have tools to measure the level of moisture in materials (and even behind them). They also have the instrumentation to detect the presence of mold spores, species, and concentrations. They are trained and know where to look and what to look for. They also follow protocols to perform inspections safely. A good inspector will also guide you and present you with the best plan of action for your situation.

Performing an inspection yourself is unlikely to reveal hidden problems (otherwise, you would already have found them). In addition, this will expose you to dangerous mycotoxins if you were indeed to see mold growth. Finally, realize that stirring up objects or materials contaminated by mold will spread the spores all over and worsen the problem. You don’t want to do this.

  1. If the inspection reveals mold contamination, hire a professional mold remediator. Mold growth is a serious matter because your health is at risk. However, there is more to mold remediation than what popular belief would have it. A competent professional remediator will follow strict protocols to do it thoroughly while preventing you and your loved ones from exposure.


References :

History of air-conditioning:

Anti-fungal in building materials:

What does it mean when you learn mold is why you feel sick?

Chances are you have been suffering from all sorts of medical issues for a long time, you have seen numerous physicians, have received all kinds of diagnoses, but no treatment turned out to be effective. Unfortunately, this is a story I hear all too often. How do you know mold is making you sick? If you’re not sure after reading this article, please read the one I just linked for you.

Suppose you are coming to me with symptoms that I suspect might result from mold exposure. In that case, I will assess to look for typical symptoms such as gastrointestinal problems, cognitive or mood issues, pain issues, sleep problems, and much more. 

These symptoms result from mold toxicity from exposure to a mold-contaminated environment. People with exposure to live mold or dead mold containing mycotoxins (more on this distinction to come) can develop a condition called CIRS, short for Chronic Inflammatory Response Syndrome.

CIRS, called “Mold Illness” or “Biotoxin Illness,” is a condition caused by other types of biotoxin exposures, such as Lyme bacteria or blue-green algae.

Symptoms are not trivial and can vary substantially from one patient to another. They also often overlap or even mimic symptoms associated with other medical conditions. For example, Lyme Disease, Ehrlichiosis, and even some autoimmune disorders come to mind. As a result, exposure to toxic mold and CIRS are often misdiagnosed or simply not diagnosed.

Since it is one of the easiest and quickest tests for preliminary assessment for CIRS, I will likely ask you to take a Visual Contrast Sensitivity Test or, in short, a VCS test. You will take this test online. Again, it is quick and inexpensive, with results immediately available.

This online test might sound like witchcraft, but it is a genuine scientific assessment. The U.S. Military Medical Services initially developed this test as a visual assessment for jet fighter pilots.

However, this test does not assess visual acuity but rather the ability to distinguish contrast at various levels and shades of black, white, and grey. This capability is part of the brain’s functions using sensory information provided by the optic nerve, which is often affected by mycotoxins. Always try to remember that while live mold produces mycotoxins, there is still a danger from dead mold, as dead mold spores contain active mycotoxins. Mold and mycotoxins are the issue.

Even though VCS is a nonspecific test of neurological function integrity, it provides a high degree of accuracy and sensitivity for biotoxin exposure, such as mycotoxins.

Over 90% of people suffering from CIRS fail a simple VCS test. It is not enough to provide a definitive diagnosis, but it gives an initial indication that CIRS might be a likely diagnosis. Therefore, we need to investigate further to determine the cause (which can potentially be a mold-contaminated environment).

In practice, if you fail the test, you are probably suffering from CIRS. However, if you pass, there is still a possibility that you do have CIRS.

Now What?

If you have failed the VCS test, I will order the appropriate bloodwork panels. I will usually ask you to perform an ERMI test of your environment (home, office, workplace, depending on your specific situation). This easy-to-do swab is another relatively quick and easy test that, once interpreted correctly, allows me to get a very good picture of the following:

  1. Were mold spores present at one point or another in this building?
  2. What species of mold were present?
  3. How bad is the contamination level?

The ERMI test does not tell me whether or not these mold spores are still active (alive). Other tests are required for that (but they are more expensive).

Once I have the results of your lab tests and the ERMI test, I will know a lot more about your situation from a physiological standpoint. In addition, I will learn more about your genetic makeup, and I will also have some suggestions vis-à-vis your environment’s conditions.

At that point, if everything is pointing towards mold contamination, we need to get answers to the following questions:

  1. Is mold actively growing in your house (or workplace)?
  2. What is the root cause for the presence of mold, and what is the source?
  3. What is the best strategy to remove the source, repair the damage, and finally, decontaminate it?

There is only one way to do this right, and it is to hire mold assessment experts.

How do I find Mold Assessment Experts, and How do I check their qualifications?

Great question. I get asked all the time.

The mold assessment & remediation industry is a very crowded space. Therefore, individuals and companies are required to hold State-issued licenses to be considered qualified to perform these services.

Many different combinations of education and experience are accepted, but everyone must pass a written examination to obtain a license (renewable usually every two years). Some states even accept certifications from other states to issue a license (as long as the candidate submits an application and pays the fees).

Despite these legal requirements, unfortunately, quite a few individuals or companies are not following strict protocols or are making unfounded claims, sometimes based on misconceptions, ignorance, or simply “anecdotal evidence.”

Some unscrupulous individuals pretending to be qualified are not even properly licensed. Despite being illegal and subject to fines and penalties, these individuals can be operating for quite some time before any complaints are filed.

As a result, finding a qualified, honest, and thorough mold inspector or remediation company may be challenging. In other words, you need to do your homework.

We have an entire handout dedicated to this topic alone which we give to patients who need us to help them find an inspector, examine a remediation proposal, and so on.

Remember that there are “two patients” when we deal with CIRS, and without environmental clean-up, the human patient will not recover.

Introduction to Leptin and Leptin resistance-NOTE: we now have Semaglutide and Tirzepatide!

Leptin and its receptors are essential regulators of body weight and energy homeostasis. Multiple studies show that decreasing leptin’s tissue (or receptor) sensitivity leads to metabolic disorders, including obesity. Physiologic mechanisms underlying the development of leptin resistance include gene mutations that encode leptin and its receptors, proteins involved in the self-regulation of leptin synthesis, and even factors that alter blood-brain barrier permeability. Leptin resistance is a complex pathophysiological phenomenon with multiple “lines of attack” for potential treatment. Why is this important? Leptin resistance is the leading driver of fat gain in humans so let me break down how I’ll discuss this complex topic.

  • What is leptin?
  • What are normal leptin levels?
  • What is leptin resistance?
  • Ways to lower leptin and treat leptin resistance
  1. Raise BDNF (this topic is complex)
  2. Lower cortisol and stress levels
  3. Lower inflammation levels
  4. Improve sleep
  5. Correct “eating habits”
  6. Fix SIRT1 enzyme issues
  7. Miscellaneous tips
What is Leptin?

Leptin is a peptide (short-protein) hormone, originally thought to be secreted solely by fat cells; now known also to be secreted by the kidneys, placenta, salivary glands, and stomach. It’s important to note that leptin levels increase exponentially, not linearly, with fat mass. Leptin receptors are found in their highest concentrations in the brain, specifically in the hypothalamus and hippocampus.

In some clinical studies, chronically-elevated leptin levels correlate with overeating, obesity, and, as mentioned above, metabolic diseases, including diabetes, hypertension, heart disease, and metabolic syndrome.

The exact way “leptin works” is unknown, but the leading theory involves leptin release post-meal, penetration of the blood-brain barrier, and satiety signaling in the hypothalamus. The hypothalamus then signals to the rest of the brain (and probably to fat cells and our microbiome) that we have enough fat stored, we no longer need to continue eating. As a result, caloric burning can continue at a regular rate.

What Are Normal Levels?

We can measure leptin levels with a simple blood test. The results are in ng/mL (nanograms per milliliter).

Normal leptin levels are approximately 4.5 – 23.5 ng/ML and vary slightly between labs. They depend on a person’s BMI, age, gender and tend to get higher throughout the day, towards nighttime when they peak. Degrees of severity are loosely given with “mild” as 15-20 ng/ML and “severe” as 50ng/L or more, but this varies from person to person.

It has been called the “weight loss hormone,” the “satiety hormone,” and even the “starvation hormone.” We know that leptin resistance potentiates the extreme hunger experienced by a high ghrelin state. This (leptin-resistant) physiologic state somehow makes fat cells “think” that they must hang onto fat for dear life. This particular metabolic problem makes weight loss quite tricky unless you deal with the leptin resistance head-on.

Leptin Resistance

Leptin resistance occurs when leptin effectively decreases appetite or increases energy expenditure through basal metabolism or lipolysis in fat cells. As a result, tissues become resistant to even high levels of leptin: a similar phenomenon to insulin resistance with (obviously) different hormonal pathways and different treatments involved.

Clinical studies demonstrate that obese people usually have very high levels of leptin that don’t perform their job correctly. One of the reasons for this is that a leading leptin production site: fat cells, make leptin in proportion to their size.

Although leptin suppresses the appetite when slightly raised, it seems to have the opposite effect when it gets too high. That’s why most researchers feel that leptin resistance leads to increased appetite and decreased energy expenditure.

We can measure leptin levels and speculate on why people become leptin resistant. Theories include leptin entering the brain less effectively, decreasing leptin receptors, or an over-activation of negative feedback loops due to chronically high leptin levels. No matter what causes it, we now have some excellent ways to combat this problem and assist with weight loss. As you’ll see, it’s never a one-size-fits-all (no pun intended) when it comes to effective weight loss strategies. Let’s now get into how we address leptin resistance in the functional medicine world.

How to increase BDNF and therefore lower leptin

General Dietary Improvements

A typical American diet, high in refined sugar and “bad” saturated fat, causes negative structural changes in the brain. Those negative changes occur primarily via neurotrophins (“brain cell fertilizers) such as BDNF. What this means in “real life” is that we see a significant decrease in all neurotrophins if you eat an inflammatory diet. Therefore, it is crucial for brain health and overall good health, and as you are learning now: weight loss, you cut out refined sugar and eat only “good” saturated fats. “Good fats” (such as avocado and coconut) help you lose weight and are suitable for your health. In addition, your testable cognitive performance will improve within months when you consume a healthy diet. 

Weight Loss

Yes, I know this header got a bit of an eye-roll from you. However, I’m just giving you the scientific facts, so know that your body and brain undergo metabolic changes when you are overweight. BDNF will decrease when you are over-fat, with high body weight. When you reduce your weight, you improve your overall health and increase your BDNF levels and help your brain perform its functions better.

Intermittent Fasting or Caloric Restriction

Reducing your daily caloric intake or practicing various proven ways to do intermittent fasting can increase levels of BDNF. There is so much data coming in on the brain health benefits of intermittent fasting and the benefits for weight management and overall health that, at a minimum, timed eating intervals should be a part of your life: 5 days per week. Restricting your food intake to 8 hours a day (e.g., 11 AM to 7 PM) is ideal, but difficult for many; and doing a 10-hour window has benefits, as does even a 12-hour window; so do what you are “able” to do and push yourself a day or two per week.  

Regular and especially Intense Exercise

If you are currently a couch potato, you have nowhere to go but up when it comes to BDNF levels. Any exercise at all will boost your BDNF levels. Whether you are walking your dogs, going up stairs, walking from your parked car to the store-anything-will help. However, high-intensity interval training (HIIT) that super-boosts your heart rate will exponentially increase your production of BDNF. Consistency is essential: one intense exercise session once in a while will not make any difference. To reap the full benefits of increasing your BDNF levels through HIIT, you need to train this way a minimum of only once per week.

Of course, doing it three times per week is even better. Studies show that as little as 10 minutes of HIIT will raise BDNF levels. Start by simply jumping rope, running on a treadmill, or doing jumping jacks or burpees for 30 seconds to a minute. Do one of these activities until you feel short of breath, then walk slowly to catch your breath. Perform this sequence three times, working up to 6 times while gradually and comfortably increasing the active intervals.


A “Rich” Social Life

Of course, I’m going to discuss social connections, not money. Social enrichment (e.g., more meaningful and numerous interactions) for adults increases levels of BDNF. In addition, studies show that children exposed to socially enriched environments experience long-lasting cognitive and behavioral benefits.

A socially enriched environment is also beneficial for animals too. Rodents, for example, have been shown to have a lifelong increase in BDNF levels, as well as positive social behaviors and reduced risk of depression when raised in a stimulating and “rich” social environment.

Specific Drugs

Some drugs can raise BDNF levels. Short term, they are probably safe, but their long-term use is entirely unclear. I will only discuss one of the classes of drugs here as I do not recommend the use of pharmaceuticals to raise BDNF. Instead, I will explain the mechanism of this one class of medication below only because there is a healthy alternative. And as you will see “in a bit,” there is another bioidentical class of substances that work better than pharmaceuticals.

SSRI Drugs

SSRIs (Selective-serotonin reuptake inhibitors such as Prozac) will increase levels of BDNF when used to treat depression. These drugs do this by elevating levels of the neurotransmitter; serotonin. However, it is unclear how these drugs affect our brains with long-term use. A no-risk way to increase serotonin is to take the building block, 5-OH tryptophan, which is perfectly safe if you are not taking other anti-depressants and not bipolar.


Supplements that increase BDNF

Some supplements will “help the cause” but are nowhere near as strong as the peptides I’ll discuss next in terms of increasing BDNF. However, they are not used only to increase BDNF. Many of these supplements (integratives) are pretty helpful for a myriad of other reasons outside this particular article’s scope. They include green tea extract, curcumin, acetyl-l-carnitine, omega-3 fish oils, resveratrol, and vitamin D, something everyone should be taking. Now for the “seriously good stuff.”

Peptides that increase BDNF

If you’re my patient, you are probably using the intra-nasal peptide Semax or the oral peptide, Dihexa which both far exceed the power of the just-named supplements to increase BDNF. If you are not familiar with peptides as a class of medications (not drugs), here is a description.

Peptides are small sequences of amino acids that make up specific proteins. I’m talking about tiny proteins that have been isolated from human secretions and have many natural target functions. They have been studied and re-purposed for use throughout the body. They act as messengers, signaling specific glands and other proteins into performing or improving particular tasks. These tasks often have no relation to their usual function. These bioidentical substances have been isolated and replicated for use by compounding pharmacies. Since they are bioidentical, there are no side effects. They are a fantastic addition to our arsenal of treatments, and there happen to be two that are quite useful for enhancing BDNF levels. A third peptide called Selank also increases BDNF levels but is more commonly used for anxiety and cortisol issues which I’ll discuss in the next section.

Heptapeptide Semax: (Amino acid sequence: Met-Glu-His-Phe-Pro-Gly-Pro) 

Semax is a “nootropic” peptide due to its ability to increase BDNF: the most potent stimulator of neurogenesis. In addition, several studies demonstrate its ability to cause the brain to release both serotonin and dopamine, enhancing feelings of well-being and improving depression.

The heptapeptide Semax is an analog of the N-terminal fragment (4-10) of ACTH (adrenocorticotropic hormone) but lacks any hormonal activity. However, after intranasal application, it stimulates memory and attention in rodents and humans. Therefore, let me just mention that it’s also useful for Adult ADHD.

Dihexa: (Endogenous hexapeptide angiotensin IV) 

Dihexa “rules” when it comes to increasing BDNF. It’s a peptide derived from angiotensin IV, a metabolite of the naturally occurring vasoconstrictor angiotensin II. Angiotensin IV enhances memory acquisition, hippocampal consolidation, and recall in animals. In addition, Dihexa is seven times more potent than  BDNF itself!

Dihexa is a first-in-class oral compound that penetrates the blood-brain barrier to increase BDNF significantly. As a result, it improves memory consolidation and retrieval and neural processing speed and concentration. The bonus is that it helps drive down leptin levels quite nicely too.

Lower leptin by lowering Stress and cortisol levels

In the hours or even days after the experience of an ongoing stressful event, glucocorticoids (e.g., cortisol and similar substances)increase in the bloodstream. This phenomenon is important when considering what cortisol does to accumulate and store body fat. Glucocorticoids enhance the activity of the enzyme lipoprotein lipase in adipose (fat) tissue, leading to an increase in fat storage. This fat storage occurs even moreso in visceral (deep) fat, where lipoprotein lipase activity is higher. Therefore, chronically elevated cortisol levels contribute to visceral fat accumulation.

High cortisol can trigger sugar cravings for reasons which are not clear. It is one of the principal “drivers” of menopausal belly fat. If you are trying to build muscle, it inhibits that by being catabolic. It not only can decrease muscle mass, but it also reduces bone mass and can slow your metabolic rate by reducing adrenal and, therefore, thyroid functioning. Finally, it can trigger leaky gut syndrome, which causes systemic inflammation, another cause of leptin resistance.

And finally, glucocorticoids influence the function of leptin, whose usual role, as you recall- is to signal satiety and therefore suppress appetite. Although glucocorticoids stimulate leptin release from fatty tissue, they also reduce the brain’s sensitivity to leptin, contributing to leptin resistance.

In functional medicine, we strive to maintain a normal fasting cortisol level in our patients. Therefore, I often re-set the adrenals with adrenal adaptogens and adrenal glandulars. Sometimes I use integratives such as a magnolia bark derivative. Sometimes I will prescribe pure liposomal GABA. Often, I’ll rely on another BDNF-enhancing intra-nasal peptide called Selank.

Heptapeptide Selank: (Thr-Lys-Pro-Arg-Pro-Gly-Pro)

Numerous clinical studies have shown that Selank has strong anti-anxiety and, therefore, cortisol lowering effects. The clinical impact of Selank is similar to those of anti-anxiety medications such as Xanax or Valium-benzodiazepine drugs, which increase the activity of the calming brain chemical: GABA. We see this similarity of effect in several clinical trials, with the advantage of using Selank being its non-addictive properties and its ability to increase BDNF.

Inflammation-another cause of High Leptin

Chronic, low-grade inflammation is innately associated with various metabolic disorders, including obesity. Many complex physiologic pathways responsible for this phenomenon are currently under investigation regarding therapeutic, pharmacological intervention. Unfortunately, the discussion of the possibilities is far too premature for this article, which focuses on alleviating leptin resistance. So, let me make sure you know what chronic inflammation is, and then let’s go into how to take care of this particular issue.

What exactly Is inflammation?: Let me clarify the concept of “acute inflammation.” Think about getting a splinter in your finger. If you don’t remove it, the area turns red and gets puffy. That’s acute inflammation- a good thing, as it’s your body responding appropriately to the situation. It’s also your immune system flooding the area to fight off any viruses or bacteria that might have come in with the splinter. If you leave the spot alone with a physical injury, the swelling will go down, and everything will go back to normal. The signs of acute inflammation are swelling, heat, redness, and pain. The symptoms of inflammation will all resolve as healing occurs.

However, if you don’t remove the splinter and instead keep poking at the same spot, you will maintain high levels of inflammation. That’s what happens with chronic internal inflammation, but you can’t feel the splinter or the poking. The inflammatory response is short and precise. When it’s chronic, inflammation can be “silent,” make you feel fatigued or contribute to many other health problems. It can even make you look older! Here are the principal causes of chronic inflammation. 

Unhealthy diets: I know I sound like a broken record with this mantra, but it is imperative to eat a healthy diet. Commonly consumed foods considered” inflammatory” are highly-processed carbohydrates, sugary foods, high-industrial fat and seed oils, high-gluten, and quite frankly, all overly processed and fast foods. Unfortunately, this just so happens to be the typical U.S. diet. And a big reason why just about everyone who is not “taking this seriously” is chronically inflamed. Furthermore, this eating pattern causes oxidative stress, which worsens inflammation.

Gut hyperpermeability AKA “leaky gut”: This is another pervasive American problem due to eating habits, consumption of pharmaceuticals (especially antibiotics), high cortisol levels (especially since the COVID pandemic), and the increase of mycotoxin illness. It is easily treated (usually with a gut-specific peptide such as BPC-157). Still, first, you need to recognize that you might have no symptoms or minor symptoms such as gastrointestinal bloating or mild constipation. Since this is the root cause of all autoimmune disease, it’s always a good idea to treat this problem, no matter what.

Your weight: Fat cells are little inflammation-producing factories. The more you have and the bigger they are, the more inflammation they cause for your entire body. The risk of chronic inflammation is a guarantee if you are obese or even just overweight. Obese and overweight women and men have higher levels of inflammatory blood markers than men and women of the same age who are not overweight or obese. According to numerous clinical studies, inflammatory markers decrease when men and women lose weight.

Excessive omega-6 intake: Omega-6 fats form the building blocks for inflammatory eicosanoids, a vital part of the inflammatory response. High omega-6 status (especially when combined with poor omega-3 levels) translates to excessive production of inflammatory eicosanoids and an exaggerated inflammatory response to normal stimuli. Cut down on your omega-6 intake by reducing your intake of meat and dairy products. Lowering omega-6 intake has been demonstrated to lower leptin levels.

Insufficient omega-3 intake: Conversely, omega-3 fats are the precursors for anti-inflammatory eicosanoids. Poor omega-3 status means inadequate anti-inflammatory eicosanoids, which blunts the anti-inflammatory reaction to normal stimuli. It’s easy to get good blood levels: eat omega-3-rich fish such as salmon or sardines and take good omega-3 fish oil supplements. Let me mention that leptin also responds to flipping your Omega 3 to Omega 6 ratio.

Lack of sleep: Poor sleep causes elevated blood inflammatory markers in and of itself. Disordered sleep is a chronic problem in the U.S. We go to bed too late, wake up too early, don’t get enough hours of sleep, or we use too many electronics late at night and disrupt the sleep quality we get. I’ll get more into the topic of sleep in this article, as disordered sleep in many forms will raise leptin levels, and I definitely need to address this issue.

Chronic stress: I know we discussed cortisol earlier as an independent risk factor for elevated leptin levels. But I’d be remiss if I didn’t discuss the relationship to inflammation (independent of causing leaky gut, too!). Your body will have a physiological, inflammatory response to emotional stress, which, as you now know, translates to a high cortisol level.

Toxins: Heavy metals such as mercury and lead, as well as biotoxins such as mycotoxins and Lyme toxins, can cause chronic inflammation.

Lack of movement:  A lack of activity causes systemic, low-grade inflammation. We often sit for hours and then don’t make time for regular exercise. We need to get out of the Zoom room and make time to move more. Get up on your feet for two to three minutes each hour you’re sitting. Better yet, do some burpees, jumping jacks, or push-ups. And you may not even have to do “this much” to get positive health benefits. Recent data regarding exercise reveals that “exercise snacks” are great for your health. An exercise snack is as little as 1,2, or 3 minutes of activity. Use your imagination-it can be any sort of movement at all. Doing it just three times a day is demonstrated to be good for your health, even if you aren’t doing anything else that day that “counts” as exercise.

Lack of outdoor time: We all spend too much time cooped up in offices or, more likely “now,” in our home offices, doing those blasted zoom calls. We just don’t spend enough time in nature. Believe it or not, this lack of time out in nature can indeed cause low-grade inflammation.

Poor recovery and Overtraining: Some people move too much- over-exercising, with too little rest and recovery. Overtraining causes chronic inflammation. Obviously, this is a potential issue for elite athletes, but even casual bikers, swimmers, and runners can overtrain. I’m certainly not discouraging regular exercise, but over-exertion to the point of daily fatigue can cause inflammation, as well as elevated cortisol levels and disrupted sleep. Speaking of sleep, I’d like to focus a bit on this near-epidemic problem.

Poor sleep raises leptin

Both “regular” sleep patterns and circadian rhythms modulate daily metabolic shifts. Various sleep deficiencies associated with short sleep duration, insufficient sleep schedules, narcolepsy, sleep apnea, circadian misalignment (including shift work), and even sleep-related eating disorders contribute to metabolic dysregulation. Sleep deficiencies or circadian disruption, which cause or contribute to metabolic dysregulation, will contribute to weight gain and obesity by disrupting energy balance, causing inflammation, impairing glucose tolerance and insulin sensitivity, and raising leptin levels.

Disruption of sleep and circadian rhythms is increasingly evident as a contributing factor to impaired physiological function, especially concerning metabolic dysregulation, overweight and obese conditions. Ongoing research regarding regulating circadian rhythm with melatonin implicates melatonin as a possible way to improve leptin resistance. Once again, what dominates the literature is a “sleep peptide” called DSIP (delta sleep-inducing peptide).

DSIP  (Trp‐‐‐Ala‐Gly‐Gly‐Asp‐Ala‐Ser‐‐‐Gly‐Glu)

This highly effective peptide is useful for insomnia of all types; sleep interruptions, re-sleeping issues, and sleep induction problems-all, with enormous success. It is also effective for people with circadian rhythm issues; again, quite successfully. Although there have been no clinical studies looking at the use of DSIP in people trying to shed pounds, I have personally seen quite a correlation in my clinical practice. Of course, this is “anecdotal,” so take that with a grain of salt.

Poor Eating Habits and Leptin

Yes, I know we discussed weight loss, intermittent fasting and have touched on food choices; but now I’d like to get more in-depth about eating habits in general.

Over-eating: Independent of metabolic changes and weight gain, consistently “eating too much” in one sitting appears to raise leptin levels. Based on epidemiologic data, no one should consume much more than 500 calories in a single meal consistently. In addition, hedonically-loaded foods (the seriously fatty-sugary-tasty stuff) interrupt the inhibitory actions of leptin on orexin (satiety) neurons in the brain and interfere with the homeostatic control of feeding.

Specific foods: We discussed the concept of inflammatory foods, but it doesn’t stop there. Unhealthy, fast-food-type diets reportedly induce a different inflammatory response in the hypothalamus in animals. This hypothalamic response subsequently promotes the development of brain leptin resistance and then- obesity.

Protein consumption: In a few small studies, increasing dietary protein intake from 15% to 30% of calories (with a constant carbohydrate intake) produced statistically significant decreases in caloric intake, so those study participants lost weight. The mechanism by which this occurred is unknown, although the theory is that it somehow causes increased brain leptin sensitivity.

Omega-3/6 content in the protein we consume: Whether due to a decrease in inflammation, or other factors, when we increase our Omega 3 fatty acid intake via supplements or fatty fish, and we decrease our Omega 6 fatty acid consumption by substituting plant-based eating for meat and dairy, we see reduced leptin levels.

SIRT1 Enzyme Dysfunction raises Leptin

SIRT1 is a NAD(+)-dependent protein deacetylase enzyme. If you have SIRTT1 dysfunction, you typically have issues with glucose and cholesterol. You also usually have some degree of fatigue caused by decreased NAD(+) levels due to decreased mitochondrial function. In addition, SIRT1 activity improves both leptin sensitivity and insulin sensitivity; conversely, a SIRT1 deficit will impair these pathways. NAD(+) is necessary to transfer energy from cell to cell and help carry out numerous metabolic functions.

Overall, SIRT1 in the hypothalamus improves energy (NAD+ levels), glucose control, and leptin and insulin sensitivity. Both SIRT1 and NAD(+) levels decrease with age in the brain’s temperature regulation center- the hypothalamus. Increased hypothalamic SIRT1 levels prevent age-associated weight gain and improve leptin sensitivity in mice. Therefore, avoiding the age-dependent (as well as disease-dependent and toxin-dependent) loss of SIRT1 and NAD+ function in the hypothalamus could potentially improve leptin sensitivity.

Exciting studies that look quite promising involve improving SIRT1 and, therefore, leptin sensitivity with IV NAD+, intra-nasal NAD+ or oral nicotinamide ribonucleotide (NMN). I use these modalities in my practice currently with (again anecdotally) notable success.

Odds and Ends

I didn’t mention that high triglyceride levels will contribute to leptin resistance. In this day and age, all primary care doctors know that high triglycerides are an independent cardiac risk factor and, therefore; treated accordingly. So, there’s that. I also didn’t discuss metformin as a viable treatment for leptin resistance, even though doctors routinely use it to treat metabolic issues in women with PCOS (polycystic ovary syndrome).

The reason for that is not due to any inherent danger of metformin use-in fact-it is a pretty safe drug; it just doesn’t work all that well for leptin resistance. Now, let me get into the “mentions” of things that didn’t quite make the cut for having enough data, but they are things that make sense to me (given the data we have), or the emerging data is super-promising. Here they are.

Autophagy is a term that you will be hearing about more and more as a contributor to disease and aging. It’s a process by which cells remove and recycle junk proteins, and some studies link it to leptin resistance. No matter what, we are starting to recommend “meds” to enhance autophagy even now. Next, let’s discuss hormones, many having positive effects on aging, disease, and metabolic issues, including excess fat. In particular, estrogen deficiency is likely to cause leptin insensitivity in the brain based on good animal data.

And believe it or not, there is more research about how what we eat might impact leptin. Some theories suggest that lectins (e.g., gluten, beans, grains, dairy, nightshades)  bind to surface receptors of cells–including leptin receptors–and mimic or block the effects of that receptor. This theory posits that lectins could interfere with the function of leptin, exacerbating leptin resistance. To “cover all bases,” I advise my moderate to severely leptin-resistant patients to avoid lectins.

New data is evolving consistently regarding the use of cold therapy, whether that be cold showers, ice baths, or even cold weather. Of course, cold might play a role in leptin regulation, so stay tuned for more data on this. But, at least we know that cold is excellent for your mitochondria and, therefore, your energy levels, so why not?. One last and critical note- if you are trying to lose weight and have leptin resistance, don’t do a ketogenic diet, or it will worsen the leptin problem; seriously! (Use keto for insulin resistance).

In my clinical practice, I find that adjusting eating and exercise plans, normalizing cortisol, sleep (often using DSIP), and prescribing NMN and dihexa do the trick every time. The “weight loss peptide” AOD-9604 then “kicks in” when leptin is low enough to allow it to accelerate lipolysis. Bon appetit!

The Basics of ADHD in Adults

ADHD is the most common psychiatric disorder of childhood. It is classified as a neurodevelopmental disorder that may persist from childhood into adulthood. In childhood, it is associated with inattention, hyperactivity, and impulsivity. Symptoms often change as a person gets older and are associated with an increased risk of developing depression, anxiety, and substance abuse. However, recent studies have challenged the idea that every adult with ADHD had it as a child. The results of those studies show the following. First of all, ADHD often goes unrecognized throughout childhood. Secondly, families may help children develop good compensation strategies. The conclusions, therefore, remain that, indeed, ADHD in adults is still considered a continuation from childhood.

Attention-Deficit/Hyperactivity Disorder (ADHD) is often a disabling condition in adults. As just noted, a significant portion of patients is not diagnosed during childhood, as diagnosis of the syndrome can be complex, especially when other psychiatric conditions are also associated. As undiagnosed ADHD patients age, they are presenting to memory clinics with attentional and executive disorders. Neuropsychological examinations of these undiagnosed ADHD patients often reveal atypical cognitive profiles that complicate the usual diagnostic procedures for ADHD and increase the risk of misdiagnosis. Therefore, first and foremost, it is recommended that any explorations of cognitive and/or behavioral disorders in adults should systematically screen for ADHD. Let’s now explore adult ADHD symptoms, usual remedies, and then functional alternatives.

  • Is it possible for Adults to Develop ADHD out-of-the-blue?
  • What are Adult ADHD Symptoms?
  • Typical Medical Treatment for ADHD in Adults
  • How do the medications work?
  • What’s the problem, then?
  • Cortisol
  • Cortisol part deux
  • The gut-brain axis
  • Fixing the ravages of high cortisol
  • Repairing the gut lining
  • Repairing the Microbiome
  • Behavioral and supplemental interventions
  • The cool stuff: peptides
  • Miscellaneous “other”

Can Adults Develop ADHD?

Adults can have ADHD, of course.  About 4% to 5% of U.S. adults have it. But surprisingly, few adults get diagnosed or treated for it. Instead, they often end up being evaluated at memory care centers, as noted above.

Who develops adult ADHD? Every adult who has ADHD has probably had it as a child. Some may have been diagnosed and known it. However, some adults may not have been diagnosed when they were younger and only find out later in life due to having “life issues” crop up, which will be discussed below.

While many children with ADHD do outgrow it, about 60% still have it as adults. Adult ADHD affects men and women equally. Many questions of late-onset ADHD remain incompletely answered, and further research is necessary to understand better and explain the etiology and development of this late-onset disorder. One very important thing we are noticing, and reporting: CIRS patients all have difficulty concentrating and often come to me on Adderall.

What are Adult ADHD Symptoms?

If you have adult ADHD, you might have difficulty with the following:

  • Ability to concentrate and focus on tasks
  • Task organization
  • Following directions
  • Remembering information
  • Finishing work on time or deadline

If you have ADHD, you may have trouble with one or more of the following:

  • Anxiety
  • Mood swings
  • Procrastination
  • Poor organization skills
  • Low tolerance for frustration
  • Trouble concentrating when reading
  • Chronic lateness and forgetfulness
  • Impulsiveness
  • Depression
  • Chronic boredom
  • Depression
  • Trouble controlling anger
  • Low self-esteem
  • Substance abuse or addiction
  • Low motivation

What is the Typical Medical Treatment for ADHD in Adults?

In a word: Stimulants! Adults with ADHD have usually been prescribed stimulant medications. As a result, studies demonstrate that about two-thirds of adults with ADHD have big improvements in their symptoms, at least at first.

Typical medications used include:

  • Amphetamine/dextroamphetamine (Adderall, Adderall XR)
  • Lisdexamfetamine (Vyvanse)
  • Methylphenidate (Ritalin, Concerta, Metadate, Daytrana, Quillivant XR, and Methylin)
  • Dextroamphetamine (Dexedrine)
  • Dexmethylphenidate (Focalin)

Studies suggest that these drugs improve (the happy brain chemical)- dopamine transmission by increasing its levels in the striatal region of the brain. Researchers have found that most amphetamines promote dopamine release, while Ritalin blocks the transporters that remove dopamine, keeping levels up. Ritalin also seems to improve norepinephrine transmission as well. This is all well in good, but amphetamines stimulate the adrenal glands to produce more and more cortisol over the long term. So-what’s wrong with that? Plenty.

Let’s Talk about Cortisol

Cortisol modulates many of the changes that occur in the body in response to stress. These include things like blood sugar levels and blood pressure. Cortisol has firm control over proper immune responses. It has anti-inflammatory activity. It also activates our entire nervous system by being coupled with adrenaline (epinephrine) release. As a result, it has a role in sleep, mood, energy, anxiety levels, and more. Short term, it acts in a beneficial way to help us through stressful situations. However, long-term adrenal stimulation by amphetamines causes persistently elevated cortisol levels, which definitely can become a problem. Here’s why.

What happens with long-term high cortisol?

Cortisol helps us deal with stress by shutting down “unnecessary functions,” like reproduction and the immune system, to allow the body to direct its energy towards dealing with the stressor. These functions are supposed to be short-lived to deal with the stress. However, our modern lives are full of stress, and when stress is chronic or caused by amphetamines, this becomes a problem.

Cortisol partially shuts down the immune system when levels are high. It interferes with T-cell (a type of white cell) production and function, making your body more susceptible to pathogens like viruses, bacteria, and fungi. Ever notice how people who are constantly under stress are also always getting sick? This is why.

Cortisol also affects your muscles and bones. Cortisol is “catabolic.” It inhibits the uptake of amino acids into muscle cells, making it impossible to fuel muscle cells. It also inhibits bone formation and decreases intestinal calcium absorption. So when cortisol is high, there’s minimal to no bone growth and little muscle growth going on. And yes, there’s more when you have long-term high cortisol levels.

Adults with ADHD tend to have BDNF levels on the low side of normal for reasons still unknown. BDNF is “brain cell food,” so it’s important to continue neurogenesis throughout our lifetimes. Add high cortisol to the mix, and first, we see gut hyperpermeability. Why? High cortisol can cause the breakdown of your GI lining. It does this by slowing down both GI motility (peristalsis) and the process of digestion. When this happens, some people experience reflux, or “heartburn,” while others have absolutely no symptoms. Blood flow then decreases to all of the digestive organs. This results in a higher concentration of toxic metabolites, which then whittle away at your gut lining.

We then see a breach in the gut-brain barrier, the slow-down of conversion of neural stem cells into neurons, and the further lowering of BDNF needed for that process to happen. Cortisol has even been shown to be a direct neurotoxin!  The result=impaired cognitive performance in terms of memory, executive functioning, speed of thought, and so on. It usually all starts with a little “brain fog.”  More about the gut-brain barrier next.

In addition, we see dampened thyroid function, blood sugar imbalances,  insomnia, osteoporosis, blood pressure elevations, lowered immune function, and universally- increased abdominal fat

What happens to the gut-brain axis?

Much recent research shows that changes in gut microbiota could affect the brain’s cognitive, behavioral, and basically- all physiological functions. Although the exact mechanism of the connectivity of the gut-brain axis has not yet been elucidated, the evidence shows that gut microbiota plays an important role by producing immune factors, hormones, and metabolites that influence brain functioning.

Stress, meaning high cortisol, can significantly impact the microbiota-gut-brain axis. Recent studies have implicated the gut microbiota in many brain conditions, including anxiety, autism, Alzheimer’s disease, schizophrenia, and Parkinson’s disease. In addition, ongoing research implicates diseases such as obesity, heart disease, and diabetes.

Fixing the Effects of High Cortisol

When we finally stop someone’s amphetamines, we still have the carnage caused (often) by years of taking them with resultant years of high cortisol levels. We know cortisol is a direct neurotoxin, likely being a risk factor for Alzheimer’s disease. We know all of the things mentioned above. However, when we’re talking about the root cause of Ulcerative colitis, Crohn’s disease, or any autoimmune disease for that matter, we see the direct effect high cortisol has on the gut. As previously mentioned, sustained high cortisol can be the sole reason for having a leaky gut. But for adult ADHD symptoms controlled by the “traditional drugs” discussed previously, it often requires someone to actually experience cognitive changes to bring them to a doctor such as myself. So what do we do?

First, we lower high cortisol levels. Adrenal (herbal) adaptogens, glandulars, liposomal GABA, and certain aromatherapy oils are proven to lower cortisol levels. Stress-reducing techniques such as “vagal breathing,” meditation, and yoga are great practices to maintain overall health as well as lower cortisol levels. Finally, just activating your hypoglossal nerve (the nerve to the tongue and vocal cords) and, therefore, your adjacent vagal nerve to tone down your sympathetic nervous system will help. All you need to do is gargle, sing or do vocal exercises. We also always need to fix the gut lining and the microbiome. Here’s how we do it.

Heal the gut 

The pentadecapeptide BPC-157  (Gly-Glu-Pro-Pro-Pro-Gly-Lys-Pro-Ala-Asp-Asp-Ala-Gly-Leu-Val) has been demonstrated to counteract peritonitis, and heal upper intestinal lesions, heal colitis lesions and seal up a hyperpermeable gut lining.

Gastric pentadecapeptide BPC 157, now found to be effective in the upper and lower GI tract, is remarkably free of side effects, as are the other peptides being used in functional medicine. More about peptides to follow.

Re-Balancing your Disturbed Microbiome 

By definition, when you have gut hyperpermeability, you have more “toxic bacteria” than “healthy bacteria” populating your GI tract.  Use prebiotic fiber to feed the good bacteria and (if you are not in a “mold and mycotoxin situation” a little bit of “good yeast” (Saccharomyces boulardii) to begin to re-create a healthy gut microbiome. If you like un-ripe bananas, they make great prebiotic fiber. Other foods include asparagus, Jerusalem artichokes, red onions, and naturally fermented (not pickled) foods such as sauerkraut.

When your gut lining is coming together-usually the 2 to 3-week mark, add probiotics. Historically, we have recommended 50 to 100 billion probiotic CFU’s per day. A mixture (in your main probiotic) of Lactobacillus species and Bifidobacterium species is probably fine. Still, even more evidence supports the use of sporulating probiotics for an even better microbiome. These probiotics are species of Bacillus with b. subtilis and b. coagulans being the most studied. Start as low as 5 billion and increasing to as many as 25 billion CFU’s daily (best done under a doctor’s supervision if you have GI symptoms). But now that you’re weaning from ADHD stimulants, what do you do?

Food, Exercise, Sleep, Therapy, and Supplements 

Studies have associated poor attention and worsened  ADHD symptoms with diets full of the unhealthy things we tell you not to eat, such as refined sugar and fried foods. In addition, artificial food colorings and the preservative-sodium-benzoate may worsen ADHD-hyperactivity in children but otherwise hasn’t been studied for other effects or in adults.

According to some good clinical evidence, regular exercise may reduce adult ADHD symptoms. And I don’t believe I need to tell you that poor sleep quality impairs attention and other cognitive functions, worsening ADHD symptoms.

Cognitive-behavioral therapy has been shown to improve ADHD symptoms in adults. In addition, mindfulness-based therapies improved ADHD symptoms in multiple studies, mostly in adults as well.

Supplements that might be useful: ADHD patients tend to have lower magnesium levels than average, with the caveat that most of us not on MG supplementation are a bit deficient. At any rate, in two clinical trials, magnesium supplementation did indeed improve adult ADHD symptoms. Similarly, there is a higher prevalence of vitamin D deficiency in ADHD patients, and studies suggest that supplementation is helpful. Finally, fish oil supplementation appears to be quite promising, is anti-inflammatory, and is usually a good “health practice” anyway.

L-Tyrosine: This amino acid is being discussed separately because the data supports its use in adults with ADHD. A review of 15 clinical trials concluded that L-tyrosine (a dopamine precursor) boosts attention and cognitive performance in stressful and demanding situations in normal adults. These were not trials done with adult ADHD symptoms, but the extrapolation of that data to patients with ADHD has resulted in numerous clinical reports of the same benefits. There is less data on SAMe (S-adenosyl-L-methionine), but one study indeed suggested that it might be a useful way to increase dopamine and norepinephrine.


Peptides are small chains of amino acids that make up proteins and are available in every part of your body. Because peptides can be found in any part of the body, they each have particular functions. They act as messengers, signaling specific glands and proteins into performing specific tasks. These; essentially bioidentical substances have been isolated and replicated for use by Functional Medicine doctors. Since they are bioidentical, there are no side effects. They are an amazing addition to our arsenal of treatments, and there happen to be three that are quite useful for adult ADHD symptoms.

Heptapeptide Semax: (Met-Glu-His-Phe-Pro-Gly-Pro) 

Semax is considered a brain-enhancing or “nootropic” peptide due to its ability to increase BDNF:brain-derived neurotrophic factor, nick-named “brain fertilizer,” since it is the largest (neurotrophic) stimulator of neurogenesis. In addition, Semax has also been found to be a potent enkephalinase inhibitor. In other words, the enzyme that destroys the natural painkillers and anti-anxiety brain chemicals called enkephalins is blocked by Semax, which has been independently proven to reduce anxiety and, therefore, likely decrease cortisol. In addition, several studies demonstrate its ability to cause the brain to release both serotonin and dopamine, enhancing feelings of well-being and, more-than-likely (due to the dopamine boost) attentiveness.

The heptapeptide Semax is an analog of the N-terminal fragment (4-10) of ACTH (adrenocorticotropic hormone) but is absent any hormonal activity. However, it has been found to stimulate memory and attention in rodents and humans after intranasal application. In addition, evidence from animal studies reveals that Semax augments the effects of psychostimulants on central dopamine release.

As noted above, it stimulates central brain-derived neurotrophic factor (BDNF) synthesis. In addition, Semax is thought to improve selective attention and modulate brain development. Since ADHD is likely to be a neurodevelopmental disorder with disturbance in both dopamine and BDNF function production, it is proposed by many neuroscientists that Semax may have excellent therapeutic potential in ADHD. In Russia, this peptide is used as a common alternative for drug therapy for children with ADHD. In addition, functional doctors in the U.S. prescribe it for mood issues, adult ADHD symptoms, cognitive and pain issues.


This peptide is widely used in Europe and Russia but not approved in the U.S. However, it has been studied for many years and is a go-to for adult ADHD in other countries. Numerous studies show that this peptide increases cognitive functioning and attention with decreased impulsivity in children and adults with ADHD.


Dihexa is a peptide derived from angiotensin IV-a metabolite of the potent, naturally occurring vasoconstrictor angiotensin II.  Angiotensin IV  has been shown to enhance acquisition, consolidation, and recall of memory and learning in animal models.  What’s more, the peptide Dihexa has been determined to be seven orders of magnitude more potent than BDNF. Thus, you first read about BDNF as the potent neurogenesis stimulant, but there’s more to it than simply being a cognitive enhancer.

Brain-derived neurotrophic factor is the most dominant neurotrophin in the CNS (central nervous system). It plays a crucial role in physiological brain functions via its two independent receptors: tropomyosin-related kinase B (TrkB) and p75. These two activities are critical during neurodevelopment. In addition, the disrupting of BDNF signaling has been documented in many neuropsychological diseases, including ADHD.

Dihexa is a first-in-class compound that is orally active, penetrates the blood-brain barrier, increases BDNF, improves memory consolidation and retrieval as well as concentration and neural processing speed.

Miscellaneous Functional Medicine tools 

Deserving of more than an honorable mention is functional medication likely to be helpful with adult ADHD symptoms. While definitive research is pending, the logic is compelling for the following.

Oral nicotinamide mononucleotide supplementation increases intracellular NAD+ concentrations, improving mitochondrial biogenesis and ATP (mitochondrial energy) output. It is well known that the brain has an enormous supply of mitochondria, so mitochondrial enhancement should, in theory, benefit all brain functions.

The peptide selank increases BDNF and decreases levels of anxiety by increasing concentrations of GABA in the brain. Due to the importance of BDNF enhancement and, in some cases, lowering anxiety to ameliorate adult ADHD symptoms, it makes sense to utilize this peptide. But, again, data is pending on these two measures.


Doesn’t everyone Know about Low Testosterone Treatment by now?

In a word: no! As a Functional Medicine doctor, about 2/3 of the “hormone therapeutic requests” I receive involve either menopausal symptoms or symptoms of low testosterone. Women read Suzanne Somer’s books. Men don’t seem to have a “go-to” for good information, so, from what I hear, they seem to have many misconceptions about testosterone treatment.  In this article, I’ll discuss testosterone replacement therapy risks and benefits, including:

  • How testosterone works
  • What are the signs/symptoms of low-T A.K.A. male hypogonadism?
  • Why do testosterone levels decline?
  • What’s the latest on testosterone and heart disease?
  • What should my testosterone level be?
  • What’s the best way to replace testosterone?
  • What about raising testosterone levels without using testosterone?
  • Testosterone replacement and future fertility
  • Erectile dysfunction
  • Libido
How does Testosterone Work, and What does it do?

Testosterone is the male sex hormone, just as estrogen and progesterone are the primary female sex hormones. Although women do indeed produce testosterone (and at some point might need replacement), this article will focus on men.

In men, testosterone is the main hormone produced in the testicles and secreted by the testes. It promotes libido (sex drive), aggressiveness, and sexual desire. It also stimulates the growth of certain organs, producing sperm, and nourishes all the tissue of the male urinary and reproductive systems. In addition, testosterone promotes protein anabolism which is the use of protein to build muscle, skin, and bone, and mitigates against protein catabolism or breakdown. It also regulates the production of prostaglandins, which (research shows) seems to keep prostate growth under control. 

The effects of testosterone are most pronounced during puberty. In fact, it brings on the enlarged larynx, thicker vocal cords, new body hair, increased muscle mass, and increased oil-gland secretion by the skin commonly associated with puberty.

Some telltale signs of hypogonadism (“Low-T”)

Testosterone deficiency can cause memory, mood, and sleep issues, usually resulting in interrupted and unrefreshed sleep and next-day brain fog. Energy is also impacted, with an all-day feeling of sluggishness, which often includes lack of drive, inability to start an exercise regimen, and loss of muscle mass.

In addition, libido is down, and erectile dysfunction is possible, but (believe it or not) E.D. is usually not due to having a low testosterone level. More on this topic to come. Here are the symptoms laid out as bullet points.

  • Irritability
  • Depressed mood
  • Aches and pains in the joints
  • Poor sleep
  • Cognitive impairment
  • Decreased energy
  • Decreased libido with or without erectile dysfunction
  • Osteoporosis if it goes on for a while
  • Loss of weight due to muscle mass loss and fat gain
  • Mild regression of secondary sexual characteristics

If you are experiencing the symptoms described above, there is always the possibility of a testicular or pituitary issue. This is the main reason I implore you not to “cheap out” and go to an online source or a “hormone mill” for your testosterone replacement. Now, these two reasons aside, I’ll discuss why (typically) men develop low testosterone levels, which include other primary causes of hormone deficiency syndromes.

What causes low testosterone?

Hormonally and physically speaking, your body peaks around age 25. Unfortunately, we often assume things like a decreased libido, foggy memory, mid-life weight gain, hair loss, and wrinkles are simply a part of “getting older.” Even worse, that’s what most non-functional doctors think too! However, we can relieve these symptoms with the use of bioidentical hormones and peptides

Before jumping into a discussion about hormone replacement, a thorough workup is necessary to rule out (or diagnose and then treat) excess weight issues, inflammation, tumors, medications, smoking, excess alcohol, diabetes, HGH deficiency, inactivity, toxins, food allergies, head trauma, groin trauma, pituitary or testicular tumors, leaky gut, silent autoimmune disease, and even high cortisol (and then subsequent leaky gut) from excessive stress. Believe it or not, all of these things can cause significant drops in testosterone levels, and oftentimes, testosterone replacement therapy isn’t even needed! In addition, every single mold and mycotoxin illness male patient I see has anterior pituitary involvement and low testosterone that can and should always be resolved without resorting to supplemental testosterone.

A brief note here about chronic pain as a cause of low testosterone and lack of treatment as a further exacerbation of any existing pain. Pain can cause disruptions in the pituitary-hypothalamic axis to lower testosterone physically. Opiates will further lower testosterone. And then, as mentioned, having low testosterone amplifies pain. Just be aware of this phenomenon for yourself or a loved one.

Low testosterone can also be caused by previous use of testosterone for (oftentimes) bodybuilding purposes. Further, a permanent interruption of the pituitary-testicular axis with “unresponsive testes” may be present after normal dosing for only a few months. Again, let me emphasize that a great form of natural hormone balancing is to fix the underlying cause of the hormonal issue(s). When underlying problems are properly addressed, we can assess whether or not testosterone replacement is actually needed.

After a good medical check-up and a visit with a Functional doctor specializing in bioidentical hormones, it’s time to discuss testosterone replacement therapy. What most men think about when they think “Low-T” is “andropause,”; the gradual waning of testosterone levels usually occurring in men in their 50’s, but sometimes as early as the late 30’s. But are there cardiac risks to using HRT? Should men worry about an increased risk of heart disease if they replace their testosterone? Let me show you the data on that.

Testosterone and Heart Disease Risks

Several years ago, there was a big stir with editorials in the Wall Street Journal and New York Times, reporting on a study showing a correlation between testosterone replacement and coronary artery disease. That particular study was farcical, as the diagnosis of low testosterone was based on symptoms, not lab testing, and replacement was performed by primary care doctors who didn’t check post-treatment testosterone levels. Furthermore, cardiac risks pre-testosterone treatment were poorly documented. Indeed, a lot of chaos was created by one study which should not have been published. Here’s the reality.

Positive Cardiac Effects of testosterone replacement

Hundreds of studies since the 50’s show that adequate testosterone helps prevent heart disease. For example, a recent comprehensive study reviewed men who had existing heart disease. Researchers studied 755 male patients, 58-78 years of age, who all had severe coronary artery disease and low testosterone levels. They were separated into three different groups, receiving various doses of testosterone, administered intra-muscularly or by a gel.

At the end of the first year, 64 patients who weren’t taking any testosterone supplements had severe adverse cardiovascular events. This included only 12 who were taking medium doses of testosterone and nine who were taking high doses. After three years, 125 patients who had not received testosterone therapy suffered severe cardiovascular events, whereas only 38 medium-dose and 22 high-patients did.

Patients who were given testosterone as part of their follow-up treatment did much better than patients who had not been given testosterone supplementation. However, the non-testosterone-therapy patients were 80 percent more likely to suffer an adverse cardiac event. This study also confirms the findings of a previous study from the same researchers, which found that testosterone therapy did not increase the risk of experiencing a heart attack or stroke for men with low testosterone levels and no prior history of heart disease.

Mayo Clinic’s Review of the Effects of Testosterone Replacement

The Mayo Clinic published a large 2018 review of the effects of testosterone replacement based on numerous studies. Here is a summary of their summary.

Randomized controlled studies confirm that testosterone replacement improves cardiac blood flow in men with chronic stable angina (chest pain) and chronic heart failure. These effects persist for at least one year. Testosterone is a coronary vasodilator as well as having other positive vascular actions on other arteries.

The same well-done studies have consistently shown that testosterone replacement therapy reduces fat mass and increases lean mass. In addition, the effect of testosterone on BMI plus waist circumference shows that benefits gradually accrue over several years. Testosterone is also beneficial for regulating carbohydrate and lipid metabolism, positively affecting metabolic pathways, all of which contribute to cardiovascular risk benefits. Further, testosterone replacement in men with type 2 diabetes and hypogonadism improves all-cause (including cardiac) mortality.

Results of a 2020 and a 2021 Analysis

In 2020, a large study concluded that testosterone replacement therapy posed no increased cardiac risk in men with no prior coronary artery disease and men with coronary artery disease. In addition, a retrospective, large-scale study published in 2021 showed a far greater risk of low testosterone causing COVID deaths in men than any cardiac risk to all testosterone-replaced men. The bottom line: testosterone “done right” with aromatization (estradiol conversion) controlled properly is (sum-total) “good for you!”

Endocrine and Urological guidelines for replacement of testosterone

There is a consensus of who needs treatment from the Endocrine and Urological medical communities. In short, they recommend therapy for men with symptomatic testosterone deficiency to either induce or maintain secondary sex characteristics such as muscle development, deep voice, and hair distribution on the chest and face and correct symptoms of hypogonadism. They (of course) strongly discourage starting testosterone treatment in patients who have fertility plans. Contraindications to therapy also include prostate cancer, palpable prostate nodule(s), a prostate-specific antigen level in all men of over 4 ng/mL, or a PSA level greater than 3 ng/mL in men at increased risk of prostate cancer without further urological evaluation. Included in the restriction on therapy are an elevated red blood cell count, untreated sleep apnea, uncontrolled heart failure, and even (per Endo guidelines) stroke or heart attack within the last six months.

Regarding actual testosterone levels, it is suggested in the “conventional literature” that treating Physicians aim for testosterone concentrations in the mid-normal range. That would be 590 ng/dL of total testosterone and 12.35 pg/mL of free testosterone. However, most scientific articles don’t discuss free testosterone and recommend a total testosterone level of 350 ng/dL. Wow, that’s a low-ball recommendation in the opinion of most hormone-replacement experts. After prescribing testosterone replacement therapy for many years, I will tell you that men get symptomatic with a Free testosterone of 12 or less as a rule of thumb. So let me clear things up here regarding “how much” testosterone you need.

Adequate Levels of Testosterone

As clinicians, we seek to replace testosterone to levels where our male patients will have good sleep, energy, libido, optimized moods, and optimal metabolic results from testosterone replacement. Too little yields inadequate clinical results; too much might compromise glucose control; the whole “roid rage thing” involves huge doses, which is a lot more than a legitimate doctor would prescribe. Those of us in the Functional Medical community look at symptoms and aim for a free testosterone of about 15-18 pg/mL. 

We also take into account a man’s albumin and SHBG (sex hormone-binding globulin) levels, as these will affect the amount of “free and unbound” testosterone, which is the best number to calculate if we’re looking for “the magic number.” Unfortunately, there is not always a good correlation between total T, free T, and free and unbound T, which is why I always say you need a hormone specialist to do any hormone replacement correctly. 

What’s the best form of treatment?

There are two types of hormones available for hormone replacement therapy: synthetic hormones and bioidentical hormones. This is important to know because of potential side effects.

Various formulations of exogenous testosterone replacement therapy exist, including oral, buccal, intramuscular, transdermal, subdermal, and nasal preparations. Bioidentical hormones are made to yield products that are biological replicas of the substances produced by our bodies. This is why they do not produce undesirable side effects when administered correctly.

In contrast, synthetic hormones are not biologically identical replicas. As a result, their use can result in severe side effects, as evidenced by clinical studies. Furthermore, bioidenticals have been shown by most clinical studies to be protective when administered properly. This can only be accomplished by a physician who has specialized in this field.

The most commonly prescribed forms of testosterone replacement therapy including commercial gels or compounded creams, injectables, and pellets. Commercially available gels are synthetic but will get men to testosterone levels which are “generally medically acceptable” but not to the levels of optimal symptomatic control as described above. Compounded bioidentical topicals come with the “hassle” of having to air dry plus the concerning factor of transfer to other humans (children and spouses) and even pets. However, this hassle factor has been reduced recently with the advent of special topical compounding formulations, so it’s still a good option.

Then there is the weekly IM or sometimes sub-q injection which is my preferred delivery system. I choose to use testosterone cypionate because after one biochemical “cleavage,” it is considered one of the most bioidentical hormones we use. Lastly, there are pellets, which generally last 3 months. The pellets are implanted into the subdermal fat of the buttocks, lower abdominal wall, or thigh with a tunneling technique using a local anesthetic.

The benefits of this method include guaranteed compliance and lack of transference to persons who may come in contact with it. Adverse effects include pellet extrusion, infection, and fibrosis. Due to the need for a surgical procedure for implantation and the sequela of side effects, this form of HRT is not recommended as a first-line treatment. Now, that said, some doctors want to “make a buck,” and they offer pellet therapy as their only choice. But we don’t always need to use testosterone, either.

Raising Testosterone without Exogenous Testosterone


Selective estrogen receptor modulators

SERMs are pharmaceuticals that act as competitive inhibitors of estrogen receptors in the hypothalamus and pituitary gland. They increase (via stimulation) the release of what is called gonadotrophins. These gonadotropins then increase the production of intra-testicular testosterone. Clomiphene citrate is a SERM that has been used to increase testosterone levels and sperm counts. Although thromboembolic events and carcinogenesis have been reported as  (uncommon) adverse effects of SERMs, it appears to be a safe short-term solution for many patients who have (as an example) mold toxin illness and other toxin-related issues.


Gonadotropin therapy (most commonly hCG-human chorionic gonadotropin) is typically used to manage infertile patients with low testosterone concentrations to recover normal sperm production. Additionally, treatment with hCG can usually preserve normal sperm production in men undergoing TRT by maintaining intratesticular testosterone concentrations. However, gonadotropin therapy’s potential side effects include gynecomastia (“man-boobs”), headache, fatigue, and mood changes.

What if I have low T and want a family?

First, you will need a sperm count performed, and if you are lucky enough to have a normal one, you need to deep freeze your sperm. However, if your count is low, then we try to increase your count with Clomiphene citrate and HCG (human chorionic gonadotropin), as discussed above. If you respond favorably, you’ll have a decent count or a “combinable samples count,” and you can freeze your sperm then.

To emphasize, do not start taking testosterone if you are planning to have children. Despite the findings just mentioned, a sizeable percentage of men who are given SERMS or Gonadotropins along with their exogenous testosterone is never able to have their pituitary-testicular connection re-established and are therefore unable to conceive. Therefore, I will not prescribe testosterone to a young man who has not frozen his sperm.

E.D. and the Role of Testosterone

Contrary to popular belief, low testosterone is less of a cause of erectile dysfunction than diabetes, pre-diabetes, or vascular disease. If you have E.D., a thorough check-up and lab testing are necessary. Once the metabolic issues are cleared up, we can focus on erectile function. Chances are, if you are in the age group that is more at risk for metabolic issues, you will also have low testosterone. In this case, testosterone replacement will obviously be of benefit, too. But if it’s “not enough,” what then? You’ve heard about viagra, Cialis and might have even tried one of these drugs. But I’ll bet you haven’t heard about PT-141, which I’ll bet you’ll find quite interesting!


PT-141 is a “peptide,” and more specifically, it’s a natural melanocortin with the following simple amino acid sequence: Asp-His-D-Phe-Arg-Trp-Lys-OH. It was originally studied in men who had not achieved a satisfactory response to viagra. It has been studied and compared to all of the PDe5 inhibitors (viagra, Cialis, and Levitra), and amazingly enough, it is superior to all of them. Therefore, I prescribe it as an intra-nasal spray, a troche (lozenge), or a subQ injection.


I would be remiss if I didn’t address “libido,” which will address female needs and male needs for this one last section. The reason for this is simple; what good is it if you have an amped-up libido if your female partner is never in the mood, right? This is where, unbelievably enough, we again can discuss PT-141, the E.D. peptide discussed above. It seems that a very nice “side effect” researchers discovered was that PT-141 not only improved E.D.; it also made the male study subjects noticeably more, well–horny! It was subsequently studied in men and then in women. Long story very short: it works! Yes, in both men and women.

Another peptide called (seriously) kisspeptin is another way to amp up libido in men and women. It appears to act on the limbic (emotional) system, making it possible to combine therapy with both PT-141 and kisspeptin for those who require it.


Natural Ways to Lower Blood Pressure: Intro

If you are not currently among almost one-half of U.S. adults with high blood pressure, then the odds are that you might develop high blood pressure at some point in your life without some preventive measures. In this article, I’ll discuss all of the proven natural ways to lower blood pressure.

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure is called secondary (rather than primary) hypertension (HTN), with those underlying conditions spelled out in this article. All types of hypertension increase your risk for serious health problems, such as stroke, heart disease, ocular blood clots, kidney failure, and dementia. So, it’s clear you want to have normal blood pressure. Below you will find a blueprint for achieving your health goals naturally, which will cover the following:

  • Eliminate the basic HTN risk factors
  • Do the “right” type of exercise
  • Eliminate two toxic types of foods right off the bat
  • Address the major metabolic issues: blood sugar, insulin, and leptin
  • Normalize your weight
  • Balance your omega fatty acids
  • Eliminate internal inflammation and oxidative stress
  • Control your stress levels
  • Fix your broken microbiome
  • Banish toxins
  • Increase nitric oxide
  • Increase vitamin D
  • Consider other foods, supplements, and integratives

The Basics of Treatment for Hypertension

Let’s first review risk factors you can easily control. For example, you can stop smoking, control alcohol consumption and, for those who are “salt-sensitive,” control your salt consumption. In addition, you can increase potassium-containing foods (such as bananas and raisins) and take a good magnesium supplement. Estimates show that 80% of Americans are magnesium deficient, and magnesium relaxes vascular smooth muscle; to directly lower blood pressure. In addition, your weight and the amount of exercise you do affect your blood pressure.


It’s important to have an exercise regimen that will help to lower your insulin levels. Studies have traditionally shown that “cardio”  or “aerobic” activities such as jogging and swimming tend to be the most beneficial for lowering blood pressure.

However, more recent studies reveal the good news that you don’t need a 30-60 minute workout to reap the insulin and blood-pressure-lowering benefits. Short, intense workouts such as high-intensity interval training (HIIT) are becoming more popular for both health and efficiency. It’s fairly easy to construct a HIIT regimen to do at home. You don’t need to do exact “timed intervals”; it’s just about getting short of breath, recovering, doing it again, and so on. If you have been exercising regularly, start “low and slow,” and if you haven’t exercised much since your “school years,” get medical clearance. Try doing burpees until you’re short of breath for 3 sets and work up to 6 sets, 2x per week. You can also do sprints on a track or in a pool. You can run in place, jump rope, or do jumping jacks.

Diet changes and precautions

Before I get into a more verbose discussion about non-inflammatory eating, I mention two food items we all used to think were healthy foods. Unfortunately, these so-called health foods have become poison for most people with existing high blood pressure, grains, and sugars (including fructose). Since many people still think grains and fruit juices are healthy choices, I want to emphasize they most certainly are not. Now, the science.

Addressing “Hypertension Pathophysiology”

Closely linked are the metabolic abnormalities of high blood sugar, high insulin levels, high leptin levels, and, therefore, insulin and leptin resistance at the receptor level.

Hypertension can be caused by cellular glycation (stiffening) from high blood sugar levels, so getting your blood sugar under control is a must. In addition, most people with hypertension have insulin receptors that don’t work efficiently, called insulin resistance. To compensate for this, your body produces more insulin. To lower insulin levels, you need to replace processed foods with real, whole foods. You also need to eliminate or dramatically reduce sugar and processed fructose (fruit) sugar and grains from your diet. Some studies show a closer correlation between fructose consumption and hypertension than even sodium! And then there’s leptin, another hormone that looms upward as you eat poorly and gain weight.

You can easily become leptin-resistant (with the attendant high leptin levels) by eating the same diet full of sugar (particularly fructose and grains once again.) Together, these foods will create the perfect environment for weight-packing bacteria to thrive in your GI tract; or microbiome. You then have your gut telling your metabolism to slow down and your high leptin levels telling you to keep eating and store more fat in your fat cells. It’s not a pretty picture, but it can be easily reversed. Other factors that play into the high leptin scenario include high cortisol levels (to be discussed) and other hormone imbalances. Often this trio shows up as belly fat. Lowering blood sugar, leptin, and insulin are partially achieved by simply losing weight which I’ll discuss next.

Normalize your Weight

I’ve talked about blood sugar, insulin, and leptin. To complete the discussion of the diet plan to normalize your weight for life, you must eat an anti-inflammatory diet. This can be a basic anti-inflammatory diet, a stricter autoimmune,no-lectin diet, or even a ketogenic diet plan. A paleo diet is effective, but you must be sure to compensate for the over-abundance of omega-6 fatty acids in meat. Here’s how you do just that.

Balancing the omega fats in your diet

Just about everyone needs to normalize their omega 6-to-3 fat ratio. Also, omega-3 fatty acids are vital for healthy blood pressure. Findings from a study of 2,000 healthy men and women between the ages of 25 and 41 showed that those with the highest serum levels of omega-3 also had the lowest blood pressure readings.

Both omega-3 and omega-6 fats are essential for your health, but most Americans consume too many omega-6 fatty acids in their diets and too few omega-3s. This is because we tend to eat more meat and milk and less omega-3 fish. Eating omega-3 fats is a great way to re-sensitize your insulin receptors if you are insulin resistant. It is also essential for normal, healthy blood pressure. Wild-caught salmon and sardines are both low-mercury and high omega-3 containing fish. However, it’s hard to consume enough to compensate for all of the omega-6s we eat, so I always recommend a good omega-3 supplement.

Inflammation and Oxidative Stress

Internal inflammation is associated with all disease states, including hypertension. Because approximately 70% of Americans are overweight, this alone is considered a major cause of reversible inflammation. In addition, eating the standard American diet (S.A.D.) described above will increase inflammation levels. Add in toxins such as heavy metals (mercury) and fluoride in drinking and showering water, and you’ve piled onto our national epidemic of inflammation. On the other hand, if you reduce your weight, clean up your diet, deal with toxins, stress and heal your probable leaky gut, then you will make a big “dent” in your inflammation problem and your blood pressure level, too.

Oxidative stress (defined as an over-abundance of free radicals which are not sufficiently quenched by antioxidants) worsens inflammation. But, this can be easily reversed with enough vegetables, fruits in moderation, and a high-antioxidant supplement.

Stress and Cortisol 

There is a publicly accepted long-term myth that stress raises your blood pressure. It does short-term, and some so-called “experts” still say it doesn’t raise it or can’t raise it long term. However, sustained high cortisol will routinely cause leaky gut, disturbing the microbiome and potentially elevating blood pressure. So, based on current research, it’s now not a myth anymore! Let me explain the role of the microbiome.

Your Microbiome

Leaky gut is caused by everything from a poor diet to high “stress levels” to proton pump inhibitor antacid drugs such as Prilosec. It sometimes produces little to no symptoms, but it always causes internal inflammation, which you now know is associated with hypertension. In addition, leaky gut always produces unfavorable alterations in the composition of the GI microbiome. And this is yet another factor in the creation of the hypertensive state.

Doesn’t it seem that lately, you read that all aspects of your health are more and more related to the health of your gut? It turns out that an unhealthy gut microbiome with less “healthy bacteria” (a dysbiotic gut) will cause hypertension; via a different mechanism than through leaky gut and/or inflammation. It also seems that “hypertensive GI tracts” have fewer bacteria that produce (healthy) butyrate and acetate.

There are two easy ways to increase gut butyrate levels that help with weight loss, insulin resistance, leptin resistance, and blood pressure. One way is to take sporulating probiotics. The other is to supplement with MCT (medium-chain triglycerides) oil. I use MCT oil for cooking and suggest that “trick” rather than MCT supplements which often cause diarrhea.

Avoid toxins

Biotoxins such as mold mycotoxins and Lyme toxins and heavy metals such as lead and mercury can damage the microbiome via other mechanisms, including (most often) the sirtuin pathway, and raise blood pressure. So next, let’s talk about sirtuins.

Sirtuins are enzymes that are produced in decreased amounts in many metabolic disorders such as obesity and metabolic syndrome. SIRT1 (the most well-known and studied sirtuin) causes an increase in leptin sensitivity. It also increases adiponectin production. Both of these actions have both anti-obesity and, therefore, anti-hypertensive effects. The SIRT1 pathway is disordered in toxin-related disorders and many disorders of mitochondrial function. Therefore diseases such as Parkinson’s disease, Hashimoto’s thyroiditis, or Chronic fatigue syndrome are also associated with SIRT1 deficiency, with a built-in risk for metabolic syndrome, including hypertension.

The Role of Nitric Oxide 

Nitric oxide (NO) protects the lining of blood vessels and vasodilates them as well. When arteries are damaged by inflammation, we see a decrease in nitric oxide near the smooth muscle linings of the blood vessels. In general, nitric oxide levels tend to decrease with age. To some degree, HIIT exercise enhances NO, but to make sure your levels are adequate, try foods or supplements. Below are some foods and supplements which raise NO levels.

Beetroot Juice 

This juice is high in NO3, which converts to NO. An 8-ounce glass per day will lower your blood pressure (on average) by 8 mm Hg (systolic) and 4 mm Hg (diastolic), demonstrated in those with existing hypertension. I find this to be much more palatable when mixed with “juiced” carrots and spinach.

Examples of other vegetables high in NO3 include whole beets, arugula (the best!), celery, cabbage, leeks, scallions, radishes, kale, turnip tops, spinach, mustard greens, eggplant, carrots, and string beans.

Vitamin D 

It’s a well-known medical fact that vitamin D deficiency is associated with arterial stiffness and subsequent hypertension. Still, a large study involving over 100,000 individuals has now demonstrated that low vitamin D levels can actually cause high blood pressure. To make the correlation even stronger, the highest vitamin D levels were shown to lower hypertension risk the most. High-D foods include the healthiest fish, wild sockeye salmon, and sardines, as well as eggs (only eat “pastured,” please). Most people are clinically deficient unless they take D3+K supplements, with most individuals requiring a minimum of 6000 IU’s per day.


This multi-use supplement increases endothelial NO production, reduces vascular oxidative stress, and prevents smooth muscle proliferation, vascular remodeling, and arterial stiffness. In addition, resveratrol inhibits immune cell infiltration into the vascular wall and mitigates vascular inflammation. All these mechanisms contribute to the positive effects of resveratrol on vascular function and blood pressure.

L-arginine plus l-citrulline

A good NO-enhancing supplement will contain l-arginine and l-citrulline. Bodybuilders typically use these supplements for the increased “pump,” and some men use them to enhance erectile function. However, if taken often, they too will lower blood pressure by increasing nitric oxide.

The Role of the Oral Microbiome

The critical role of the oral microbiome in both our oral and systemic health is being elucidated more and more with each study that emerges. Elevations in plasma [NO2] following dietary NO3 ingestion and the associated physiological responses are blunted by the use of antiseptic and antibacterial mouthwashes and even by toothpaste. This blunting is directly related to the diminution of healthy oral bacteria in the oral microbiome. Natural tooth powders are not as pleasant to use as commercial toothpaste products, but natural toothpaste seems to be an improvement from the highly processed supermarket brands. Mouthwash should be used sparingly, if at all.

Other Helpful Supplements

Vitamin E

Natural vitamin E (200 IU’s per day) has been shown to lower blood pressure. Natural vitamin E is always listed as the “d-” form (d-alpha-tocopherol, d-beta-tocopherol). Synthetic vitamin E is listed as “dl-” forms. Don’t take synthetic vitamin E, as it’s ineffective and might even cause harm.

Vitamin C

Studies (meaning a review of 29 studies done in 2012) indicate that 500 mg of vitamin C per day might help lower blood pressure. In 2020, another meta-analysis was done, focusing on 8 studies published between 1991 and 2018. Overall, 614 participants were included. The number of participants in the individual studies ranged from 12 to 480. Participants’ mean age ranged from 46 to 78 years. The duration of the intervention varied from 4 to 24 weeks. All participants had essential hypertension. The average SBP and DBP of the participants ranged from 143 to 173 mmHg and from 76 to 97 mmHg, respectively. The supplementary dose of VitC in the treatment group varied between 300 and 1000 mg/dL. The results? There was indeed a correlation between supplemental vitamin C and hypertensive control.

Why? At present, the main theory is that VitC increases intracellular concentrations of tetrahydrobiopterin, an endothelial nitric oxide synthase co-factor that promotes the production of nitric oxide, which is a potent vasodilator. However, there is also evidence that Vitamin C enhances the biological activity of nitric oxide.


This can lower blood pressure by 10%, but only if you take it as a supplement. Although allicin is produced when raw garlic is crushed or chewed, much of it is destroyed during cooking. For about ten years, researchers have been aware the allicin made from alliin in garlic blocks the activity of angiotensin II—a substance that raises blood pressure. In addition, supplemental garlic elevates levels of nitric oxide.

Note, however, the health benefits of garlic supplements are due to ajoene, diithins, and allicin, not just due to allicin. So, shop carefully since ajoene and diithins are considerably more potent than “just allicin.”


Nattokinase enzymes have potent fibrinolytic (blood-clot-busting) activity, anti-atherosclerotic, lipid-lowering, antiplatelet (anti-platelet stickiness), and even neuroprotective effects.

In addition, with regards to the topic of this article, a well done double-blind, placebo-controlled, randomized study showed that supplementing with nattokinase for eight weeks resulted in a significant reduction of both diastolic and systolic blood pressure.

Nattokinase is an enzyme found in the food natto, which is a fermented soy product. Whether consumed as fermented soy or as a supplement, the natto enzyme has been used successfully for 25 years to treat hypertension and various circulatory issues in China and continues to be studied worldwide.

Odds and Ends

Ongoing research on peptides for weight control and metabolic issues will certainly yield some actionable results soon. Flavonoids such as green tea (EGCG) and pomegranate extract show promise for hypertension as well. Studies looking at herbs such as curcumin, ginger, and hawthorn extract are also quite encouraging. And what about hormones per se?

The idea that menopause or the associated estrogen decrease is associated with blood pressure increase is still under debate. The epidemiological challenge is the coincidence between menopause and aging and the evidence that both rising blood pressure and menopause have common determinants such as diet, body mass index, smoking, and even socio-economic class. In addition, there seems to be no correlation between testosterone levels in men and blood pressure levels. The bottom line, as always, is to eat healthfully, exercise correctly, and supplement smartly. For some, that might include nitric oxide supplementation.


Mold and mycotoxins-what’s the story?

You may know that mold can cause allergic reactions such as a runny nose, itchy eyes, and even asthma. You also may know that’s it’s not a good idea to have mold in your home and that visible mold should be cleaned up. However, you may not know that toxins from live or dead mold spores (mixed with “other things”) can make you sick with a disease called Chronic Inflammatory Response Syndrome (CIRS). If you have a multi-system, multi-symptom illness and have seen more than your fair share of doctors who have given you one different diagnosis after another, you might have CIRS. But how can you sort it all out? How do you know if mold is making you sick?

  • How do you know if mold is making you sick?
  • Where and how are you being exposed?
  • Why isn’t everyone getting sick like me?
  • Exactly why am I feeling so sick?
  • How can I tell if a building is “sick”?
  • How can I tell if it’s the mold mycotoxins that are making me sick?
  • How can I get better?

How do you know if mold is making you sick?

Allergic disease is fairly specific, causing itchy eyes, runny and stuffed up nose and sinuses, coughing, asthma, and skin rashes. Most people who develop allergies to varies types of fungus do not develop CIRS due to their genetics. More on this to come. So- if you are self-diagnosing to find the proper Functional doctor, what kinds of symptoms should make you suspicious?

People often report that they are experiencing extreme fatigue and feel like they’ve been sick “forever” with no good explanation. Of course, this doesn’t mean that all cases of chronic fatigue are due to CIRS, but a good number of them certainly are. Twenty-two other common symptoms include:

  1. Brain fog
  2. Difficulty concentrating
  3. Headaches
  4. Memory problems
  5. Mood swings
  6. Anxiety
  7. Depression
  8. Weakness
  9. Muscle aches
  10. Unexplained pain
  11. Fibromyalgia
  12. Light sensitivity
  13. Chronic cough
  14. Shortness of breath
  15. Vertigo
  16. Metallic taste in the mouth
  17. Static shocks
  18. Inability to regulate temperature
  19. Digestive issues such as bloating, diarrhea, or constipation
  20. Excessive thirst and frequent urination
  21. Hormonal issues
  22. Blurry vision

If you recognize yourself in this list of symptoms and have had “regular doctors” tell you that you have Chronic Fatigue, Fibromyalgia, a “bad” menopause, or worse, it’s “all in your head,” please know that regular doctors have not learned about CIRS and that you need to look for doctors who specialize in mold illness. These doctors are all Functional Medicine doctors such as myself, and many of us have had CIRS, making us quite empathetic to what you’re experiencing.

Where are you getting exposed to mold? And it is just the mold?

Even the cleanest homes have many routes where moisture can be trapped inside. This is especially so in any home located in a high-humidity environment with either a vented attic or a basement. In addition, if a home has experienced flooding, it’s bound to have issues. According to several studies, it is estimated that approximately 50% of all buildings in the U.S, including homes, have moisture problems and, thereby have mold issues. Yes, 50%!

Mold illness is on the rise in our country due to several factors. We make our homes, offices, and schools out of materials perfect for mold growth. Wood and drywall are essentially just paper, and when they get wet, they don’t dry easily. Add water, and this creates a petri dish for mold proliferation. We also construct buildings “more tightly,” allowing for less re-circulated air. Then there’s the increased flooding problem. And it’s not just the mold per se.

Biological contaminants which thrive in damp indoor environments include gram-negative and positive bacteria, endotoxins (aka lipopolysaccharides, or LPS; cell wall components of gram-negative bacteria), beta-glucans (a diverse group of polysaccharides), hemolysins (exotoxins produced by bacteria capable of destroying cells), inflammagens (irritants that cause inflammation and edema), microbial and non-microbial volatile organic compounds (VOCs), and mold mycotoxins. This “mycotoxin mixture” is what triggers the symptoms of CIRS. And yes, the mycotoxins (toxins produced by toxic mold species) are the most noxious element, driving the symptoms.

Hundreds of sub-species of indoor molds/fungi produce by-products called mycotoxins. Mycotoxins are microscopic proteins that disperse throughout your body via your lungs and can wreak absolute havoc. Some mycotoxins are listed among the most toxic substances found in existence.  They are so damaging that they have been used as chemical warfare agents.

Mycotoxins are so small; they can pass through cell membranes, making it more difficult for your immune system to identify, attack, and remove them. For some people (more to come on this), it’s absolutely impossible. Therefore, mold illness usually starts with one or two low-level symptoms that increase in number and intensity over the months and even years. Years of untreated illness can become suddenly or insidiously debilitating. And always remember- dead mold spores and fragments contain mycotoxins, so if you’ve had a remediation company tell you that “there is no more mold here, all clear, no problem”—guess what—there still is an enormous problem.

Why doesn’t everyone get sick from mold mycotoxins?

Let’s discuss how we detoxify our bodies naturally. We sweat; through our skin, flush some toxins out via our urine, and use the liver and GI tract to do most of the “heavy lifting” when it comes to detoxification. Our overall “toxic burden” is determined by two important factors: how well our innate detoxification system works and the levels of toxins we’re exposed to. If we have a high level of toxin exposure and our detoxification system is compromised due to environmental factors, genetic predisposition, or both, we’ll have a high toxic load that will produce unpleasant symptoms. When we’re talking about mold illness, genes matter.

It has been estimated that approximately 25% of people have human leukocyte antigen (HLA) genes that prevent their bodies from being able to recognize and thus eliminate what are called biotoxins. Mold or mycotoxin illness is the biotoxin we’re discussing here, but chronic Lyme and blue-green algae can also trigger the same symptoms as we’re discussing in this article. In addition, certain bacteria (probably including Borrelia, Babesia, Bartonella, and other organisms transmitted by tick bites) can also secrete biotoxin-like compounds that produce symptoms of waxing and waning inflammation.

All biotoxins remain in the body and trigger a chronic, systemic inflammatory response; hence, the name is CIRS. A quick but important fact regarding CIRS: Multiple Antibiotic Resistant Coagulase Negative Staphylococci (MARCoNS) are found in the nasal passages of a large percentage of patients. Notable is that this biofilm-producing organism will not clear without proper overall treatment and will conversely inhibit recovery from biotoxin illness.

Why DO the mold mycotoxins make you feel so sick?

The interference with the sirtuin enzymatic pathways causes numerous metabolic issues and physical symptoms. For example, SIRT1 issues lead to decreased NAD levels, which is the primary cause of fatigue. In addition, SIRT pathway issues lead to glucose and cholesterol abnormalities and many more complex biochemical abnormalities. At the beginning of this illness, occasionally, all that is noticed are lab abnormalities, leading to resistance from some people who “just don’t want to deal with the problem.”  But this decision is to their peril, as they cannot detox “on their own,” even in a toxin-free environment, and symptoms (as well as diseases) will eventually occur.

The constant, ongoing inflammation caused by mycotoxins can lead to the following, caused by inflammatory cytokine release:

  • Gut hyper-permeability-AKA “leaky gut” which then leads to gastrointestinal symptoms, as well as a breach in the gut-brain barrier; causing all sorts of “brain issues.”
  • These cytokine-induced brain issues can involve the anterior pituitary (“hormone problems”) or the posterior pituitary (low endorphin=pain issues and/or ADH=thirst and urination issues). Brain issues also often involve the hypothalamus (temperature dysregulation) and neurotransmitter dysfunction leading to depression and/or anxiety issues. Headache is a common system, as is brain fog, difficulty concentrating, and difficulty with memory. Frontal lobe involvement creates lapses in judgment, thought to be responsible for the phenomenon of wanting to ignore the problem.
  • Increased cytokine levels attract inflammatory white blood cells, restricting blood flow and reducing oxygen in the tissues. As a result, vascular endothelial growth factor (VEGF), which normally stimulates the formation of blood vessels, is reduced. Reduced VEGF can result in worsened fatigue as well as debilitating nocturnal muscle cramps.
  • A reduced level of Vasoactive Intestinal Peptide (VIP) can cause shortness of breath and even wheezing, mimicking asthma. It even can cause pulmonary hypertension and eventually heart failure!

The body also suffers from low MSH (melanocyte-stimulating hormone) production for a variety of reasons. MSH is made by the “middle” pituitary gland, hypothalamus, and skin cells. Low MSH results from this inflammatory process but is also exacerbated by the biofilm secreted by the MARCoNS organism discussed above, which cleaves intact MSH, worsening this whole vicious cycle. The low MSH is additionally thought to trigger the entire innate inflammatory response (leading to high TGFB1 and MMP9 innate immune markers) and causes severe sleep issues, immune system dysfunction (infections), chronic pain, and gut malabsorption.

Low MSH further decreases posterior pituitary production of ADH (anti-diuretic hormone), causing some patients to experience excessive thirst and urination and low blood pressure, and the sensation of electric shocks from excess salt on their skin; causing a “battery cell” phenomenon. And yes, their “regular doctors” think these symptoms are totally “in their heads” but it’s not!

People with certain HLA genotypes may develop other inappropriate immune responses, including the formation of auto-antibodies that lead to thyroiditis such as Hashimoto’s disease, gluten sensitivity or Celiac disease, Inflammatory bowel disease such as Ulcerative colitis or Crohn’s disease, blood clotting conditions, neurological conditions such as Multiple Sclerosis and more.

Continued immune dysregulation can also create other problems such as mast cell activation syndrome (basically resulting in a massively overactive histamine=allergic response), all sort of food intolerances, and then multiple chemical sensitivities. There is even rather strong evidence that CIRS from mold mycotoxins causes EMF sensitivity!

How to diagnose the problematic building(s)

If you smell a musty odor in (for instance) a damp basement, that’s the waste products of live mold until proven otherwise. If you have had water intrusion from a storm or a leaky pipe that wasn’t cleaned up within 48 hours, you probably have mold growth. Places to check include behind toilets, refrigerators and around windows, doors, in attics (under the insulation), in HVAC systems, and in the basement. You don’t have the tools to check for mold growth behind walls, under floors, and so on, so where should you start if you suspect your home has live or dead (toxin-containing spores!) mold?

The best method to do a quick screening for mold is the ERMI test. The ERMI test uses mold-specific quantitative polymerase chain reaction (MSQPCR) technology to identify mold DNA in dust that has settled in buildings.

The test, developed by the EPA and validated in many well-done studies (with some cited in the references section) compares the relative “moldiness” of a home compared to a group of reference homes that do not have mold. Thirty-six species of mold are divided into 26 species of (generally toxin-producing) molds associated with water-damaged buildings (Group 1 on your ERMI report) and 10 common species which are not associated with water-damaged buildings (Group 2 on your report).

The mold or ERMI index in a particular building is the sum of the logs of Group 1 minus the sum of the logs of Group 2. After you get your report, one of the doctors who specialize in mold illness (such as myself) will be able to guide you through the interpretation of your report, and make suggestions regarding inspection, remediation, and post-remediation fogging, which is a crucial step to rid your home of dead mold spores and mycotoxins. If you have not yet secured a doctor and want to proceed on your own, I wouldn’t recommend doing so, but let me give you this advice, so you don’t waste money on non-qualified “home mold remediation experts.”

If you suspect live mold, you need a qualified inspector to check “everywhere.”  You need an indoor environmental professional who is certified to do what he is doing. You need to make sure that the company that diagnoses the problem is not the same company that fixes (remediates) the problem. Here is a guide for you to use to choose a good company. If you are one of my patients in the area, I highly recommend ORC Services.

To emphasize, your best bet is to enlist the help of a mold-literate Functional doctor early on if you suspect that mold is making you or other family members sick. And again, no matter how good your remediation company is, remember, they don’t treat mycotoxin illness; they are tasked with killing the live mold in your dwelling, and that’s it. They won’t check for dead mold spores because they don’t generally use a fogging solution which is formulated to deal with this issue. Please remember this, and know that getting rid of the live mold is the first, but not final step in getting your environment mycotoxin-free. Also, remember that moving furniture, clothing, or other belongings into a “clean space” will cross-contaminate that clean space.

What tests do I need to tell if mold mycotoxins are making me sick?

The first test you should do is a Functional Visual Acuity Test; a visual test that detects not visual acuity but rather the ability of your optic nerves to detect subtle differences in gray-and-white contract. This test is also known as the visual contrast sensitivity (VCS) test. Mold mycotoxins are inhaled up the nose where-in CIRS patients, they will interfere with optic nerve blood flow. A VCS test is ideally performed in the office of a CIRS-literate Functional doctor. However, there are two online versions that can be used as a starting place. The one I find most useful is the VCS on the website of the doctor who first discovered CIRS; Dr. Ritchie Shoemaker.

The VCS test which is available on Dr. Shoemaker’s website, Surviving Mold, costs $15. This online test uses a scoring algorithm to determine the likelihood that a patient is being adversely affected by mold mycotoxin exposure.

This VCS test is so accurate that, if it is positive, meaning that you “fail” in one or both eyes, there is a ninety-two percent chance that you have active CIRS. However, a negative test does not rule out CIRS, and there are occasionally “false positives.” This is another reason that you absolutely cannot diagnose and treat yourself, as suggested by a few misguided social media groups.

If you are in a toxic home, have a positive VCS test, or simply have a host of seemingly un-related symptoms , you need special laboratory testing done. A good place to start is with an MSH, TGFbeta1, MMP9, and HLA analysis, and then other tests if certain symptoms are present.

The basics of CIRS Treatment 

Job one is to make sure you are in a non-toxic environment. Detoxing you or trying to clear your MARCoNS while you’re in a toxin-filled environment is like trying to take water out of a bathtub which is filled to the top–with a teaspoon–while the water is still running. Makes sense? Suggestions including renting a place to live during remediation, renting a mobile home, pitching a nice tent if the weather is nice, or walling off the area being remediated, if physically possible. This last option is what everyone wants to do, but unfortunately, mold is often cross-contaminated throughout a home, even if it started in one location. At any rate, this is something to discuss with your doctor.

Air filtration units are a good idea, but don’t think that they are a substitute for remediation and then post-remediation fogging. We have IQAir units in our personal home. We have the IQAir Healthpro plus units that are super-effective to filter particles all the way down to 0.003 microns- smaller than dead mold spore fragments. Get them from a dealer so you’ll have a valid warranty; the guaranteed efficacy is over 99.5%!

Make sure that you find a CIRS-literate M.D. who understands the physiology of the disease and doesn’t “simply detox you” or you’ll be waiting a long time for more energy, a good night’s sleep, pain relief and other symptomatic relief. You are going to need inflammation quelled, your leaky gut fixed, and your brain functions repaired right off the bat.   A minority of doctors know how to do this, but I most certainly do.  

A typical regimen includes peptides to repair leaky gut, damaged neurons (brain cells) and nicotinamide mononucleotide (or IV or troche-based NAD) to improve energy. Hormonal imbalances, pain issues, and insomnia need to be addressed as well. A good detoxification regimen starts with making sure that the organs and biochemical processes of detoxification are in working order. This often means boosting methylation systems, liver, GI and kidney functions. Most people are able to sweat, so we take advantage of this by recommending saunas; if someone can gain ready access to one. If not, we rely on oral detox preparations, which contain Vitamin C, glutathione plus charcoal, and other GI-friendly (non-cholestyramine) fibrous “binders.”  We get rid of the MARCoNS with a silver-EDTA spray, not with antibiotic spray, which can further damage the gut.

Hopefully, this article has been helpful. If you’d like to have a free phone consultation with me about your particular situation, just contact me, and I’ll help.

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